Impact of Renal Dysfunction on the Outcome of Acute Myocardial Infarction
|
|
- Theodore Warner
- 6 years ago
- Views:
Transcription
1 ORIGINAL ARTICLE JIACM 2010; 11(4): Impact of Renal Dysfunction on the Outcome of Acute Myocardial Infarction Shagun Sachdeva*, NP Singh**, Renuka Saha*** Abstract The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction. End-stage renal disease is associated with one of the highest risks, but the influence of milder degrees of renal impairment is less well defined. This study attempts to assess the prevalence of renal dysfunction in patients of acute myocardial infarction (AMI) and to study its short-term prognostic significance. Out of a total of 150 cases studied, 20% below 45 and 33% above the age of 45 had renal dysfunction. 49% of the AMI patients who did not have renal dysfunction and 77% of AMI patients who had renal dysfunction developed an adverse outcome (recurrent acute coronary syndromes, revascularisation (PTCA/CABG), left ventricular failure, and death) after AMI. Patients with renal dysfunction had a significantly increased risk (almost 4 times) of developing an adverse outcome after AMI. Further studies are recommended in view of the short duration of study and the small sample size. Key words: Renal dysfunction, acute myocardial infarction, acute renal failure. Introduction The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction 1-5. Patients with end-stage renal disease, as defined by a glomerular filtration rate (GFR) of less than 15.0 ml per minute per 1.73 m 2 are known to have decreased survival after myocardial infarction, especially if they are receiving renal-replacement therapy. But limited information exists on the risks and survival associated with lesser degrees of renal dysfunction in patients who have had an acute myocardial infarction (AMI). Also, the majority of what is known relates to the serum creatinine level, which is an insensitive indicator of renal function. Furthermore, many of these studies have concentrated on fatal outcomes 6-8. Keeping this in mind, this study is planned to assess the prevalence of renal dysfunction in patients of acute myocardial infarction and to study it s impact on the outcomes after acute myocardial infarction. Material and methods This study was conducted on one hundred fifty (150) consecutive patients (who fulfilled the inclusion and exclusion criteria) admitted to the internal medicine ward of Lok Nayak Hospital, New Delhi. Eligible patients included men and women, 18 of age or older, who had had an acute myocardial infarction, who were treated according to the standard protocol of treatment of AMI, and who were willing to participate in the study. All serious and unconscious patients and those who were not able to respond and who were treated out of the standard protocol for the treatment of AMI were not included. Patients of end-stage renal disease (GFR of < 15 ml/min/1.73 m 2 of body surface area for more than 3 months) were also excluded. After the selection of the patients, informed consent was obtained from each of them, and were evaluated with a detailed history and examination. The investigations carried-out were: cardiac enzymes-troponins, CPK, serum creatinine, blood urea, serum uric acid, urinary protein levels, and blood sugar. Creatinine clearance was derieved from Cockroft Gault equation. (Creatinine clearance = [(140-age) *body mass] / (plasma creatinine * 0.72) * GF- GF (gender correction factor). Females , males Adverse outcome in this study refers to recurrent acute coronary syndromes, revascularisation (PTCA/CABG), left ventricular failure, and death. The data was recorded in a questionnaire with information about all the parameters as discrete and continuous data. Once the data was collected, the patients were divided into two groups, with renal dysfunction and without renal dysfunction. The data under both these categories was compared using appropriate statistical methods. The diagnosis of renal * Research Associate, ** Professor, *** Statistician, Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi
2 dysfunction was based on history, physical examination, estimation of serum creatinine, and glomerular filtration rate calculated by the Cockroft Gault equation, supplemented with urinary protein and glucose estimation 15. The diagnosis of AMI was based on the WHO criteria 16. The study was approved the by institutional ethics commitee. Observations and results A total of 150 cases were studied out of which, 76% were males and 24 % were females. 15% of these cases were below 45 of age. Age-wise distribution of renal dysfunction among AMI patients 20% of the cases below the age of 45 and 33% of the cases above the age of 45 had renal dysfunction. In total, 31% of all cases of AMI studied had renal dysfunction (Fig. 1). 