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Chronic kidney disease cardiovascular mortality

Takuya Wakamatsu, Suguru Yamamoto, Toru Ito, Yoko Sato, Koji Matsuo, Yoshimitsu Takahashi, Yoshikatsu Kaneko, Shin Goto, Junichiro James Kazama, Fumitake Gejyo, Ichiei Narita
In chronic kidney disease (CKD) patients, accumulation of uremic toxins is associated with cardiovascular risk and mortality. One of the hallmarks of kidney disease-related cardiovascular disease is intravascular macrophage inflammation, but the mechanism of the reaction with these toxins is not completely understood. Macrophages differentiated from THP-1 cells were exposed to indoxyl sulfate (IS), a representative uremic toxin, and changes in inflammatory cytokine production and intracellular signaling molecules including interleukin (IL)-1, aryl hydrocarbon receptor (AhR), nuclear factor (NF)-κ, and mitogen-activated protein kinase (MAPK) cascades as well as the NLRP3 inflammasome were quantified by real-time PCR, Western blot analysis, and enzyme-linked immunosorbent assay...
March 15, 2018: Toxins
Venkatesh Ravi, Fady Iskander, Abhimanyu Saini, Carolyn Brecklin, Rami Doukky
BACKGROUND: Pericardial effusion is common in hospitalized patients with chronic kidney disease (CKD). We sought to identify predictors of pericardial effusion in CKD patients and to evaluate the impact of pericardial effusion on their mortality and morbidity. METHODS: In a retrospective nested case control study design, we analyzed hospitalized adult patients with CKD stage 4, 5, and end-stage renal disease (ESRD) diagnosed with pericardial effusion. Randomly selected patients with CKD stage 4, 5, and ESRD without pericardial effusion were used as controls...
March 13, 2018: Clinical Cardiology
M Rroji, G Spasovski
Secondary hyperparathyroidism (SHPT) is common among patients with end-stage renal disease (ESRD). SHPT is associated with high-turnover bone disease, interstitial and vascular calcifications, cardiovascular morbidity and mortality. The pharmacological management of SHPT has progressed in recent years. The introduction of targeted therapies, such as selective vitamin D receptors activators and calcium-sensing receptor modulators, offers an increased opportunity to adequately control elevated parathyroid hormone (PTH), especially in patients with chronic kidney disease under dialysis treatment...
March 12, 2018: International Urology and Nephrology
Subir Bhatia, Shilpkumar Arora, Sravya M Bhatia, Mohammed Al-Hijji, Yogesh N V Reddy, Parshva Patel, Charanjit S Rihal, Bernard J Gersh, Abhishek Deshmukh
BACKGROUND: Chronic kidney disease (CKD) remains an independent predictor of cardiovascular morbidity and mortality. CKD complicates referral for percutaneous coronary intervention (PCI) in non-ST-segment-elevation myocardial infarction (NSTEMI) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients. METHODS AND RESULTS: Using the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess PCI utilization and in-hospital outcomes in NSTEMI admissions with CKD...
March 10, 2018: Journal of the American Heart Association
Wesley Hayes, Fabio Paglialonga
Dysregulation of intravascular fluid leads to chronic volume overload in children with end-stage kidney disease (ESKD). Sequelae include left ventricular hypertrophy and remodeling and impaired cardiac function. As a result, cardiovascular complications are the commonest cause of mortality in the pediatric dialysis population. The clinical need to optimize intravascular volume in children with ESKD is clear; however, its assessment and management is the most challenging aspect of the pediatric dialysis prescription...
March 9, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Wei Ling Lau, Javad Savoj, Michael B Nakata, Nosratola D Vaziri
In chronic kidney disease (CKD), influx of urea and other retained toxins exerts a change in the gut microbiome. There is decreased number of beneficial bacteria that produce short-chain fatty acids, an essential nutrient for the colonic epithelium, concurrent with an increase in bacteria that produce uremic toxins such as indoxyl sulphate, p -cresyl sulphate, and trimethylamine-N-oxide (TMAO). Due to intestinal wall inflammation and degradation of intercellular tight junctions, gut-derived uremic toxins translocate into the bloodstream and exert systemic effects...
March 15, 2018: Clinical Science (1979-)
Smitha R Vidi
PURPOSE OF REVIEW: Hypertension is an independent risk factor for progression of chronic kidney disease (CKD) in children. Children with early CKD develop hypertension secondary to renal disease. This review aims to highlight recent advances that help us better understand the current role of hypertension in progression of CKD in children. RECENT FINDINGS: There is increasing evidence that children with CKD who have hypertension develop early atherosclerosis and cardiac adaptive changes...
