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Coca in and renal failure

Meredith A Brisco, Michael R Zile, Jennifer S Hanberg, F Perry Wilson, Chirag R Parikh, Steven G Coca, W H Wilson Tang, Jeffrey M Testani
BACKGROUND: Worsening renal function (WRF) is a common endpoint in decompensated heart failure clinical trials because of associations between WRF and adverse outcomes. However, WRF has not universally been identified as a poor prognostic sign, challenging the validity of WRF as a surrogate endpoint. Our aim was to describe the associations between changes in creatinine and adverse outcomes in a clinical trial of decongestive therapies. METHODS AND RESULTS: We investigated the association between changes in creatinine and the composite endpoint of death, rehospitalization or emergency room visit within 60 days in 301 patients in the Diuretic Optimization Strategies Evaluation (DOSE) trial...
October 2016: Journal of Cardiac Failure
Alexander J Kula, Jennifer S Hanberg, F Perry Wilson, Meredith A Brisco, Lavanya Bellumkonda, Daniel Jacoby, Steven G Coca, Chirag R Parikh, W H Wilson Tang, Jeffrey M Testani
BACKGROUND: Reduction in systolic blood pressure (SBP reduction) during the treatment of acute decompensated heart failure is strongly and independently associated with worsening renal function. Our objective was to determine whether SBP reduction or titration of oral neurohormonal antagonists during acute decompensated heart failure treatment negatively influences diuresis and decongestion. METHODS AND RESULTS: SBP reduction was evaluated from admission to discharge in consecutive acute decompensated heart failure admissions (n=656)...
January 2016: Circulation. Heart Failure
Behnood Bikdeli, Kelly M Strait, Kumar Dharmarajan, Shu-Xia Li, Purav Mody, Chohreh Partovian, Steven G Coca, Nancy Kim, Leora I Horwitz, Jeffrey M Testani, Harlan M Krumholz
OBJECTIVES: This study sought to determine the use of intravenous fluids in the early care of patients with acute decompensated heart failure (HF) who are treated with loop diuretics. BACKGROUND: Intravenous fluids are routinely provided to many hospitalized patients. METHODS: We conducted a retrospective cohort study of patients admitted with HF to 346 hospitals from 2009 to 2010. We assessed the use of intravenous fluids during the first 2 days of hospitalization...
February 2015: JACC. Heart Failure
Meredith A Brisco, Stephen E Kimmel, Steven G Coca, Mary E Putt, Mariell Jessup, Wilson W H Tang, Chirag R Parikh, Jeffrey M Testani
BACKGROUND: The long-term durability and prognostic significance of improvement in renal function after mechanical circulatory support (MCS) has yet to be characterized in a large multicenter population. The primary goals of this analysis were to describe serial post-MCS changes in estimated glomerular filtration rate (eGFR) and determine their association with all-cause mortality. METHODS AND RESULTS: Adult patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) with serial creatinine levels available (n=3363) were studied...
January 2014: Circulation. Heart Failure
Jeffrey M Testani, Meredith A Brisco, W H Wilson Tang, Stephen E Kimmel, Anjali Tiku-Owens, Paul R Forfia, Steven G Coca
BACKGROUND: Digitalis glycosides are known to improve the hemodynamic and neurohormonal perturbations that contribute to heart failure (HF)-induced renal dysfunction (RD). The objective of this study was to determine if randomization to digoxin is associated with improvement in renal function (IRF) and to evaluate if patients with digoxin-induced IRF have improved clinical outcomes. METHODS AND RESULTS: Patients in the Digitalis Investigation Group (DIG) dataset with protocol-driven 1-year serum creatinine levels (performed in a central laboratory; n = 980) were studied...
May 2013: Journal of Cardiac Failure
Julie Calixto Lobo, Milena Barcza Stockler-Pinto, Najla Elias Farage, Tanize do Espirito Santo Faulin, Dulcinéia Saes Parra Abdalla, João Paulo Machado Torres, Luis Guillermo Coca Velarde, Denise Mafra
Despite the fact that low plasma zinc (Zn) levels play important roles in the oxidative stress, the relationships between lipid peroxidation and inflammation biomarkers with low plasma Zn levels have not been investigated in chronic kidney disease (CKD) patients. The aim of this study was to evaluate the Zn plasma levels, electronegative LDL [LDL(-)] levels, and inflammation markers as predictors of cardiovascular (CV) mortality in hemodialysis (HD) patients. Forty-five HD patients (28 men, 54.2 ± 12.7 years, 62...