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Age<45 AMI without renal dysfunction AMI with renal dysfunction Age>45 Fig. 1: Prevalence of renal dysfunction in AMI. Age-wise distribution of adverse outcome after AMI. 58% of all AMI patients studied developed an adverse outcome after AMI. Out of which, 73% of cases were below the age of 45, and 55% who were above the age of 45, developed an adverse outcome after AMI (Fig. 2). Impact of renal dysfunction on the outcome after AMI Renal dysfunction was found in 31% of all cases of AMI. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% The risk of an adverse outcome after an AMI was found to be significantly higher in patients with renal dysfunction than in patients without renal dysfunction (77% vs 49%, odds ratio 3.54 with confidence interval ) (Fig. 3). In this study no significant association was found between the other variables considered and the outcome after AMI. Therefore, a multivariate analysis was not required for their adjustment in order to find an association between renal dysfunction and outcomes after AMI. Discussion Adverse outcome absent after AMI Adverse outcome present after AMI Age<45 Age>45 Fig. 2: Prevalence of adverse outcome after AMI. Acute renal failure (ARF) has traditionally been defined as the abrupt loss of kidney function that results in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes. The loss of kidney function is most easily detected by measurement of the serum creatinine which is used to estimate the glomerular filtration rate (GFR) 14. Chronic kidney disease (CKD) has a more rigid definition: The National Kidney Foundation (kidney disease outcomes and quality initiative guidelines, 2002) define CKD as kidney damage for > 3 months with or without decrease in the GFR as manifested by either pathologic abnormality or markers of kidney damage including 278 Journal, Indian Academy of Clinical Medicine Vol. 11, No. 4 October-December, 2010
3 Fig. 3: AMI with renal dysfunction Adverse outcome No adverse outcome AMI without renal dysfunction Adverse outcome No adverse outcome abnormality in composition of blood and urine, or abnormality in imaging techniques and GFR < 60 ml/min/ 1.73 m 2 for > 3 months with or without kidney damage. The Joint National Committee (JNC) for Detection and Treatment of Hypertension recognises renal dysfunction as an independent cardiovascular risk factor. Renal disease was a common and significant independent risk factor for adverse events in patients who had a myocardial infarction complicated by heart failure, left ventricular systolic dysfunction, or both 1-9. The loss of kidney function is most easily detected by measurement of the serum creatinine which is used to estimate the glomerular filtration rate (GFR). Some prior studies have used the serum creatinine level 11 rather than the estimated GFR to detect renal dysfunction. The accuracy of the serum creatinine level as a marker of renal function is limited, owing to nonlinear associations with GFR that vary according to age, sex, race, and lean body mass. Three problems are associated with the use of the serum creatinine to quantitatively define ARF. Firstly, serum creatinine does not accurately reflect the GFR in a patient who is not in a steady state. In the early stages of severe acute renal failure, the serum creatinine may be low even though the actual (not estimated) GFR is markedly reduced since there may not have been sufficient time for the creatinine to accumulate. Secondly, creatinine is removed by dialysis. As a result, it is usually not possible to assess kidney function by measuring the serum creatinine once dialysis is initiated. One exception is when the serum creatinine continues to fall on days when haemodialysis is not performed, indicating recovery of renal function. And lastly, numerous epidemiologic studies and clinical trials have used different cut-off values for serum creatinine to quantitatively define ARF 14. The lack of consensus in the quantitative definition of ARF, in particular, has hindered clinical research since it confounds comparisons between studies. Some definitions employed in clinical studies have been extremely complex with graded increments in serum creatinine for different baseline serum creatinine values 12. As an example, in a classic study of the epidemiology of hospital-acquired acute renal failure, ARF was defined as a 0.5 mg/dl increase in serum creatinine if the baseline serum creatinine was 1.9 mg/dl, an 1.0 mg/dl increase in serum creatinine if the baseline serum creatinine was 2.0 to 4.9 mg/dl, and a 1.5 mg/dl increase in serum creatinine if the baseline serum creatinine was 5.0 mg/ dl 14. Consequently, the National Kidney Foundation uses GFR rather than the serum creatinine level to define renal dysfunction 6-8,13,15. Data on the effect of mild renal insufficiency in patients with coronary artery disease/ami are limited 10,11. But from whatever studies that were done, it was found that a low estimated GFR was independently associated with an increased risk of death and complications from cardiovascular causes, reinforcing the concept that renal disease is a risk factor for cardiovascular events. Several studies have suggested that cut-off values for an estimated GFR of less than 60.0 ml per minute per 1.73 m 2 are predictive of adverse cardiovascular outcomes. Findings suggest that patients with renal impairment Journal, Indian Academy of Clinical Medicine Vol. 11, No. 4 October-December,