April 2018: Current Opinion in Pediatrics
Kristen L Nowak, Michel Chonchol
Chronic, low-grade inflammation is a common comorbid condition in chronic kidney disease (CKD), and particularly in chronic dialysis patients. In this review, we consider the question of whether inflammation affects outcomes in dialysis patients. Levels of proinflammatory cytokines, as well as C-reactive protein, are elevated in chronic dialysis patients. Multiple factors likely contribute to chronic inflammatory activation in kidney disease patients including the uremic milieu, lifestyle and epigenetic influences, infectious and thrombotic events, the dialysis process, and dysbiosis...
March 7, 2018: Seminars in Dialysis
Roberto Minutolo, Francis B Gabbai, Michele Provenzano, Paolo Chiodini, Silvio Borrelli, Carlo Garofalo, Ferdinando C Sasso, Domenico Santoro, Vincenzo Bellizzi, Giuseppe Conte, Luca De Nicola
Background: No study has assessed whether the prognosis of coexisting diabetes mellitus and chronic kidney disease (DM-CKD) is dictated by DM per se or by the extent of proteinuria. Methods: In this pooled analysis of four prospective studies in CKD patients treated with drugs inhibiting the renin-angiotensin system, we compared the risk of all-cause mortality, fatal and non-fatal cardiovascular (CV) events and end-stage renal disease (ESRD) between patients with (n = 693) and without diabetes (n = 1481) stratified by proteinuria level (<0...
March 2, 2018: Nephrology, Dialysis, Transplantation
Sarah Seiler-Mussler, Anne S Limbach, Insa E Emrich, John W Pickering, Heinz J Roth, Danilo Fliser, Gunnar H Heine
BACKGROUND AND OBJECTIVES: In patients with CKD, elevated plasma parathyroid hormone (PTH) levels are associated with greater cardiovascular morbidity and mortality. However, the reference method for PTH measurement is disputed. It has been argued that measurement of nonoxidized PTH better reflects biologically active PTH than measurements with conventional assays. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: PTH and nonoxidized PTH levels were measured at study baseline in 535 patients with CKD with an eGFR range between 89 and 15 ml/min per 1...
March 5, 2018: Clinical Journal of the American Society of Nephrology: CJASN
Seoyoung C Kim, Tuhina Neogi, Eun Ha Kang, Jun Liu, Rishi J Desai, MaryAnn Zhang, Daniel H Solomon
BACKGROUND: Patients with gout are at an increased risk of cardiovascular (CV) disease including myocardial infarction (MI), stroke, and heart failure (HF). OBJECTIVES: The authors conducted a cohort study to examine comparative CV safety of the 2 gout treatments-probenecid and allopurinol-in patients with gout. METHODS: Among gout patients ≥65 years of age and enrolled in Medicare (2008 to 2013), those who initiated probenecid or allopurinol were identified...
March 6, 2018: Journal of the American College of Cardiology
Juan R Muñoz-Castañeda, María V Pendón-Ruiz de Mier, Mariano Rodríguez, María E Rodríguez-Ortiz
Patients with advanced chronic kidney disease exhibit an increase in cardiovascular mortality. Recent works have shown that low levels of magnesium are associated with increased cardiovascular and all-cause mortality in hemodialysis patients. Epidemiological studies suggest an influence of low levels of magnesium on the occurrence of cardiovascular disease, which is also observed in the normal population. Magnesium is involved in critical cellular events such as apoptosis and oxidative stress. It also participates in a number of enzymatic reactions...
February 27, 2018: International Journal of Molecular Sciences
Stefano Savonitto, Nuccia Morici, Nicoletta Franco, Leonardo Misuraca, Laura Lenatti, Luca A Ferri, Emilia Lo Jacono, Chiara Leuzzi, Elena Corrada, Tiziana C Aranzulla, Angelo Cagnacci, Delia Colombo, Carlo La Vecchia, Francesco Prati
BACKGROUND: Early menopause has been associated with increased cardiovascular mortality, but prospective studies investigating outcomes of postmenopausal women with acute coronary syndromes (ACS) in relation to menopausal age are lacking. METHODS: We analyzed the 1-year outcome of 373 women with acute myocardial infarction enrolled in the Ladies ACS study. All patients underwent coronary angiography, with corelab analysis. Menopause questionnaires were administered during admission...
