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heart failure and dialysis

Cunlin Wang, Robert Kane, Mark Levenson, Jeffrey Kelman, Michael Wernecke, Joo-Yeon Lee, Steven Kozlowski, Carmen Dekmezian, Zhiwei Zhang, Aliza Thompson, Kimberly Smith, Yu-Te Wu, Yuqin Wei, Yoganand Chillarige, Qin Ryan, Chris Worrall, Thomas E MaCurdy, David J Graham
Importance: In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect...
October 24, 2016: JAMA Internal Medicine
Peter A McCullough, Christopher T Chan, Eric D Weinhandl, John M Burkart, George L Bakris
The prevalence of cardiovascular disease, including cardiac arrhythmia, coronary artery disease, cardiomyopathy, and valvular heart disease, is higher in hemodialysis (HD) patients than in the US resident population. Cardiovascular disease is the leading cause of death in HD patients and the principal discharge diagnosis accompanying 1 in 4 hospital admissions. Furthermore, the rate of hospital admissions for either heart failure or fluid overload is persistently high despite widespread use of β-blockers and renin-angiotensin system inhibitors and attempts to manage fluid overload with ultrafiltration...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Masato Nishimura, Toshiko Tokoro, Satoru Yamazaki, Tetsuya Hashimoto, Hiroyuki Kobayashi, Toshihiko Ono
BACKGROUND: We examined the prevalence, prognosis, and effect of endothelin receptor antagonists on survival in end-stage kidney disease patients with idiopathic pre-capillary pulmonary hypertension. METHODS: We investigated 1988 end-stage kidney disease patients in Toujinkai Hospital from January 1, 2001 to December 31, 2014. Pulmonary hypertension was screened by symptoms (dyspnea, hypotension, or near syncope) and echocardiography, and diagnosed by computed tomography with enhancement, pulmonary flow scintigraphy, and right heart catheterization...
October 19, 2016: Clinical and Experimental Nephrology
Joo Hoon Lee, Jae Suk Baek, Jeong Jin Yu, Young-Hwue Kim, Jae-Kon Ko, Young Seo Park
OBJECTIVE: To evaluate the relationship between B-type natriuretic peptide (BNP) and cardiac parameters on echocardiography. DESIGN AND METHOD: Echocardiography was checked at 6 months ∼ 1 year interval in children with end-stage renal disease on peritoneal dialysis, which was more frequently done in patients with hypertension or any heart problems. We reviewed blood pressure (BP) and echocardiographic findings of those children (since February 2005). Data were presented as mean ± standard deviation (median, minimum ∼ maximum)...
September 2016: Journal of Hypertension
Noman Ahmed Jang Khan, Masroor A Khan, Guillermo Juan Morell Chardon
End stage renal disease has a list of consequences, cardiovascular being the most common. Inefficient dialysis can cause significant deposition of calcium all over the body, including heart valves making heart function impaired. We illustrate a case of 38-year-old female with end stage renal disease on peritoneal dialysis. The patient had been complaining of pain and swelling of the right hand for the last few months and had been seen by hand surgeon and was admitted electively for the biopsy of hand lesions...
2016: Case Reports in Cardiology
Nisha Bansal, Charles E McCulloch, Feng Lin, Cassianne Robinson-Cohen, Mahboob Rahman, John W Kusek, Amanda H Anderson, Dawei Xie, Raymond R Townsend, Claudia M Lora, Jackson Wright, Alan S Go, Akinlolu Ojo, Arnold Alper, Eva Lustigova, Magda Cuevas, Radhakrishna Kallem, Chi-Yuan Hsu
Blood pressure is a modifiable risk for cardiovascular disease (CVD). Among hemodialysis patients, there is a U-shaped association between blood pressure and risk of death. However, few studies have examined the association between blood pressure and CVD in patients with stage 4 and 5 chronic kidney disease. Here we studied 1795 Chronic Renal Insufficiency Cohort (CRIC) Study participants with estimated glomerular filtration rate <30 ml/min per 1.73 m(2) and not on dialysis. The association of systolic (SBP), diastolic (DBP), and pulse pressure with the risk of physician-adjudicated atherosclerotic CVD (stroke, myocardial infarction, or peripheral arterial disease) and heart failure was tested using Cox regression adjusted for demographics, comorbidity and medications...