4 already have an increased risk of cardiovascular events and that this risk increases with worsening renal function 1,4,6. Our study is in agreement with the latter. Mechanisms by which renal dysfunction increases cardiovascular risk are under investigation. The progressive increase in cardiovascular risk with worsening estimated GFR is partly explained by factors associated with renal decline, including anaemia, oxidative stress, derangements in calcium-phosphate homoeostasis, inflammation, and conditions promoting coagulation, all of which are associated with accelerated atherosclerosis and endothelial dysfunction. Another possible explanation could be that a decrease in renal function may be associated with other non-traditional risk factors. Such factors include, for example, changes in coagulation, lipids, endothelial dysfunction, homocysteine and/or the presence of anaemia, oxidative stress, proteinuria, and inflammation. On the other hand, renal dysfunction may be the result of both duration and severity of other causes of cardiovascular disease, such as hypertension. Thus, reduced kidney function may reflect residual confounding from CVD risk factors 1, 2, 6. Our study demonstrates that a significant proportion of patients who present with AMI have abnormal renal function. 31% of all cases of AMI studied were found to have renal dysfunction. Explanations for the higher frequency of renal dysfunction in our cohort than in previous cohorts include possible selection bias for patients with nearly normal renal function in other studies and an increasing incidence of chronic kidney disease. This possibility is partly accounted for by increasing rates of hypertension and diabetes mellitus. 49% of the AMI patients who did not have renal dysfunction and 77% of AMI patients who had renal dysfunction developed an adverse outcome after AMI. Thus, among patients who have had a myocardial infarction, any degree of renal impairment should be considered a potent, independent, and easily identifiable risk factor for cardiovascular complications 1. This study extends previous observations regarding the association of renal dysfunction and adverse clinical outcomes among patients with coronary artery disease. In the presence of STEMI, elevated creatinine and/or reduced creatinine clearance on presentation are associated with increased mortality, independent of other conventional risk factors. Retrospective analyses have demonstrated that renal dysfunction is associated with an increased risk of CHF and mortality after acute MI 7,13. Because creatinine levels were measured at presentation, these creatinine levels likely reflect renal status near the time of onset of the event and less likely reflect changes in renal haemodynamics due to impaired systemic perfusion. Limitations of the study The sample size was small. This resulted in certain known statistically significant relationships to come out to be statistically insignificant. Also, since the serum creatinine levels were measured at presentation and since the patients were followed-up for only one month, it is not possible for us to comment on the acuteness or the chronicity of the renal dysfunction. Conclusion In conclusion, the present study showed that renal dysfunction is strongly associated with an increased risk of adverse outcome after AMI in men and women from the general population. The underlying mechanism behind this relationship is unclear but seems to be independent from common risk factors such as hypertension, diabetes, smoking, BMI, alcohol intake, physical activity, and dyslipidaemia. Thus, estimation of GFR in addition to the consideration of present conventional risk factors may be a valuable tool for individual cardiovascular risk assessment. Further studies are needed to investigate the pathophysiological mechanisms underlying this association. References 1. Anavekar NS, McMurray JV, Velazquez SC. Relation between Renal Dysfunction and Cardiovascular Outcomes after Myocardial Infarction. NEJM 2004; 351: Al Suwaidi J, Reddan DN, Williams K et al. Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation 2002; 106: Wright RS, Reeder GS, Herzog CA et al. Acute myocardial infarction and renal dysfunction: a high-risk combination. Division of Cardiology, Mayo Alliance for Clinical Trials, Mayo Clinic. Ann Intern Med 2002; 137: Journal, Indian Academy of Clinical Medicine Vol. 11, No. 4 October-December, 2010