February 21, 2018: International Journal of Cardiology
Ida Giardino, Maria D'Apolito, Michael Brownlee, Angela Bruna Maffione, Anna Laura Colia, Michele Sacco, Pietro Ferrara, Massimo Pettoello-Mantovani
Chronic kidney disease in children is an irreversible process that may lead to end-stage renal disease. The mortality rate in children with end-stage renal disease who receive dialysis increased dramatically in the last decade, and it is significantly higher compared with the general pediatric population. Furthermore, dialysis and transplant patients, who have developed end-stage renal disease during childhood, live respectively far less as compared with age/race-matched populations. Different reports show that cardiovascular disease is the leading cause of death in children with end-stage renal disease and in adults with childhood-onset chronic kidney disease, and that children with chronic kidney disease are in the highest risk group for the development of cardiovascular disease...
December 2017: Türk Pediatri Arşivi
Masamitsu Ubukata, Masaki Hara, Yuki Nishizawa, Teruhiro Fujii, Kosaku Nitta, Akihito Ohta
In patients with lymphoma, an important issue that has been recognized is renal involvement, including glomerulonephritis, acute kidney injury, and lymphoma infiltrating the kidney. However, the prevalence and mortality of chronic kidney disease (CKD) have not been fully understood in lymphoma patients. This study aimed to evaluate the prevalence of CKD and its impact on mortality in those patients.This was a retrospective cohort study of 429 consecutive lymphoma patients who were admitted or regularly visited our hospital from January 2013 to October 2016...
January 2018: Medicine (Baltimore)
Elin Isaksson, Martin Almquist, Astrid Seeberger, Gunnar Sterner
BACKGROUND: Secondary hyperparathyroidism and altered levels of parathyroid hormone (PTH) are associated with vascular events in chronic kidney disease. After renal transplantation, this association is not clear. Pre-transplant parathyroidectomy (PTX) is common, but post-transplant data are scarce. We aimed to study the effect of PTH at the time of transplantation on risk of post-transplant vascular events in renal transplant recipients with and without pre-transplant PTX. METHODS: 258 patients from two Swedish transplant units were followed for 6 years...
February 24, 2018: Clinical and Experimental Nephrology
Esther R van de Wal-Visscher, Jeroen P Kooman, Frank M van der Sande
BACKGROUND: Magnesium (Mg) is an essential cation for multiple processes in the body. The kidney plays a major role in regulating the Mg balance. In a healthy individual, total-body Mg content is kept constant by interactions among intestine, bones and the kidneys. SUMMARY: In case of chronic kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal Mg absorption. Usually Mg remains normal; however, when glomerular filtration rate declines, changes in serum Mg are observed...
January 26, 2018: Blood Purification
Marijke J E Dekker, Frank M van der Sande, Florence van den Berghe, Karel M L Leunissen, Jeroen P Kooman
Extracellular fluid overload (FO), which is assessed using bioimpedance technologies, is an important predictor of outcome in dialysis patients and in patients with early stages of chronic kidney disease. While traditional cardiovascular abnormalities are assumed to mediate this risk, recently also, the importance of noncardiovascular factors, such as systemic inflammation and malnutrition has been shown. While both FO and inflammation are independent risk factors for mortality, recent studies have shown that their combined presence can lead to a cumulative risk profile...
January 26, 2018: Blood Purification
Gerard M London
Accelerated ageing is observed in patients with chronic kidney disease (CKD)/end-stage renal disease. Premature vascular aging and arterial stiffening are the most characteristic features of this "progeria" that is already observed in those with the early stages of CKD. Aortic stiffening is associated with high characteristic impedance, left ventricular hypertrophy, decreased coronary perfusion, and is a strong prognostic marker of mortality and cardiovascular morbidity. With aging, the arterial stiffening is more pronounced in the aorta and central arteries than in peripheral conduit arteries...
January 26, 2018: Blood Purification
Mahboob Rahman, Jesse Yenchih Hsu, Niraj Desai, Chi-Yuan Hsu, Amanda H Anderson, Lawrence J Appel, Jing Chen, Debbie L Cohen, Paul E Drawz, Jiang He, Pan Qiang, Ana C Ricardo, Susan Steigerwalt, Matthew R Weir, Jackson T Wright, Xiaoming Zhang, Raymond R Townsend
BACKGROUND AND OBJECTIVES: Central BP measurements provide noninvasive measurement of aortic BP; our objectives were to examine the association of central and brachial BP measurements with risk of cardiovascular outcomes and mortality in patients with CKD and to determine the role of central BP measurement in conjunction with brachial BP in estimating cardiovascular risk. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a prospective, longitudinal study (the Chronic Renal Insufficiency Cohort), central BP was measured in participants with CKD using the SphygmoCorPVx System...
February 23, 2018: Clinical Journal of the American Society of Nephrology: CJASN
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