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diabetes dialysis stroke

Till Keller, Christoph Wanner, Vera Krane, Daniel Kraus, Bernd Genser, Hubert Scharnagl, Winfried März, Christiane Drechsler
BACKGROUND: Mortality is high among patients undergoing hemodialysis for whom cardiac troponin concentration is a strong predictor of outcome. Modern troponin assays allow measurement of very low concentrations. STUDY DESIGN: Using data from a randomized controlled trial, a cohort analysis to evaluate the prognostic value of very low cardiac troponin T (TnT) concentrations. SETTING & PARTICIPANTS: 1,255 patients with end-stage renal disease and type 2 diabetes mellitus undergoing maintenance hemodialysis from the German Diabetes and Dialysis Study (4D) who had a median follow-up of 4 years...
January 5, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Sujha Subramanian, Robai Gakunga, Joseph Kibachio, Gladwell Gathecha, Patrick Edwards, Elijah Ogola, Gerald Yonga, Naftali Busakhala, Esther Munyoro, Jeremiah Chakaya, Nancy Ngugi, Nyawira Mwangi, Daniel Von Rege, Lili-Marie Wangari, David Wata, Robert Makori, Julius Mwangi, Walter Mwanda
INTRODUCTION: The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services. METHODS AND FINDINGS: We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center-a public outpatient facility, and private sector practitioners and hospitals...
2018: PloS One
Yoojin Noh, Jimin Lee, Sooyoung Shin, Inwhee Park, Soo Kyung Bae, Euichul Oh, Sukhyang Lee
Background Decline in estimated glomerular filtration rate (eGFR) is an important surrogate marker for the assessment of renal function. Addition of a second agent to angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) treatment may improve current therapeutic strategies aimed at suppressing renal disease progression. Objective To determine the effect of cilostazol in combination with ACEI or ARB treatment on the decline in eGFR. Setting A tertiary hospital in Korea. Method In an observational cohort study, we analyzed 5505 patients who were prescribed ACEI or ARB and cilostazol or other antiplatelet agents...
December 27, 2017: International Journal of Clinical Pharmacy
Adamasco Cupisti, Lorenzo Ghiadoni, Claudia Zullo, Michele Marchini, Enrico Varricchio, Alessandro Puntoni, Elisabetta Giglio, Ophelia Meniconi, Maria R Bruno, Maria F Egidi
BACKGROUND: Arterial hypertension is very common in chronic kidney disease (CKD) patients and its prevalence increases with lowering estimated glomerular filtration rate (eGFR). Blood pressure (BP) control is a cornerstone in the treatment of CKD patients but still most treatment decisions are based on office BP measurement (OBPM). The aim of this cross-sectional, retrospective study is to investigate the prevalence of hypertension phenotypes in CKD patients and whether different home (HBPM) or OBPM are associated with a different CKD stage and cardiovascular comorbidities...
November 22, 2017: Panminerva Medica
Eri Minamino-Muta, Takao Kato, Takeshi Morimoto, Tomohiko Taniguchi, Hiroki Shiomi, Kenji Nakatsuma, Shinichi Shirai, Kenji Ando, Norio Kanamori, Koichiro Murata, Takeshi Kitai, Yuichi Kawase, Makoto Miyake, Chisato Izumi, Hirokazu Mitsuoka, Masashi Kato, Yutaka Hirano, Shintaro Matsuda, Kazuya Nagao, Tsukasa Inada, Tomoyuki Murakami, Yasuyo Takeuchi, Keiichiro Yamane, Mamoru Toyofuku, Mitsuru Ishii, Moriaki Inoko, Tomoyuki Ikeda, Akihiro Komasa, Eiji Tada, Katsuhisa Ishii, Kozo Hotta, Nobuya Higashitani, Toshikazu Jinnai, Yoshihiro Kato, Yasutaka Inuzuka, Chiyo Maeda, Yuko Morikami, Naritatsu Saito, Ryuzo Sakata, Kenji Minatoya, Takeshi Kimura
Whether patients with severe aortic stenosis (AS) die because of AS-related causes is an important issue for the management of these patients. We used data from CURRENT AS registry, a Japanese multicenter registry, to assess the causes of death in severe AS patients and to identify the factors associated with non-cardiac mortality. We enrolled 3815 consecutive patients with a median follow-up of 1176 days; the 1449 overall deaths comprised 802 (55.3%) from cardiac and 647 (44.7%) from non-cardiac causes. Heart failure (HF) (25...