5 4. Shlipak MG, Heidenreich PA, Noguchi H et al. Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. General Internal Medicine Section, Veterans Affairs Medical Center (111A1) and University of California, San Francisco, USA. shlip@itsa.ucsf.edu 5. Thomas H, Hostetter MD. Chronic Kidney Disease Predicts Cardiovascular Disease. NEJM 2004; 351: Gibson CM, Pinto DS, Murphy SA et al. Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality. J Am Coll Cardiol 2003; 42: Tokmakova M, Skali H, Solomon SD et al. Moderate renal dysfunction augments cardiovascular risk after myocardial infarction. Presented at the European Society of Cardiology Congress, Vienna, August 30 September 3, Sorensen CR, Brendorp B, Rask-Madsen C et al. The prognostic importance of creatinine clearance after acute myocardial infarction. Eur Heart J 2002; 23: Wheeler DC. Cardiovascular disease in patients with chronic renal failure. Lancet 1996; 348: [PMID: ]. 10. Mann JF, Gerstein HC, Pogue J et al. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomised trial. Ann Intern Med 2001; 134: Herzog CA, Ma JZ, Collins AJ. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 1998; 339: Walsh CR, O Donnell CJ, Camargo CA Jr et al. Elevated serum creatinine is associated with 1-year mortality after acute myocardial infarction. Am Heart J 2002; 144: Freeman RV, Mehta RH, Al Badr W et al. Influence of concurrent renal dysfunction on outcomes of patients with acute coronary syndromes and implications of the use of glycoprotein IIb/IIIa inhibitors. J Am Coll Cardiol 2003; 41: Mehta RL, Chertow GM. Acute renal failure definitions and classification: time for change? J Am Soc Nephrol 2003; 14: Stevens LA, Levey AS. Measurement of kidney function. In: Medical Clinics of North America, Singh AK, (Ed), W.B. Saunders, Philadelphia 2005; p ISFC/WHO Task Force on Standardisation of Clinical Nomenclature and Criteria for Diagnosis of Ischaemic Heart Disease;Nomenclature and Criteria for Diagnosis of Ischaemic. Heart Disease Circulation 1979; 59 (3): Journal, Indian Academy of Clinical Medicine Vol. 11, No. 4 October-December,
Effects of Kidney Disease on Cardiovascular Morbidity and Mortality
Effects of Kidney Disease on Cardiovascular Morbidity and Mortality Joachim H. Ix, MD, MAS Assistant Professor in Residence Division of Nephrology University of California San Diego, and Veterans Affairs
More informationSerum Creatinine and Blood Urea Nitrogen Levels in Patients with Coronary Artery Disease
Serum Creatinine and Blood Urea Nitrogen Levels in Patients with Coronary Artery Disease MAK Akanda 1, KN Choudhury 2, MZ Ali 1, MK Kabir 3, LN Begum 4, LA Sayami 1 1 National Institute of Cardiovascular
More informationHow to manage ACS patients with Comorbidities? Patients with Renal Failure
How to manage ACS patients with Comorbidities? Patients with Renal Failure François Schiele, MD, PhD Department of Cardiology, University Hospital Jean Minjoz, Besançon, France. Potential conflicts of
More informationAKI: definitions, detection & pitfalls. Jon Murray
AKI: definitions, detection & pitfalls Jon Murray Previous conventional definition Acute renal failure (ARF) An abrupt and sustained decline in renal excretory function due to a reduction in glomerular
More informationOutline. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 7/23/2013. Question 1: Which of these patients has CKD?
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationScreening and early recognition of CKD. John Ngigi (FISN) Kidney specialist
Screening and early recognition of CKD John Ngigi (FISN) Kidney specialist screening Why? Who? When? How? Primary diagnosis for patients who start dialysis Other 10% Glomerulonephritis 13% No. of dialysis
More informationPrevalence of anemia and cardiovascular diseases in chronic kidney disease patients: a single tertiary care centre study
International Journal of Advances in Medicine Sathyan S et al. Int J Adv Med. 2017 Feb;4(1):247-251 http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20170120
More informationPersons with advanced chronic kidney disease (CKD) have. Heart Failure
Heart Failure Chronic Kidney Disease, Cardiovascular Risk, and Response to Angiotensin-Converting Enzyme Inhibition After Myocardial Infarction The Survival And Ventricular Enlargement (SAVE) Study Mariya
More informationCardiovascular Risk Among Adults With Chronic Kidney Disease, With or Without Prior Myocardial Infarction
Journal of the American College of Cardiology Vol. 48, No. 6, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.05.047
More informationCardiovascular Disease in CKD. Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center
Cardiovascular Disease in CKD Parham Eftekhari, D.O., M.Sc. Assistant Clinical Professor Medicine NSUCOM / Broward General Medical Center Objectives Describe prevalence for cardiovascular disease in CKD
More informationJournal of the American College of Cardiology Vol. 45, No. 11, by the American College of Cardiology Foundation ISSN /05/$30.
