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ACEI in cardiorenal syndrome

Franz Maximilian Rasche, Claudia Joel, Thomas Ebert, Thomas Frese, Filip Barinka, Volker Busch, Wilma Gertrud Rasche, Tom H Lindner, Jochen Schneider, Stephan Schiekofer
Dual renin-angiotensin-aldosterone blockade (dRAASb) is purposed in the prevention of the cardiorenal syndrome (CRS). However, all attempts with dRAASb even in patients with moderate impaired chronic kidney disease (CKD) were terminated due to the typical severe adverse events (SAE), e. g., hyperkalemia and rise of serum creatinine. The aim of our study with the direct renin inhibitor aliskiren was to evaluate the effect of dRAASb with a washout phase in patients with severely advanced CKD. We have studied 45 patients (G3b to 4, A2 and >A3; median glomerular filtration rate (GFR) CKD-EPI 31 (23-40) ml/min per 1...
January 2018: Experimental and Clinical Endocrinology & Diabetes
Aashish Sharma, Marco Sartori, Jose J Zaragoza, Gianluca Villa, Renhua Lu, Elena Faggiana, Alessandra Brocca, Luca Di Lullo, Sandro Feriozzi, Claudio Ronco
Cardiorenal syndrome type 5 (CRS-5) includes conditions where there is a simultaneous involvement of the heart and kidney from a systemic disorder. This is a bilateral organ cross talk. Fabry's disease (FD) is a devastating progressive inborn error of metabolism with lysosomal glycosphingolipid deposition in variety of cell types, capillary endothelial cells, renal, cardiac and nerve cells. Basic effect is absent or deficient activity of lysosomal exoglycohydrolase a-galactosidase A. Renal involvement consists of proteinuria, isosthenuria, altered tubular function, presenting in second or third decade leading to azotemia and end-stage renal disease in third to fifth decade mainly due to irreversible changes to glomerular, tubular and vascular structures, especially highlighted by podocytes foot process effacement...
November 2015: Heart Failure Reviews
Peter A McCullough, Maria Rosa Costanzo, Marc Silver, Bruce Spinowitz, Jun Zhang, Norman E Lepor
Hyperkalemia is defined as serum potassium concentrations elevated above the upper limit of normal (> 5.0 mEq/L). It has become more common in cardiovascular practice due to the growing population of patients with chronic kidney disease and the broad application of drugs that modulate renal elimination of potassium by reducing production of angiotensin II (angiotensin-converting enzyme inhibitors, direct renin inhibitors, β-adrenergic receptor antagonists), blocking angiotensin II receptors (angiotensin receptor blockers), or antagonizing the action of aldosterone on mineralocorticoid receptors (mineralocorticoid receptor antagonists)...
2015: Reviews in Cardiovascular Medicine
Thierry H Le Jemtel, Indranee Rajapreyar, Michael G Selby, Brian Payne, David R Barnidge, Natasa Milic, Vesna D Garovic
BACKGROUND: Renal structural alterations have been partially uncovered in cardiorenal syndrome (CRS). Patients with CRS may have evidence of tubular damage, but markers of glomerular damage other than proteinuria have not been thoroughly investigated. The nature of renal damage in CRS may have therapeutic implications, as glomerular damage requires tight blood pressure control and renin-angiotensin-aldosterone system (RAAS) inhibition. The present investigation evaluates patients with CRS type 2 (CRS-2) for direct evidence of glomerular damage as evidenced by the presence of urinary podocin...
April 2015: Cardiorenal Medicine
Renato De Vecchis, Cesare Baldi
The deterioration of renal function, which is linked to chronic heart failure by a chronological and causal relationship (ie, the so-called cardiorenal syndrome [CRS] type 2), has recently become a matter of growing debate. This debate has concerned the efficacy, safety, and cost effectiveness of the therapies that have been implemented thus far for this syndrome (for example, the intravenous [IV] loop diuretics, such as repeated IV boluses or slow IV infusions, as well as mechanical fluid removal, particularly by means of isolated ultrafiltration [IUF])...
2014: Therapeutics and Clinical Risk Management
Francois Roubille, Marion Morena, Hélène Leray-Moragues, Bernard Canaud, Jean-Paul Cristol, Kada Klouche
In the setting of cardiorenal syndrome(s) (CRS), the main pathophysiological triggers of renal disease progression include increases in renal venous pressure, maladaptive activation of the renin-angiotensin-aldosterone (RAAS) and the sympathetic nervous systems, and a chronic inflammatory state. In acute decompensated heart failure (HF)/type 1 CRS, diuretics remain the mainstay of first-line therapy in order to prevent congestion and renal venous hypertension. In chronic HF/type 2 CRS, RAAS multiple inhibition has been recommended in addition to diuretics...
