Category Archives: Heart Disease
Chronic kidney disease is associated with neovascularization and intraplaque hemorrhage in coronary atherosclerosis in elders: results from the Hisayama Study.
Hemodialysis.com eInterview with Toshiaki Nakano, MD, PhD
Department of Medicine and Clinical Science
Graduate School of Medical Sciences, Kyushu University
3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Nakano: In this population-based autopsy study, we examined the relationships of chronic kidney disease (CKD) with neovascularization and intraplaque hemorrhage in coronary atherosclerosis from 375 autopsy samples from 126 subjects. Lower eGFR was associated with increased numbers of newly formed blood vessels. The multivariate-adjusted odds ratio of the presence of intraplaque hemorrhages was 6.22 (95% CI, 1.10–35.04) in subjects with an eGFR of <30 mL/min/1.73 m2 compared with those with an eGFR of ≥60 mL/min/1.73 m2. We found that elderly patients with CKD have higher risks of intimal neoangiogenesis and intraplaque hemorrhages in coronary arteries.
Marie Benz, MD on Google+Lipoprotein Kinetics in Male Hemodialysis Patients Treated with Atorvastatin.
Hemodialysis.com eInterview with Prof. Hans Dieplinger PhD
Division of Genetic Epidemiology
Department of Medical Genetics, Clinical and Molecular Pharmacology
Innsbruck Medical University
Schöpfstrasse 41
A-6020 Innsbruck Austria
email hans.dieplinger@i-med.ac.at
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Dieplinger: Our study was based on previous investigations from our group on the kinetics of atherogenic lipoproteins in hemodialysis patients. These former studies revealed a metabolic disorder of diminished synthesis AND degradation of apoB-containing lipoproteins resulting in prolonged residence times in circulation of these lipoproteins despite of their concentrations in normal ranges. The aim of our recent study was therefore to test whether HMG-CoA-reductase inhibitors (statins) which are known to normalize impaired degradation of apoB-containing lipoproteins in hypercholesterolemic patients exert similar beneficial effects also in CKD patients treated with hemodialysis. The main findings in a small group of male hemodialysis patients were significant reductions of total and LDL cholesterol as well as improved kinetics (including residence times) of atherogenic lipoproteins.
Predictors of cardiovascular events in hemodialysis patients after stress myocardial perfusion imaging
Hemodialysis.com: eInterview with Tatsuhiko Furuhashi
Division of Cardiovascular Medicine
Toho University Ohashi Medical Center
153-8515
2-17-6 Ohashi Meguro-ku Tokyo
Hemodialysis.com: What are the main findings of the study?
Answer: In hemodialysis patients, normal stress myocardial perfusion imaging (MPI) alone cannot guarantee good prognosis in terms of cardiovascular events.
Hemodialysis.com: Were any of the findings unexpected?
Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy – a meta-analysis of 11 randomized controlled trials involving 21,295 participants
Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy – a meta-analysis of 11 randomized controlled trials involving 21,295 participants
Prof. Maciej Banach, MD, FNLA, FAHA, FESC, FASA, FRSPH
President, Polish Lipid Association
http://www.polishlipidassociation.com
Editor-in-chief, Archives of Medical Science
http://www.ArchivesofMedicalScience.com
Head, Department of Hypertension
Chair of Nephrology and Hypertension
Medical University of Lodz, Poland
E-mail: maciej.banach@umed.lodz.pl
Hemodialysis.com: What are the main findings of the study?
Dr. Banach: The use of statins in subjects with non-dialysis-dependent chronic kidney disease (CKD) resulted in a marked (statistically significant) reduction in death from all causes, cardiac causes, cardiovascular events and stroke. The use of statins in dialysis-dependent CKD patients resulted in a non‑significant effect on death from all causes and stroke, but had the effect of reducing death from cardiac causes and cardiovascular events (however the last two data were obtained on the very limited studies).
Dynamic cardiac dyssynchrony is strongly associated with 2-year dialysis adequacy in continuous ambulatory peritoneal dialysis patients
Hemodialysis.com Interview with Ching-Hui Huang, MD
Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan
Hemodialysis.com: What are the main findings of the study?