Journal of the American College of Cardiology Vol. 45, No. 11, 2005 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.02.068
More informationAGING KIDNEY IN HIV DISEASE
AGING KIDNEY IN HIV DISEASE Michael G. Shlipak, MD, MPH Professor of Medicine, Epidemiology and Biostatistics, UCSF Chief, General Internal Medicine, San Francisco VA Medical Center Kidney, Aging and HIV
More informationChapter 1: CKD in the General Population
Chapter 1: CKD in the General Population Overall prevalence of CKD (Stages 1-5) in the U.S. adult general population was 14.8% in 2011-2014. CKD Stage 3 is the most prevalent (NHANES: Figure 1.2 and Table
More informationOutline. Outline CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW. Question 1: Which of these patients has CKD?
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationHYPERTENSION GUIDELINES WHERE ARE WE IN 2014
HYPERTENSION GUIDELINES WHERE ARE WE IN 2014 Donald J. DiPette MD FACP Special Assistant to the Provost for Health Affairs Distinguished Health Sciences Professor University of South Carolina University
More informationChronic Kidney Disease is Associated with Cognitive Decline: the Northern Manhattan Study (NOMAS) Seattle VA Chief of Medicine Rounds June 9, 2009
Chronic Kidney Disease is Associated with Cognitive Decline: the Northern Manhattan Study (NOMAS) Seattle VA Chief of Medicine Rounds June 9, 2009 Minesh Khatri Internal Medicine R2 Background Patients
More informationTrial to Reduce. Aranesp* Therapy. Cardiovascular Events with
Trial to Reduce Cardiovascular Events with Aranesp* Therapy John J.V. McMurray, Hajime Uno, Petr Jarolim, Akshay S. Desai, Dick de Zeeuw, Kai-Uwe Eckardt, Peter Ivanovich, Andrew S. Levey, Eldrin F. Lewis,
More informationNew Clinical Trends in Geriatric Medicine. April 8, 2016 Amanda Lathia, MD, MPhil Staff, Center for Geriatric Medicine
New Clinical Trends in Geriatric Medicine April 8, 2016 Amanda Lathia, MD, MPhil Staff, Center for Geriatric Medicine Objectives Review current guidelines for blood pressure (BP) control in older adults
More informationMorbidity & Mortality from Chronic Kidney Disease
Morbidity & Mortality from Chronic Kidney Disease Dr. Lam Man-Fai ( 林萬斐醫生 ) Honorary Clinical Assistant Professor MBBS, MRCP, FHKCP, FHKAM, PDipID (HK), FRCP (Edin, Glasg) Hong Kong Renal Registry Report
More informationJournal of the American College of Cardiology Vol. 35, No. 3, by the American College of Cardiology ISSN /00/$20.
Journal of the American College of Cardiology Vol. 35, No. 3, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00608-7 The Prognostic
More informationTREAT THE KIDNEY TO SAVE THE HEART. Leanna Tyshler, MD Chronic Kidney Disease Medical Advisor Northwest Kidney Centers February 2 nd, 2009
TREAT THE KIDNEY TO SAVE THE HEART Leanna Tyshler, MD Chronic Kidney Disease Medical Advisor Northwest Kidney Centers February 2 nd, 2009 1 ESRD Prevalent Rates in 1996 per million population December
More informationOutline. Outline 10/14/2014 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW. Question 1: Which of these patients has CKD?
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationUniversity of Groningen. Acute kidney injury after cardiac surgery Loef, Berthus Gerard
University of Groningen Acute kidney injury after cardiac surgery Loef, Berthus Gerard IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it.