2014: Blood Purification
Ankur Jindal, Mariana Garcia-Touza, Nidhi Jindal, Adam Whaley-Connell, James R Sowers
In this article, the literature is reviewed regarding the role of blood pressure variability and nocturnal nondipping of blood pressure as well as the presence of diabetic kidney disease (DKD), in the absence of albuminuria, as risk predictors for progressive DKD. The importance of glycemic and blood pressure control in patients with diabetes and chronic kidney disease, and the use of oral hypoglycemic agents and antihypertensive agents in this patient cohort, are also discussed.
December 2013: Endocrinology and Metabolism Clinics of North America
Bård Waldum, Ingrid Os
Interactions between the heart and the kidneys are increasingly acknowledged among both cardiologists and nephrologists. The term cardiorenal syndrome now applies to the bidirectional nature of how disease in one organ system affects the function of the other organ system. Cardiovascular disease is a major threat to patients with chronic kidney disease, while renal dysfunction is prevalent in patients with cardiac disease and is a significant predictor of prognosis in cardiac patients. Still, renal patients with cardiac disease have largely been excluded from the clinical trials that have been the basis of modern cardiologic treatment...
2013: Cardiology
Masato Ohsawa, Kouichi Tamura, Tomohiko Kanaoka, Hiromichi Wakui, Akinobu Maeda, Toru Dejima, Kengo Azushima, Kazushi Uneda, Ryu Kobayashi, Yuko Tsurumi-Ikeya, Yoshiyuki Toya, Tetsuya Fujikawa, Satoshi Umemura
An altered ambulatory blood pressure (BP) and heart rate (HR) profile is related to chronic kidney disease (CKD) and cardiorenal syndrome. In this study, we examined the effects of aliskiren, when added to angiotensin II type 1 receptor blockers, on ambulatory BP and cardiorenal function in CKD. Thirty-six hypertensive CKD patients were randomly assigned to the aliskiren add-on group (n = 18) or the benazepril add-on group (n = 18). Ambulatory BP and cardiorenal function parameters were measured at baseline and 24 weeks after treatment...
2013: International Journal of Molecular Sciences
Dmitry Shchekochikhin, Robert W Schrier, JoAnn Lindenfeld
CRS is a common problem in patients with advanced heart failure. Arterial underfilling with consequent neurohormonal activation, systemic and intrarenal vasoconstriction, and salt and water retention cause the main clinical features of CRS which include a progressive decline in renal function, worsening renal function during treatment of heart failure (HF) decompensation and resistance to loop diuretics. Impaired renal function in HF patients often reflects more advanced stages of cardiac failure, and thus is associated with a worse prognosis...
July 2013: Current Cardiology Reports
Ken J Lu, Leighton G Kearney, David L Hare, Michelle Ord, Deidre Toia, Elizabeth Jones, Louise M Burrell, Piyush M Srivastava
Anemia and chronic kidney disease are common in patients with heart failure (HF) and are associated with adverse outcomes. We analyzed the effect of cardiorenal anemia (CRA) syndrome, defined as anemia (hemoglobin <130 g/L for men, <120 g/L for women) and stage 3 or greater chronic kidney disease (estimated glomerular filtration rate <60 ml/min/1.73 m(2)), in outpatients with HF. Consecutive patients with HF were prospectively enrolled from 2000 to 2005 (n = 748). The baseline clinical characteristics, pathology test results, and medication use were compared between those with and without CRA syndrome...
April 15, 2013: American Journal of Cardiology
Yoshio Konishi
Focus on the role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of hypertension and renal damage has shifted recently to the role of the local RAAS in the kidneys. Inappropriate augmentation of intrarenal RAAS activity in patients with chronic kidney disease has suggested playing important roles in the development of hypertension and renal injury. In this article, I show the recent findings that salt-induced this augmentation may contribute to the development of salt-sensitive hypertension and play a key role in cardiorenal syndrome (CRS), and that blockade of intrarenal RAAS may be an important strategy for salt-sensitive hypertension and CRS...
