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Deguchi T, Sato M, Kohyama N, Fujita K, Nagumo S, Suzuki H, Ebato M, Kogo M. Development of a model predicting cardiac events in heart failure patients with decreased renal function: a retrospective study. Int J Clin Pharm 2023; 45:210-219. [PMID: 36414822 DOI: 10.1007/s11096-022-01502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inappropriate and multiple medications affect the prognosis of patients with acute decompensated heart failure (ADHF). However, in ADHF patients with decreased renal function, there have been no reports on prognostic factors, including medication data, or models for predicting cardiac events. AIM To develop a model including medication data to predict cardiac events in ADHF patients with decreased renal function. METHOD This retrospective cohort study included 443 first-time admitted ADHF patients with decreased renal function (estimated glomerular filtration rate < 60 mL/min/1.73 m2 at discharge) in the Showa University Fujigaoka Hospital. The primary outcome was cardiac events within one year after discharge, defined as the composite of HF readmission, HF mortality, and cardiovascular mortality. The model for predicting cardiac events was developed using predictive factors extracted by multivariable analysis. The cardiac events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test. RESULTS The incidence of cardiac events within one year after discharge was 20.1%. By multivariable analysis, we observed that atrial fibrillation, weight loss < 5%, brain natriuretic peptide ≥ 200 pg/mL, polypharmacy, and beta-blockers use below target dosage were significantly associated with an increased risk of cardiac events. The developed model, the cardiac events rate in the high-risk group was significantly higher than in the low-risk group (41.0 vs. 9.2%, p < 0.001). CONCLUSION The developed model for predicting cardiac events will be useful in decision-making to support appropriate early management of ADHF patients with decreased renal function.
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Affiliation(s)
- Tomokazu Deguchi
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan. .,Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Miki Sato
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Noriko Kohyama
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Kanako Fujita
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan.,Department of Pharmacy, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Mari Kogo
- Division of Pharmacotherapeutics, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
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The Impact of CKD Anaemia on Patients: Incidence, Risk Factors, and Clinical Outcomes-A Systematic Literature Review. Int J Nephrol 2020; 2020:7692376. [PMID: 32665863 PMCID: PMC7349626 DOI: 10.1155/2020/7692376] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/25/2020] [Indexed: 12/15/2022] Open
Abstract
Anaemia is a common consequence of chronic kidney disease (CKD); however, the risk factors for its development and its impact on outcomes have not been well synthesised. Therefore, we undertook a systematic review to fully characterise the risk factors associated with the presence of anaemia in patients with CKD and a contemporary synthesis of the risks of adverse outcomes in patients with CKD and anaemia. We searched MEDLINE, EMBASE, and the Cochrane Library from 2002 until 2018 for studies reporting the incidence or prevalence of anaemia and associated risk factors and/or associations between haemoglobin (Hb) or anaemia and mortality, major adverse cardiac events (MACE), hospitalisation, or CKD progression in adult patients with CKD. Extracted data were summarised as risk factors related to the incidence or prevalence of anaemia or the risk (hazard ratio (HR)) of outcome by Hb level (<10, 10-12, >12 g/dL) in patients not on dialysis and in those receiving dialysis. 191 studies met the predefined inclusion criteria. The risk factor most associated with the prevalence of anaemia was CKD stage, followed by age and sex. Mean HRs (95% CI) for all-cause mortality in patients with CKD on dialysis with Hb <10, 10-12, and >12 g/dL were 1.56 (1.43-1.71), 1.17 (1.09-1.26), and 0.91 (0.87-0.96), respectively. Similar patterns were observed for nondialysis patients and for the risks of hospitalisation, MACE, and CKD progression. This is the first known systematic review to quantify the risk of adverse clinical outcomes based on Hb level in patients with CKD. Anaemia was consistently associated with greater mortality, hospitalisation, MACE, and CKD progression in patients with CKD, and risk increased with anaemia severity. Effective treatments that not only treat the anaemia but also reduce the risk of adverse clinical outcomes are essential to help reduce the burden of anaemia and its management in CKD.