November 7, 2017: Scientific Reports
Mark Findlay, Rachael MacIsaac, Mary Joan MacLeod, Wendy Metcalfe, Jamie P Traynor, Jesse Dawson, Patrick B Mark
Background: The risk of stroke in end-stage renal disease (ESRD) on renal replacement therapy (RRT) is up to 10-fold greater than the general population. However, whether this increased risk differs by RRT modality is unclear. Methods: We used data contained in the Scottish Renal Registry and the Scottish Stroke Care Audit to identify stroke in all adult patients who commenced RRT for ESRD from 2005 to 2013. Incidence rate was calculated and regression analyses were performed to identify variables associated with stroke...
October 24, 2017: Nephrology, Dialysis, Transplantation
Zakeih Chaker, Vinay Badhwar, Fahad Alqahtani, Sami Aljohani, Chad J Zack, David R Holmes, Charanjit S Rihal, Mohamad Alkhouli
BACKGROUND: Studies assessing the differential impact of sex on outcomes of aortic valve replacement (AVR) yielded conflicting results. We sought to investigate sex-related differences in AVR utilization, patient risk profile, and in-hospital outcomes using the Nationwide Inpatient Sample. METHODS AND RESULTS: In total, 166 809 patients (63% male and 37% female) who underwent AVR between 2003 and 2014 were identified, and 48.5% had a concomitant cardiac surgery procedure...
September 21, 2017: Journal of the American Heart Association
Yan-Rong Li, Sung-Sheng Tsai, Yu-Sheng Lin, Chang-Min Chung, Szu-Tah Chen, Jui-Hung Sun, Miaw-Jene Liou, Tien-Hsing Chen
BACKGROUND: Evidences support the benefits of moderate- to high-intensity statins for patients with acute myocardial infarction (AMI) except for those with type 2 diabetes mellitus (T2DM) on dialysis after AMI. This study was aimed to investigate the safety and efficacy of secondary prevention of cardiovascular diseases using moderate- to high-intensity statins in T2DM patients on dialysis after AMI. METHODS: A simulated prospective cohort study was conducted between January 1st, 2001 and December 31st, 2013 utilizing data from the Taiwan National Health Insurance Research Database...
2017: Diabetology & Metabolic Syndrome
Mark C Lin, Elani Streja, Melissa Soohoo, Medhat Hanna, Javad Savoj, Kamyar Kalantar-Zadeh, Wei Ling Lau
BACKGROUND: Controversy exists regarding the benefits and risks of warfarin therapy in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In this study, we assessed mortality and cardiovascular outcomes associated with warfarin treatment in patients with stages 3-5 CKD and ESRD admitted to the University of California-Irvine Medical Center. METHODS: In a retrospective matched cohort study, we identified 59 adult patients with stages 3-6 CKD initiated on warfarin during the period 2011-2013, and 144 patients with stages 3-6 CKD who had indications for anticoagulation therapy but were not initiated on warfarin...
2017: American Journal of Nephrology
Krzysztof Hoppe, Krzysztof Schwermer, Anna Olewicz-Gawlik, Patrycja Klysz, Anna Kawka, Ewa Baum, Dorota Sikorska, Katarzyna Ścigacz, Magdalena Roszak, Bengt Lindholm, Krzysztof Pawlaczyk, Andrzej Oko
BACKGROUND: Cardiovascular (CV) incidents are the major cause of mortality in maintenance dialysis (MD) patients undergoing peritoneal dialysis (PD) or hemodialysis (HD). CV injury indicators may be useful to investigate the dialysis modality influence on survival. OBJECTIVES: The aim of this study was to compare selected laboratory and echocardiographic (ECHO) markers of CV injury in terms of dialysis vintage (DV), CV-related mortality and all-cause mortality. MATERIAL AND METHODS: The study involved 301 patients on HD (n = 301) and PD (n = 58), who were divided into subgroups according to DV...