October 4, 2016: Kidney International
Dipesh K Shah, Salil V Deo, Andrew D Althouse, Jeffery J Teuteberg, Soon J Park, Robert L Kormos, Harold M Burkhart, Victor O Morell
BACKGROUND: Adults with congenital heart disease may present with end-stage heart failure necessitating orthotopic heart transplant (OHT). We sought to review the United Network for Organ Sharing (UNOS) experience with this unique cohort focusing on surgical outcomes and survival. METHODS: From the UNOS registry, 737 adult congenital heart disease recipients (ACHDR) out of 26,993 OHT patients (2.7%) who underwent OHT were studied to analyze early and late outcomes and compared to non-congenital recipients (NCR) over a 15-year period (2000-2014)...
October 5, 2016: Journal of Cardiac Surgery
Andrew I Chin, Kathleen Tong, John P McVicar
Heart failure necessitating left ventricular assist device (LVAD) support can lead to kidney failure requiring dialysis. Some of these patients may require long-term hemodialysis (HD). Optimal vascular access for a patient on long-term HD therapy with an LVAD remains a complex issue. The majority of LVADs are of the continuous-flow type, and it has been theorized that native arteriovenous fistula maturation may be impaired in a setting of decreased pulsatile arterial flow. We describe a case of successful creation and use of an arteriovenous fistula in an HD-dependent patient with a continuous-flow LVAD...
September 27, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Wenxue Hu, Wenna He, Wei Liu, Xiaowu Fang, Yanhua Wu, Feng Yu, Wenke Hao
BACKGROUND/AIMS: Cardiorenal syndrome type 1 (CRS1) is a syndrome characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). The aims of this study were to investigate the risk factors and the prognosis of CRS1 in elderly patients. METHODS: A total of 312 elderly patients (≥60 years old) with acute heart failure (AHF) were studied. They were assigned as CRS1 (suffered from in-hospital AKI) or NCRS1 (without AKI) group. Clinical and laboratory data were recorded...
September 28, 2016: Kidney & Blood Pressure Research
Hannelore Sprenger-Mähr, Emanuel Zitt, Karl Lhotta
INTRODUCTION: The number of patients suffering from acute kidney injury requiring dialysis (AKI-D) is increasing. Whereas causes and outcome of AKI-D in the intensive care unit (ICU) are described extensively, few data exist about AKI-D patients treated outside the ICU. Aim of this study was to identify the causes of AKI-D, determine in-depth the comorbid conditions and outcome of this particular patient group and identify possibilities for its prevention. METHODS: We retrospectively studied all AKI-D patients treated outside the ICU in a single nephrology referral center between January 2010 and June 2015...
2016: PloS One
Takayuki Adachi, Tsutomu Sakurada, Takanori Otowa, Keita Uehara, Shina Sueki, Shigeki Kojima, Nagayuki Kaneshiro, Katsuomi Matsui, Tadahisa Tomohiro, Yugo Shibagaki
Vascular access intervention therapy (VAIVT) has been positioned as the first choice of treatment for stenosis lesions frequently observed in arteriovenous fistula (AVF) for hemodialysis patients in Japan. Furthermore, increased blood flow can provide a stable dialysis. In contrast, it has been reported that excess blood flow of AVF causes high-output heart failure. Although VAIVT is used to increase blood flow of AVF, the impact of VAIVT on cardiac load has been rarely reported. We examined the factors associated with cardiac load in hemodialysis patients undergoing VAIVT by measuring levels of α human atrial natriuretic polypeptide (hANP) and brain natriuretic peptide (BNP) before and after VAIVT...
October 2016: Hemodialysis International
Sara L Zettervall, Peter A Soden, Klaas H J Ultee, Crystal Seldon, Jinhee Oh, Kevin McGann, Marc L Schermerhorn, Raul J Guzman
OBJECTIVE: Elevated serum phosphate levels have been associated with increased risks of cardiovascular events and death in several patient populations. The effects of serum phosphate on outcomes in patients with critical limb ischemia (CLI) have not been evaluated. In this study, we assessed the effect of abnormal phosphate levels on mortality and major limb events after surgical intervention for CLI. METHODS: A retrospective review was undertaken to identify all patients at a single institution who underwent a first-time open or endovascular intervention for CLI between 2005 and 2014...
September 22, 2016: Journal of Vascular Surgery
Mohamed Shokr, Ramanjit Kaur, Kevin Belgrave, Arshad Javed, Mahir Elder, Shaun Cardozo, Luis Afonso, Amir Kaki
Catheter related thrombosis (CRT) is a commonly encountered entity fraught with substantial risk for mortality secondary to various complications including pulmonary embolism (PE), tricuspid regurgitation, endocarditis, right sided heart failure, and cardiogenic and septic shock. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients. Management strategies include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines...