2013: Renal Failure
Mark A Perazella, Steven G Coca
Acute kidney injury (AKI) is common and increasing in hospitalized patients. The earlier recognition of renal injury, at a stage described as 'incipient AKI', may allow renoprotective strategies to be initiated at a time when more kidney tissue is salvageable. 'Incipient AKI' represents renal injury as manifested by new-onset proteinuria, cellular activity on urine microscopy, or elevated novel biomarkers of kidney injury in the absence of clinical data that meet current diagnostic criteria for AKI. We propose three strategies to preserve kidney function and minimize further kidney injury in patients with 'incipient AKI'...
August 2013: Nature Reviews. Nephrology
Meredith A Brisco, Steven G Coca, Jennifer Chen, Anjali Tiku Owens, Brian D McCauley, Stephen E Kimmel, Jeffrey M Testani
BACKGROUND: Identifying reversible renal dysfunction (RD) in the setting of heart failure is challenging. The goal of this study was to evaluate whether elevated admission blood urea nitrogen/creatinine ratio (BUN/Cr) could identify decompensated heart failure patients likely to experience improvement in renal function (IRF) with treatment. METHODS AND RESULTS: Consecutive hospitalizations with a discharge diagnosis of heart failure were reviewed. IRF was defined as ≥20% increase and worsening renal function as ≥20% decrease in estimated glomerular filtration rate...
March 2013: Circulation. Heart Failure
Janice L Zimmerman
Cocaine, a natural alkaloid derived from the coca plant, is one of the most commonly abused illicit drugs. Cocaine is commonly abused by inhalation, nasal insufflation, and intravenous injection, resulting in many adverse effects that ensue from local anesthetic, vasoconstrictive, sympathomimetic, psychoactive, and prothrombotic mechanisms. Cocaine can affect all body systems and the clinical presentation may primarily result from organ toxicity. Among the most severe complications are seizures, hemorrhagic and ischemic strokes, myocardial infarction, aortic dissection, rhabdomyolysis, mesenteric ischemia, acute renal injury and multiple organ failure...
October 2012: Critical Care Clinics
Steven G Coca, Faramarz Ismail-Beigi, Nowreen Haq, Harlan M Krumholz, Chirag R Parikh
BACKGROUND: Aggressive glycemic control has been hypothesized to prevent renal disease in patients with type 2 diabetes mellitus. A systematic review was conducted to summarize the benefits of intensive vs conventional glucose control on kidney-related outcomes for adults with type 2 diabetes. METHODS: Three databases were systematically searched (January 1, 1950, to December 31, 2010) with no language restrictions to identify randomized trials that compared surrogate renal end points (microalbuminuria and macroalbuminuria) and clinical renal end points (doubling of the serum creatinine level, end-stage renal disease [ESRD], and death from renal disease) in patients with type 2 diabetes receiving intensive glucose control vs those receiving conventional glucose control...
May 28, 2012: Archives of Internal Medicine
Dena E Rifkin, Steven G Coca, Kamyar Kalantar-Zadeh
Acute kidney injury (AKI) has been implicated as an independent risk factor for the development of CKD in recent observational studies. The presumption in the nephrology community is that this association represents a causal relationship. However, because of potential problems related to residual confounding (shared risk factors), ascertainment bias (sicker patients have more follow-up assessments), misclassification of exposure (problems with defining baseline kidney function and AKI representing a discrete event versus progression of renal disease), and misclassification of outcome (de novo CKD versus CKD progression), it is difficult to conclude with certainty that AKI is truly causal for CKD...
June 2012: Journal of the American Society of Nephrology: JASN
Jeffrey M Testani, Brian D McCauley, Jennifer Chen, Steven G Coca, Thomas P Cappola, Stephen E Kimmel
BACKGROUND: In the setting of acute decompensated heart failure, worsening renal function (WRF) and improved renal function (IRF) have been associated with similar hemodynamic derangements and poor prognosis. Our aim was to further characterize IRF and its associated mortality risk. METHODS AND RESULTS: Consecutive patients with a discharge diagnosis of congestive heart failure at the Hospital of the University of Pennsylvania were reviewed. IRF was defined as a ≥20% improvement and WRF as a ≥20% deterioration in glomerular filtration rate...
December 2011: Journal of Cardiac Failure
Steven G Coca, Swathi Singanamala, Chirag R Parikh
Acute kidney injury may increase the risk for chronic kidney disease and end-stage renal disease. In an attempt to summarize the literature and provide more compelling evidence, we conducted a systematic review comparing the risk for CKD, ESRD, and death in patients with and without AKI. From electronic databases, web search engines, and bibliographies, 13 cohort studies were selected, evaluating long-term renal outcomes and non-renal outcomes in patients with AKI. The pooled incidence of CKD and ESRD were 25...