More informationTHE PROGNOSIS OF PATIENTS WITH CHRONIC KIDNEY DISEASE AND DIABETES MELLITUS
214 ILEX PUBLISHING HOUSE, Bucharest, Roumania http://www.jrdiabet.ro Rom J Diabetes Nutr Metab Dis. 21(3):23-212 doi: 1.2478/rjdnmd-214-25 THE PROGNOSIS OF PATIENTS WITH CHRONIC KIDNEY DISEASE AND DIABETES
More informationSUPPLEMENTAL MATERIAL
SUPPLEMENTAL MATERIAL Clinical perspective It was recently discovered that small RNAs, called micrornas, circulate freely and stably in human plasma. This finding has sparked interest in the potential
More informationPredicting and changing the future for people with CKD
Predicting and changing the future for people with CKD I. David Weiner, M.D. Co-holder, C. Craig and Audrae Tisher Chair in Nephrology Professor of Medicine and Physiology and Functional Genomics University
More informationALLHAT RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 4 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR)
1 RENAL DISEASE OUTCOMES IN HYPERTENSIVE PATIENTS STRATIFIED INTO 4 GROUPS BY BASELINE GLOMERULAR FILTRATION RATE (GFR) 6 / 5 / 1006-1 2 Introduction Hypertension is the second most common cause of end-stage
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. Cardiovascular Risk Factors
Cardiovascular Risk Factors ROB WALKER (Dunedin, New Zealand) Lipid-lowering therapy in patients with chronic kidney disease Date written: January 2005 Final submission: August 2005 Author: Rob Walker
More informationEarly risk stratification is essential in the management of
Cystatin C A Novel Predictor of Outcome in Suspected or Confirmed Non ST-Elevation Acute Coronary Syndrome Tomas Jernberg, MD, PhD; Bertil Lindahl, MD, PhD; Stefan James, MD, PhD; Anders Larsson, MD, PhD;
More informationE.Ritz Heidelberg (Germany)
Predictive capacity of renal function in cardiovascular disease E.Ritz Heidelberg (Germany) If a cure is not achieved, the kidneys will pass on the disease to the heart Huang Ti Nei Ching Su Wen The Yellow
More informationEchocardiography analysis in renal transplant recipients
Original Research Article Echocardiography analysis in renal transplant recipients S.A.K. Noor Mohamed 1*, Edwin Fernando 2, 1 Assistant Professor, 2 Professor Department of Nephrology, Govt. Stanley Medical
More informationCVD risk assessment using risk scores in primary and secondary prevention
CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities
More informationChapter 2: Identification and Care of Patients With Chronic Kidney Disease
Chapter 2: Identification and Care of Patients With Chronic Kidney Disease Introduction The examination of care in patients with chronic kidney disease (CKD) is a significant challenge, as most large datasets
More informationFigure 1 LVH: Allowed Cost by Claim Volume (Data generated from a Populytics analysis).
Chronic Kidney Disease (CKD): The New Silent Killer Nelson Kopyt D.O. Chief of Nephrology, LVH Valley Kidney Specialists For the past several decades, the health care needs of Americans have shifted from
More informationScreening for chronic kidney disease racial implications. Not everybody that pees has healthy kidneys!
Screening for chronic kidney disease racial implications Not everybody that pees has healthy kidneys! Screening for chronic kidney disease racial implications 1) Definition of CKD 2) Why should we screen
More informationRENAL FUNCTION, REVASCULARISATION AND RISK.
This is a pre-copy-editing, author-produced PDF of an article accepted for publication in European Heart Journal following peer review. The definitive publisher-authenticated version Eur Heart J 2007;28:782-4
More informationDisclosures. Outline. Outline 5/23/17 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationDisclosures. Outline. Outline 7/27/2017 CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationUSRDS UNITED STATES RENAL DATA SYSTEM
USRDS UNITED STATES RENAL DATA SYSTEM Chapter 2: Identification and Care of Patients With CKD Over half of patients from the Medicare 5 percent sample have either a diagnosis of chronic kidney disease
More informationDo Associations With C-Reactive Protein and Extent of Coronary Artery Disease Account for the Increased Cardiovascular Risk of Renal Insufficiency?