March 2017: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
David A Drew, Bang-Bon Koo, Rafeeque Bhadelia, Daniel E Weiner, Sarah Duncan, Maria Mendoza-De la Garza, Aditi Gupta, Hocine Tighiouart, Tammy Scott, Mark J Sarnak
BACKGROUND: Patients treated with dialysis have high rates of brain infarcts, brain atrophy, and white matter disease. There are limited data regarding the presence of more subtle damage to brain white matter. METHODS: In the Cognition and Dialysis Study, we compared brain structure using diffusion tensor imaging in hemodialysis (HD) patients to individuals without known kidney disease, using tract based spatial statistics (TBSS) to compare Fractional Anisotropy (FA) and Mean Diffusivity (MD)...
July 5, 2017: BMC Nephrology
Zachary Hothem, Dustin Baker, Christina S Jenkins, Jason Douglas, Rose E Callahan, Catherine C Shuell, Graham W Long, Robert J Welsh
BACKGROUND: Increased longevity has led to more nonagenarians undergoing elective surgery. Development of predictive models for hospital readmission may identify patients who benefit from preoperative optimization and postoperative transition of care intervention. Our goal was to identify significant predictors of 30-d readmission in nonagenarians undergoing elective surgery. METHODS: Nonagenarians undergoing elective surgery from January 2011 to December 2012 were identified using the American College of Surgeons National Surgical Quality Improvement Project participant use data files...
June 1, 2017: Journal of Surgical Research
David M Charytan, Scott D Solomon, Peter Ivanovich, Giuseppe Remuzzi, Mark E Cooper, Janet B McGill, Hans-Henrik Parving, Patrick Parfrey, Ajay K Singh, Emmanuel A Burdmann, Andrew S Levey, Dick de Zeeuw, Kai-Uwe Eckardt, John J V McMurray, Brian Claggett, Eldrin F Lewis, Marc A Pfeffer
BACKGROUND: How cardiovascular (CV) events affect progression to end-stage renal disease (ESRD), particularly in the setting of type 2 diabetes, remains uncertain. STUDY DESIGN: Observational study. SETTING & PARTICIPANTS: 4,022 patients with type 2 diabetes, anemia, and chronic kidney disease from the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). PREDICTOR: Postrandomization CV events. OUTCOMES: ESRD (defined as initiation of dialysis for >30 days, kidney transplantation, or refusal or nonavailability of renal replacement therapy) and post-ESRD mortality within 30 days and during overall follow-up after an intercurrent CV event...
October 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Ryoma Michishita, Takuro Matsuda, Shotaro Kawakami, Satoshi Tanaka, Akira Kiyonaga, Hiroaki Tanaka, Natsumi Morito, Yasuki Higaki
AIM: Chronic kidney disease (CKD) may be an etiologic cause of aging, hypertension, diabetes mellitus (DM), and metabolic syndrome. However, the influence of these cardiovascular risk factors and their combination on the development of CKD remains controversial. This retrospective study evaluated the influence of cardiovascular risk factors and their combination on the incidence of CKD during a 6-year follow-up period in middle-aged and older males. METHODS: The subjects were 303 males without a history of cardiovascular disease, stroke, renal dysfunction, or dialysis treatment...
June 7, 2017: Clinical and Experimental Hypertension: CHE
Paul N Bennett, Nicole Capdarest-Arest, Kristen Parker
The progressive physical deterioration of dialysis patients is apparent to all who are involved in their care. Exercise can help stem this decline, yet exercise uptake in chronic and end-stage kidney disease is low. The involvement of exercise professionals has been shown to significantly increase patients' physical function and improve their quality of life. However, exercise professionals are scarce in renal programs, far less than dietetic and social work services. A review of 10 years of renal exercise publications in the physical therapy and rehabilitation literature found that only 0...