March 2012: Kidney International
Andrés Coca-Pelaz, Blanca Vivanco-Allende, Cesar Alvarez-Marcos, Carlos Suarez-Nieto
Amyloid goiter is a rare condition characterized by a diffuse enlargement of the thyroid gland due to amyloid deposition. Extremely uncommon is the development of differentiated carcinomas within this type of lesion. We describe to our knowledge the sixth case of a papillary thyroid carcinoma within an amyloid goiter, arising in a 45-year old woman with chronic renal failure due to primary amyloidosis. This is the first case of a multifocal papillary carcinoma within an amyloid goiter which produces compressive symptoms...
October 2012: Auris, Nasus, Larynx
Jeffrey M Testani, Steven G Coca, Richard P Shannon, Stephen E Kimmel, Thomas P Cappola
AIMS: Renal neurohormonal activation leading to a reduction in glomerular filtration rate (GFR) has been suggested as a mechanism for renal insufficiency (RI) in the setting of heart failure. We hypothesized that RI occurring in the presence of renal neurohormonal activation may be prognostically more important than RI in the absence of renal neurohormonal activation. METHODS AND RESULTS: Subjects in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial (n = 429), Beta-Blocker Evaluation of Survival Trial (BEST) (n = 2691), and Studies Of Left Ventricular Dysfunction (SOLVD) trial (n = 6782) limited datasets were studied...
November 2011: European Journal of Heart Failure
Jeffrey M Testani, Stephen E Kimmel, Daniel L Dries, Steven G Coca
BACKGROUND: Worsening renal function (WRF) in the setting of heart failure has been associated with increased mortality. However, it is unclear if this decreased survival is a direct result of the reduction in glomerular filtration rate (GFR) or if the mechanism underlying the deterioration in GFR is driving prognosis. Given that WRF in the setting of angiotensin-converting enzyme inhibitor (ACE-I) initiation is likely mechanistically distinct from spontaneously occurring WRF, we investigated the relative early WRF-associated mortality rates in subjects randomized to ACE-I or placebo...
November 2011: Circulation. Heart Failure
Jeffrey M Testani, Steven G Coca, Brian D McCauley, Richard P Shannon, Stephen E Kimmel
AIMS: One of the primary determinants of blood flow in regional vascular beds is perfusion pressure. Our aim was to investigate if reduction in blood pressure during the treatment of decompensated heart failure would be associated with worsening renal function (WRF). Our secondary aim was to evaluate the prognostic significance of this potentially treatment-induced form of WRF. METHODS AND RESULTS: Subjects included in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial limited data were studied (386 patients)...
August 2011: European Journal of Heart Failure
F J Tovillas-Morán, M Vilaplana-Cosculluela, A Dalfó-Pibernat, E Zabaleta-del-Olmo, J M Galcerán, A Coca, A Dalfó-Baqué
BACKGROUND: A decrease in renal function is associated with cardiovascular morbidity and mortality. The aim of this study was to analyse the association of cardiovascular morbidity and mortality with baseline glomerular filtration rate (GFR), calculated according to the Cockcroft-Gault and MDRD formulas, with the incidence of major adverse cardiovascular events (MACEs) in a cohort of hypertensive individuals followed for 12 years. METHOD: We performed a prospective study of a random sample of 223 hypertensive patients free of MACEs, who were followed in an urban Primary Care Centre...
2010: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Antoni Sisó, Manuel Ramos-Casals, Albert Bové, Pilar Brito-Zerón, Natalia Soria, Norma Nardi, Adriana Testi, Marta Perez-de-Lis, Cándido Díaz-Lagares, Alejandro Darnell, Juan Sentís, Antonio Coca
We describe the natural history of lupus nephritis (LN) in a historical cohort of 190 white patients with the diagnosis of biopsy-proven LN followed in a single reference center.We evaluated 670 patients with systemic lupus erythematosus (SLE) consecutively followed in our department from 1970 until 2006. All patients fulfilled the 1997 revised criteria for the classification of SLE. White patients (Spanish-born) with biopsy-proven LN were selected as the study population.The cohort included 190 patients (170 female patients and 20 male) with a mean age at LN diagnosis of 31 years...
September 2010: Medicine (Baltimore)
Monica Doménech, Antonio Coca
Hypertension is one of the main risk factors for the development of cardiovascular diseases and the search for new therapeutic strategies aimed at optimizing its control remains an ongoing research and clinical challenge. In recent years, there has been a marked increase in the use of combinations of antihypertensive drugs with complementary mechanisms of action, with the aims of reducing blood pressure levels more rapidly and vigorously than strategies employing monotherapy and improving treatment compliance and adhesion...
2010: Patient Preference and Adherence
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