Journal of the American College of Cardiology Vol. 42, No. 1, 2003 2003 by the American College of Cardiology Foundation ISSN 0735-1097/03/$30.00 Published by Elsevier Inc. doi:10.1016/s0735-1097(03)00564-3
More informationThe cardiologist s interest in renal function
ASSESSING CARDIOVASCULAR RISK IN PATIENTS WITH CHRONIC KIDNEY DISEASE Jeffrey Brinker, MD* ABSTRACT The manifestations of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) are
More informationHeart Failure and Cardio-Renal Syndrome 1: Pathophysiology. Biomarkers of Renal Injury and Dysfunction
CRRT 2011 San Diego, CA 22-25 February 2011 Heart Failure and Cardio-Renal Syndrome 1: Pathophysiology Biomarkers of Renal Injury and Dysfunction Dinna Cruz, M.D., M.P.H. Department of Nephrology San Bortolo
More information1. Albuminuria an early sign of glomerular damage and renal disease. albuminuria
1. Albuminuria an early sign of glomerular damage and renal disease albuminuria Cardio-renal continuum REGRESS Target organ damage Asymptomatic CKD New risk factors Atherosclerosis Target organ damage
More informationAspirin Resistance in Patients with Chronic Renal Failure (P 5325)
Aspirin Resistance in Patients with Chronic Renal Failure (P 5325) Beste Ozben Sadic 1, Azra Tanrikulu 1, Mehmet Koc 2, Tomris Ozben 3, Oguz Caymaz 1 1 Marmara University, Faculty of Medicine, Department
More informationCRAIOVA UNIVERSITY OF MEDICINE AND PHARMACY FACULTY OF MEDICINE ABSTRACT DOCTORAL THESIS
CRAIOVA UNIVERSITY OF MEDICINE AND PHARMACY FACULTY OF MEDICINE ABSTRACT DOCTORAL THESIS RISK FACTORS IN THE EMERGENCE OF POSTOPERATIVE RENAL FAILURE, IMPACT OF TREATMENT WITH ACE INHIBITORS Scientific
More informationEffective Health Care Program
Comparative Effectiveness Review Number 37 Effective Health Care Program Chronic Kidney Disease Stages 1 3: Screening, Monitoring, and Treatment Executive Summary Objectives This systematic review evaluates
More informationBeta-blockers for coronary heart disease in chronic kidney disease
Nephrol Dial Transplant (2008) 23: 2274 2279 doi: 10.1093/ndt/gfm950 Advance Access publication 10 January 2008 Original Article Beta-blockers for coronary heart disease in chronic kidney disease Michel
More informationIntroduction to Clinical Diagnosis Nephrology
Introduction to Clinical Diagnosis Nephrology I. David Weiner, M.D. C. Craig and Audrae Tisher Chair in Nephrology Professor of Medicine and Physiology and Functional Genomics University of Florida College
More informationOutline. Outline. Introduction CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW 8/11/2011
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationJMSCR Vol 06 Issue 12 Page December 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.02 Original Research Article Fractional
More informationDr.Nahid Osman Ahmed 1
1 ILOS By the end of the lecture you should be able to Identify : Functions of the kidney and nephrons Signs and symptoms of AKI Risk factors to AKI Treatment alternatives 2 Acute kidney injury (AKI),
More informationElevation of Serum Creatinine: When to Screen, When to Refer. Bruce F. Culleton, MD, FRCPC; and Jolanta Karpinski, MD, FRCPC
Elevation of Serum Creatinine: When to Screen, When to Refer Bruce F. Culleton, MD, FRCPC; and Jolanta Karpinski, MD, FRCPC Presented at the University of Calgary s CME and Professional Development 2006-2007
More informationThe Munich Myocardial Infarction Registry: impact of C-reactive protein and kidney function on hospital mortality in diabetic patients
Original article The Munich Myocardial Infarction Registry: impact of C-reactive protein and kidney function on hospital mortality in diabetic patients Diabetes & Vascular Disease Research 7(3) 225 230
More informationProtecting the heart and kidney: implications from the SHARP trial