September 2017: Seminars in Dialysis
S Nayak-Rao, M P Shenoy
Renal failure is a potent risk factor for stroke, which is a leading cause of morbidity and mortality worldwide. The risk of stroke is 5-30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. Case fatality rates are also higher reaching almost 90%. It is therefore important to understand the factors that predispose to stroke in this vulnerable population to better apply preventive strategies. The heightened risk of stroke in CKD represents the interplay of the vascular co-morbidities that occur with renal impairment and factors specific to renal failure such as malnutrition-inflammation-atherosclerosis complex, the effect of uremic toxins, dialysis techniques, vascular access, and the use of anticoagulants to maintain flow in the extracorporeal circuit...
May 2017: Indian Journal of Nephrology
Christiane Drechsler, Salim S Hayek, Changli Wei, Sanja Sever, Bernd Genser, Vera Krane, Andreas Meinitzer, Winfried März, Christoph Wanner, Jochen Reiser
BACKGROUND AND OBJECTIVES: Soluble urokinase plasminogen activator receptor is a novel biomarker strongly predictive of cardiovascular outcomes implicated in the pathogenesis of kidney disease. Soluble urokinase plasminogen activator receptor levels, however, correlate with declining kidney function. It is unclear whether soluble urokinase plasminogen activator receptor levels remain associated with outcomes in patients with ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We measured plasma soluble urokinase plasminogen activator receptor levels in 1175 patients (mean age =66±8 years old, 54% men) with type 2 diabetes mellitus on hemodialysis participating in the German Diabetes and Dialysis Study followed for a median of 4 years for outcomes including all-cause death, cardiovascular events, and infection-related mortality...
August 7, 2017: Clinical Journal of the American Society of Nephrology: CJASN
Salma I Patel, Harini A Chakkera, Paul W Wennberg, David A Liedl, Fadi Alrabadi, Stephen S Cha, Darren D Hooley, Hatem Amer, Hani M Wadei, Fadi E Shamoun
Patients with end-stage renal disease undergoing kidney transplant often have diffuse atherosclerosis and high cardiovascular morbidity and mortality rates. We analyzed the correlation of peripheral arterial disease (PAD), here quantified by an abnormal ankle-brachial index (ABI) measured within the 5 years prior to kidney transplant, with graft failure and mortality rates (primary end points) after adjusting for known cardiovascular risk factors (age, sex, smoking history, hypertension, diabetes, stroke, known coronary artery disease or heart failure, years of dialysis)...
June 2017: Vascular Medicine
Cheuk Fan Shum, Clinton D Bahler, Clint Cary, Timothy A Masterson, Ronald S Boris, Thomas A Gardner, Hristos Z Kaimakliotis, Richard S Foster, Richard Bihrle, Michael O Koch, James E Slaven, Chandru P Sundaram
INTRODUCTION: Partial nephrectomy (PN) reduces the risk of postoperative chronic renal insufficiency (CRI). However, some patients still develop CRI after PN, and may eventually require dialysis. Being able to predict renal function before PN helps in counseling patients and managing expectations. We aimed to construct nomograms that predict estimated glomerular filtration rates (eGFRs), defined by the modification of diet in renal disease (MDRD) and the chronic kidney disease epidemiology collaboration (CKD-EPI) formulae, at 1 year after PN, using only preoperative covariates as predictors...
July 2017: Journal of Endourology
P Michael Grossman, Syed S Ali, Herbert D Aronow, Michael Boros, Timothy J Nypaver, Theodore L Schreiber, Yeo Jung Park, Peter K Henke, Hitinder S Gurm
BACKGROUND: The incidence, risk factors, and outcomes associated with Contrast-induced nephropathy (CIN) after Percutaneous Vascular Intervention (PVI) in contemporary medical practice are largely unknown. METHODS: A total of 13 126 patients undergoing PVI were included in the analysis. CIN was defined as an increase in serum creatinine from pre-PVI baseline to post-PVI peak Cr of ≥0.5 mg/dL. RESULTS: CIN occurred in 3% (400 patients) of the cohort, and 26 patients (6...
April 3, 2017: Journal of Interventional Cardiology
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