September 2012: Nihon Rinsho. Japanese Journal of Clinical Medicine
Edward Rojas, Manuel Velasco, Valmore Bermúdez, Zafar Israili, Peter Bolli
Diabetes mellitus coexisting with hypertension is greater than chance alone would predict. Hypertensive patients have been shown to have altered composition of skeletal muscle tissue, decreased blood flow to skeletal muscle and post-receptor signaling alterations in the IRS insulin pathway, all inducing insulin resistance states, which partially explains why blood pressure goals in DM patients are lower than in normoglycemic patients. Although optimal first-step antihypertensive drug therapy in type 2 DM or impaired fasting glucose levels (IFG) should be individualized for each patient, converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have been demonstrated in some but not all studies to decrease the rate of development of proteinuria and diabetic renal disease...
October 2012: Current Hypertension Reports
Ali A Valika, Mihai Gheorghiade
Heart failure syndromes are often associated with multi-organ dysfunction, and concomitant liver, renal, and neurologic involvement is very common. Neuro-hormonal antagonism plays a key role in the management of this syndrome, and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are one of the cornerstones of therapy. Cardiorenal physiology is becoming more recognized in these patients with advanced heart failure, and the role of neuro-hormonal blockade in this setting is vaguely defined in the literature...
March 2013: Heart Failure Reviews
Mazen Albaghdadi, Mihai Gheorghiade, Bertram Pitt
Acute heart failure syndromes (AHFS) are a heterogeneous group of commonly encountered and difficult to manage clinical syndromes associated with high morbidity and mortality. Dyspnoea, pulmonary, and systemic congestion often characterize AHFS due to acutely elevated intracardiac filling pressures and fluid overload. Diuresis, respiratory support, vasodilator therapy, and gradual attenuation of the activation of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) are the keystones of AHFS management...
November 2011: European Heart Journal
Giovanna Leoncini, Francesca Viazzi, Roberto Pontremoli
A growing body of evidence indicates that the metabolic syndrome and hypertension are interrelated at an epidemiological as well as pathophysiological level. Due to the high prevalence of concomitant signs of subclinical organ damage and the high risk of cardiorenal complications, hypertensive patients with metabolic syndrome are to be considered at high risk. Although the management of this condition must begin with the implementation of a healthy lifestyle and dietary habits, these measures are usually insufficient to adequately control blood pressure values and reduce the cardiovascular risk in the long term...
November 2010: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Kosaku Nitta
Chronic kidney disease (CKD) is now widely accepted as a risk factor for cardiovascular disease and mortality. Heart failure patients with CKD have a worse prognosis. The heart and kidneys act in tandem to regulate blood pressure, vascular tone, diuresis, natriuresis, intravascular volume homeostasis, peripheral tissue perfusion, and oxygenation. Cardiorenal syndrome is a pathophysiological condition in which combined cardiac and renal dysfunction amplifies the progression of failure of the individual organs, and it has an extremely poor prognosis...
April 2011: Clinical and Experimental Nephrology
Piotr Ponikowski, Claudio Ronco, Stefan D Anker
In the past two decades European cardiologists have always been told to follow the evidence-based guidelines in their everyday clinical practice. In the case of patients with heart failure and concomitant renal disease, this universal rule is not easily applicable simply because there is a lack of specific trials in this field. Patients with cardiorenal syndromes are at risk of complications and have high morbidity and mortality. However, the management of these patients is often empirical. Drugs commonly recommended for the treatment of chronic and acutely decompensated heart failure are not always accepted for patients with concomitant renal disease...
2010: Contributions to Nephrology
S N Tereshchenko, I V Zhirov
Renal dysfunction is an independent risk factor of chronic cardiac failure (CCF) and death due to this disease. CCF patients are elderly patients with diabetes mellitus, arterial hypertension and long-term chronic cardiac insufficiency. CCF patients do not often have left ventricular systolic dysfunction, renal affection is not associated with low ejection syndrome. Renal affection in CCF is primarily caused by activation of the system rennin-angiotensin, inflammation, disturbed bioavailability of nitric oxide, hyperactivation of the sympathetic nervous system...
2009: Terapevticheskiĭ Arkhiv
Himanshu Sekhar Mahapatra, Robert Lalmalsawma, Narendra Pal Singh, Mahender Kumar, Suresh Chandra Tiwari
Very often, physicians confront with patients who have concomitant heart and kidney failure. The coexistence of kidney and heart failure carries an extremely bad prognosis. The exact cause of deterioration of kidney function and the mechanism underlying this interaction are complex, multifactorial in nature, and still not completely understood. Both the heart and the kidney act in tandem to regulate blood pressure, vascular tone, diuresis, natriuresis, etc. An extension to the Guytonian model of volume and blood pressure control is proposed called cardiorenal connection...
April 2009: Iranian Journal of Kidney Diseases
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