2016: Case Reports in Cardiology
Joo Hoon Lee, Jae Suk Baek, Jeong Jin Yu, Young-Hwue Kim, Jae-Kon Ko, Young Seo Park
OBJECTIVE: To evaluate the relationship between B-type natriuretic peptide (BNP) and cardiac parameters on echocardiography. DESIGN AND METHOD: Echocardiography was checked at 6 months ∼ 1 year interval in children with end-stage renal disease on peritoneal dialysis, which was more frequently done in patients with hypertension or any heart problems. We reviewed blood pressure (BP) and echocardiographic findings of those children (since February 2005). Data were presented as mean ± standard deviation (median, minimum ∼ maximum)...
September 2016: Journal of Hypertension
Divya Ratan Verma, Yash Pershad, Ashish Pershad, Kenith Fang, George Gellert, Michael F Morris
BACKGROUND: Computed tomography (CT) has become the standard imaging modality for pre-procedural aortic annular sizing prior to transcatheter aortic valve replacement (TAVR). We hypothesized that the accuracy of CT derived annular measurements would be greater at sites with higher TAVR procedural volume. METHODS: Within a large integrated health system, TAVR was performed at low (<40 cases), intermediate (40-75 cases), and high-volume sites (>75 cases). 181 patients underwent TAVR with a Sapien XT transcatheter heart valve (THV)...
August 27, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Thomas A Mavrakanas, David M Charytan
PURPOSE OF REVIEW: This review article focuses on the most significant cardiovascular complications in dialysis patients [sudden cardiac death (SCD), acute coronary syndromes, heart failure, and atrial fibrillation]. RECENT FINDINGS: Current and ongoing research aims to quantify the rate and pattern of significant arrhythmia in dialysis patients and to determine the predominant mechanism of SCD. Preliminary findings from these studies suggest a high rate of atrial fibrillation and that bradycardia and asystole may be more frequent than ventricular arrhythmia as a cause of sudden death...
November 2016: Current Opinion in Nephrology and Hypertension
Gautam R Shroff, Paolo Raggi
Extensive myocardial fibrosis is known to occur in patients undergoing dialysis due to a variety of mechanisms not necessarily restricted to coronary artery disease. Fibrosis may predispose to reentry arrhythmias and long-term myocardial dysfunction, and sudden death and congestive heart failure are the most frequent causes of death in patients undergoing renal replacement therapy. Despite the high accuracy of magnetic resonance for imaging of myocardial fibrosis, its use has been restricted by the risk of inducing nephrogenic systemic sclerosis with the injection of gadolinium...
October 2016: Kidney International
Mu-Yang Hsieh, Tsung-Yan Chen, Lin Lin, Min-Tsun Liao, Ren-Huei Wang, Ruei-Cheng Kuo, Chao-Lun Lai, Chih-Cheng Wu
OBJECTIVES: Right heart catheterization is an important diagnostic tool but carries risks of adverse events. Little is known about the feasibility and safety of using dialysis arteriovenous (AV) shunts. We aim to evaluate the feasibility and safety of using dialysis AV shunts for access in right heart catheterization. METHODS: Hemodialysis patients who required right heart catheterization were prospectively enrolled. A 7 Fr sheath was inserted and a balloon-tipped pulmonary artery catheter was advanced for right heart catheterization...
September 15, 2016: Journal of Invasive Cardiology
Paulo César Brandão Veiga Jardim, Weimar Kunz Sebba Barroso de Souza, Renato Delascio Lopes, Andréa Araújo Brandão, Marcus V Bolívar Malachias, Marco Mota Gomes, Heitor Moreno Júnior, Eduardo Costa Duarte Barbosa, Rui Manoel Dos Santos Póvoa
BACKGROUND: A registry assessing the care of hypertensive patients in daily clinical practice in public and private centers in various Brazilian regions has not been conducted to date. Such analysis is important to elucidate the effectiveness of this care. OBJECTIVE: To document the current clinical practice for the treatment of hypertension with identification of the profile of requested tests, type of administered treatment, level of blood pressure (BP) control, and adherence to treatment...
August 2016: Arquivos Brasileiros de Cardiologia
Wen Tang, Xiu-Hong Hu, Lei Zhu, Zhe-Li Niu, Chu-Yan Su, Qing-Feng Han, Tao Wang
PURPOSE: To investigate the effect of pre-dialysis renal care on peritoneal dialysis (PD) patients' outcomes in China. METHODS: In this retrospective cohort study, patients who started PD during January 1, 2006, to December 31, 2014, were included. Patients' medical charts were reviewed to extract the information. To explore the effect of pre-dialysis renal care on patients' outcomes, patient were divided into two groups according to whether or not they had frequent renal clinic visits: Group A (with frequent visits) and Group B (without frequent visits)...
November 2016: International Urology and Nephrology
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