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Afsar B, Siriopol D, Aslan G, Eren OC, Dagel T, Kilic U, Kanbay A, Burlacu A, Covic A, Kanbay M. The impact of exercise on physical function, cardiovascular outcomes and quality of life in chronic kidney disease patients: a systematic review. Int Urol Nephrol 2018; 50:885-904. [DOI: 10.1007/s11255-018-1790-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/07/2018] [Indexed: 12/18/2022]
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Sugiura T, Okumiya T, Kubo T, Takeuchi H, Matsumura Y. Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Aortic Stenosis. Int Heart J 2016; 57:430-3. [PMID: 27357437 DOI: 10.1536/ihj.15-433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic intravascular hemolysis has been identified in patients with cardiac valve prostheses, but only a few case reports have evaluated intravascular hemolysis in patients with native valvular heart disease. To detect intravascular hemolysis in patients with aortic stenosis, erythrocyte creatine was evaluated with hemodynamic indices obtained by echocardiography.Erythrocyte creatine, a marker of erythrocyte age, was assayed in 30 patients with aortic stenosis and 10 aged matched healthy volunteers. Peak flow velocity of the aortic valve was determined by continuous-wave Doppler echocardiography. Twenty of 30 patients with aortic stenosis had high erythrocyte creatine levels (> 1.8 µmol/g Hb) and erythrocyte creatine was significantly higher as compared with control subjects (1.98 ± 0.49 versus 1.52 ± 0.19 µmol/g Hb, P = 0.007). Peak transvalvular pressure gradient ranged from 46 to 142 mmHg and peak flow velocity ranged from 3.40 to 5.95 m/second. Patients with aortic stenosis had a significantly lower erythrocyte count (387 ± 40 versus 436 ± 42 × 10(4) µL, P = 0.002) and hemoglobin (119 ± 11 versus 135 ± 11 g/L, P < 0.001) as compared with control subjects. Erythrocyte creatine had a fair correlation with peak flow velocity (r = 0.55, P = 0.002).In conclusion, intravascular hemolysis due to destruction of erythrocytes was detected in patients with moderate to severe aortic stenosis and the severity of intravascular hemolysis was related to valvular flow velocity of the aortic valve.
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Fujino T, Yao A, Hatano M, Inaba T, Muraoka H, Minatsuki S, Imamura T, Maki H, Kinugawa K, Ono M, Nagai R, Komuro I. Targeted Therapy Is Required for Management of Pulmonary Arterial Hypertension After Defect Closure in Adult Patients With Atrial Septal Defect and Associated Pulmonary Arterial Hypertension. Int Heart J 2015; 56:86-93. [DOI: 10.1536/ihj.14-183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Takeo Fujino
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Atsushi Yao
- Division for Health Service Promotion, The University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hironori Muraoka
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Minoru Ono
- Department of Cardiothoracic Surgery, Graduate School of Medicine, The University of Tokyo
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Relation of serum uric acid levels and outcomes among patients hospitalized for worsening heart failure with reduced ejection fraction (from the efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan trial). Am J Cardiol 2014; 114:1713-21. [PMID: 25312638 DOI: 10.1016/j.amjcard.2014.09.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/22/2022]
Abstract
We investigated the clinical profiles associated with serum uric acid (sUA) levels in a large cohort of patients hospitalized for worsening chronic heart failure with ejection fraction (EF) ≤40%, with specific focus on gender, race, and renal function based interactions. In 3,955 of 4,133 patients (96%) with baseline sUA data, clinical characteristics and outcomes were compared across sUA quartiles. The primary end points were all-cause mortality and a composite of cardiovascular mortality or heart failure hospitalization. Interaction analyses were performed for gender, race, and baseline renal function. Median follow-up was 9.9 months. Mean sUA was 9.1 ± 2.8 mg/dl and was higher in men than in women (9.3 ± 2.7 vs 8.7 ± 3.0 mg/dl, p <0.001) and in blacks than in whites (10.0 ± 2.7 vs 9.0 ± 2.8 mg/dl, p <0.001). Higher sUA was associated with lower systolic blood pressure and EF, higher natriuretic peptides, and more impaired renal function. After accounting for 24 baseline covariates, in patients with enrollment estimated glomerular filtration rate ≥30 ml/min/1.73 m(2), sUA was strongly associated with increased all-cause mortality (hazard ratio 1.44, 95% confidence interval 1.22 to 1.69, p <0.001) and the composite end point (hazard ratio 1.44, 95% confidence interval 1.26 to 1.64, p <0.001). However, in patients with estimated glomerular filtration rate <30 ml/min/1.73 m(2), sUA was not related with either end point (both p >0.4). Adjusted interaction analyses for gender, race, and admission allopurinol use were not significant. In conclusion, sUA is commonly elevated in patients hospitalized for worsening chronic heart failure and reduced EF, especially in men and blacks. The prognostic use of sUA differs by baseline renal function, suggesting different biologic and pathophysiologic significance of sUA among those with and without significant renal dysfunction.
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