Think tank meetingCardiovascular disease and chronic kidney disease: Insights and an update
Section snippets
Epidemiology
The aging of the US population has resulted in a significant increase in both cardiovascular and renal diseases. Currently, there are approximately 406,081 patients with end-stage renal disease (ESRD) in the United States.1 This hardly describes the impact of renal disease, because moderate chronic kidney disease (CKD), which is defined as a glomerular filtration rate (GFR) <60 mL/min/1.73m2, is nearly 10 times more prevalent than ESRD. The National Health And Nutrition Epidemiology Survey
Defining CKD
Although the impact of dialysis-dependent renal failure on cardiovascular diseases has been studied to some extent, milder forms of CKD have not been sufficiently investigated.16, 17 Analyses of the associations of CKD are difficult to compare because of unclear definitions of what constitutes CKD and how to exactly measure it. Often in the cardiovascular literature, a serum creatinine level <1.5 mg/dL has been used to identify “normal renal function,” and a creatinine level ≥1.5 mg/dL has been
Causes of coronary artery disease and accelerated atherosclerosis
The etiology of cardiovascular disease in CKD is complex and may result from an increased prevalence of classic cardiovascular risk factors and factors unique to uremia or dialysis (Table III). 26, 27, 28, 29, 30 Because approximately 40% of patients undergoing dialysis have diabetes mellitus as their stated etiology for ESRD and 25% of patients undergoing dialysis have hypertension as their stated etiology for ESRD, patients with CKD have a higher prevalence of the cardiovascular risk factor
Treatment of acute and chronic coronary artery disease
Patients with CKD clearly constitute a high-risk group for cardiovascular disease and cardiac death.12 Therefore both primary and secondary prevention of coronary disease is essential in such patients. However, because of differences in the mechanism of atherosclerotic and thrombotic disease between patients with and patients without CKD, an increased risk of certain therapies in patients with CKD, and a lack of data on therapeutic outcomes in such patients, it is unclear whether treatment
Future directions
Although CKD is highly prevalent in the United States and significantly contributes to the morbidity and mortality rates of the population, there is still a paucity of clinical data on medications and outcomes in patients with CKD. Fear of adverse effects and adverse events in this population may be driving the absence of these data. An important issue raised at our meeting was the absence of incentives for ongoing study after FDA approval. Policies are needed that would encourage these needed
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Effects of liraglutide on no-reflow in patients with acute ST-segment elevation myocardial infarction
2016, International Journal of CardiologyThe role of echocardiographic study in patients with chronic kidney disease
2015, Journal of the Formosan Medical AssociationCitation Excerpt :There are several possible explanations for poor prognosis of CKD patients, including traditional cardiovascular risk factors (i.e., hypertension, diabetes mellitus, and dyslipidemia), nontraditional factors (e.g., malnutrition, inflammation, and oxidative stress), and CKD-related risk factors (e.g., atherosclerosis, anemia, altered calcium–phosphate metabolism).8–15 These factors may contribute to the development and deterioration of the coronary artery disease (CAD), microvasculopathy, valvulopathy, cardiomyopathy, and arrhythmias.9,16–22 Cardiac abnormalities, especially abnormal left ventricular (LV) geometry and functions, are frequently detected in CKD patients and have been proven to be correlated with high cardiovascular mortality/morbidity and all-cause mortality.2,3,23–25
Effects of liraglutide on left ventricular function in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
2015, American Heart JournalCitation Excerpt :Hypoglycaemia was defined as plasma glucose level ≤3.9 mmol/L.12 Current smoking was defined as partaking of at least one cigarette per day. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula,13 and renal insufficiency was defined as an eGFR of <60 mL/min per 1.73 m2.14 Each patient’s Killip classification was assigned on the basis of the severity of signs of heart failure at the time of hospital admission: Killip class 1 was defined by the absence of rales in the lung fields and the absence of an S3 heart sound; Killip class 2 was defined by the presence of rales in <50% of the lung fields, or by the presence of an S3 gallop, accompanied by elevated jugular venous pressure; Killip class 3 was defined by the presence of rales in >50% of the lung fields.15
Role of thyroid hormones and mir-208 in myocardial remodeling in 5/6 nephrectomized rats
2013, Archives of Medical Research