Answer: Dynamic systolic dyssynchrony was significantly associated with future dialysis adequacy (Kt/V and WCC) in CAPD patients.
Heart Failure with Preserved or Reduced Ejection Fraction in Patients Treated With Peritoneal Dialysis
Hemodialysis.com Interview with
Angela Yee-Moon Wang, MD, PhD, FRCP
Research performed at Prince of Wales Hospital, Chinese University of Hong Kong
Current affiliation: Dept of Med, Queen Mary Hospital, University of Hong Kong
Hemodialysis.com: What are the main findings of the study?
Dr. Wang: This prospective study is so far the first to investigate the prevalence of heart failure with preserved ejection fraction (HFPEF) and compare the long-term clinical outcomes of heart failure with preserved or reduced ejection fraction in the dialysis population and specifically in the peritoneal dialysis (PD) patients.
We observed a very high prevalence of heart failure with preserved ejection fraction (HFPEF) (~ 55%) in the PD patients, suggesting that this is a very common heart failure entity in the PD patients. Furthermore, our study is the first to show that PD patients having HFPEF were associated with an increased risk of mortality and adverse cardiovascular outcomes including cardiovascular death, fatal or non-fatal cardiovascular events, and heart failure compared to patients without heart failure. However, the risk for all-cause mortality, cardiovascular death, fatal or non-fatal cardiovascular events, and heart failure was lower when compared to patients having heart failure with reduced ejection fraction (HFREF).
Effect of serum FGF-23, MGP and fetuin-A on calcium-phosphate metabolism in maintenance hemodialysis patients
Hemodialysis.com Interview with Jian-Ying Niu
Division of Nephrology
the Fifth People’s Hospital of Shanghai 200240 China
Hemodialysis.com: What are the main findings of the study?
Answer: In this study, we enrolled 64 patients (30 males,34 females, 60.6+-11.3 years of age) who received an average dialysis vintage of 6.88+-2.94 years, and evaluated the serum level of FGF-23, MGP and fetuin-A, as well as the coronary artery calcification score (CACS) with coronary artery computed tomography scan.
There were 13 (20.31%), 16 (25%), and 35 (54.69%) patients exhibited a CACS of 0–100, 100–400, and >400, respectively. The dialysis vintage, serum FGF-23, fetuin-A, phosphorus and high-density lipoprotein-C levels were identified as independent variables of CACS by stepwise multiple regression analysis. The area under receiver operating characteristic curve indicated that serum FGF-23 and fetuin-A were useful for identifying CAC in MHD patients. The cut-off value corresponding to the highest Youden’s index was serum FGF-23 ≥ 256 pg/mL and fetuin-A ≤ 85mg/mL, which was defined as the optimal predictors of CAC.
Decline in 20-year mortality after myocardial infarction in patients with chronic kidney disease: evolution from the prethrombolysis to the percutaneous coronary
Hemodialysis.com Interview with Sjoerd T. Nauta MSc
Thoraxcenter, Department of Cardiology
Rotterdam 3015 CE, The NetherlandsSjoerd Nauta
Hemodialysis.com: What are the main findings of the study?
Answer: We measured temporal trends in treatment and mortality after myocardial infarction depending on kidney function at presentation in 12,087 patients admitted for myocardial infarction to a coronary care unit from 1985 to 2008. The patients were categorized into those with normal kidney function (estimated glomerular filtration rate over 90 ml/min per 1.73m2), and those with CKD as defined by Kidney Foundation practice guidelines, with 8632 patients (71%) at CKD stages 2–5. Treatment of MI improved in all groups of kidney function, but patients with stage 4–5 kidney dysfunction were less likely to receive evidence-based medical treatment and reperfusion therapy. Temporal trends in 30-day mortality reveal impressive mortality reductions during this 24-year period that were comparable for all stages of kidney function and were sustained during long-term follow-up. Although the outcome after MI improved across the whole range of kidney function, we showed that kidney dysfunction remains a strong risk factor for increased both short- and long-term mortality.