Cardiology Update, Davos, 2013: Satellite Symposium Protecting the heart and kidney: implications from the SHARP trial Colin Baigent Professor of Epidemiology CTSU, University of Oxford S1 First CTT cycle:
More informationNovel Risk Markers in ACS (Hyperglycemia, Anemia, GFR)
Novel Risk Markers in ACS (Hyperglycemia, Anemia, GFR) Shaul Atar, MD Department of Cardiology Faculty of Medicine of the Galilee Western Galilee Medical Center, Nahariya, Israel TIMI Risk Score Age 65
More informationManagement of early chronic kidney disease
Management of early chronic kidney disease GREENLANE SUMMER GP SYMPOSIUM 2018 Jonathan Hsiao Renal and General Physician Introduction A growing public health problem in NZ and throughout the world. Unknown
More informationCKDinform: A PCP s Guide to CKD Detection and Delaying Progression
CKDinform: A PCP s Guide to CKD Detection and Delaying Progression Learning Objectives Describe suitable screening tools, such as GFR and ACR, for proper utilization in clinical practice related to the
More informationCHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH CHIEF-GENERAL INTERNAL MEDICINE, SAN FRANCISCO VA MEDICAL CENTER PROFESSOR OF MEDICINE, EPIDEMIOLOGY AND BIOSTATISTICS,
More informationMicroalbuminuria As Predictor Of Severity Of Coronary Artery Disease In Non-Diabetic Patients:
ISPUB.COM The Internet Journal of Cardiology Volume 9 Number 1 Microalbuminuria As Predictor Of Severity Of Coronary Artery Disease In Non-Diabetic Patients: F Aziz, S Penupolu, S Doddi, A Alok, S Pervaiz,
More informationIn the general population, patients with peripheral arterial
Impact of Renal Insufficiency on Mortality in Advanced Lower Extremity Peripheral Arterial Disease Ann M. O Hare,* Daniel Bertenthal, Michael G. Shlipak, Saunak Sen, Mary-Margaret Chren *Divisions of Nephrology
More informationContrast Induced Nephropathy
Contrast Induced Nephropathy O CIAKI refers to an abrupt deterioration in renal function associated with the administration of iodinated contrast media O CIAKI is characterized by an acute (within 48 hours)
More informationThe Triple Threat. Cardiac Care in the NT Annual Workshop 2017 is proudly supported by:
The Triple Threat DR KELUM PRIYADARSHANA FRACP CONSULTANT NEPHROLOGIST ROYAL DARWIN HOSPITAL Cardiac Care in the NT Annual Workshop 2017 is proudly supported by: Pathogenesis Diabetes CKD CVD Diabetic
More informationAngiotensin Converting Enzyme inhibitor (ACEi) / Angiotensin Receptor Blocker (ARB) To STOP OR Not in Advanced Renal Disease
Angiotensin Converting Enzyme inhibitor (ACEi) / Angiotensin Receptor Blocker (ARB) To STOP OR Not in Advanced Renal Disease Investigator Meeting 12 th September 2017 - Sheffield Prof Sunil Bhandari Consultant
More informationNumerous epidemiologic studies have shown an association
SYMPOSIUM ARTICLE Cardiorenal Risk Factors Barry M. Wall, MD Abstract: The chronic renocardiac syndrome, in which chronic kidney disease (CKD) contributes to impairment of cardiac function or structure,
More informationJOSHUA K. KAYIMA INTERLINKING CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, AND OBESITY
INTERLINKING CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, AND OBESITY JOSHUA K. KAYIMA ASSOCIATE PROFESSOR DEPT. OF CLINICAL MEDICINE AND THERAPEUTICS UNIVERSITY OF NAIROBI Introduction According to
More informationSeveral prognostic risk markers for mortality, reintervention, and the
Surgery for Acquired Cardiovascular Disease van de Wal et al Mild preoperative renal dysfunction as a predictor of longterm clinical outcome after coronary bypass surgery Ruud M. A. van de Wal, MD, PharmD
More informationA STUDY ON DYSLIPIDAEMIA IN CHRONIC KIDNEY DISEASE (CKD) WITH SPECIAL REFERENCE TO HAEMODIALYSIS
A STUDY ON DYSLIPIDAEMIA IN CHRONIC KIDNEY DISEASE (CKD) WITH SPECIAL REFERENCE TO HAEMODIALYSIS Shweta Sharma 1, Sandhya Gautam 2, Dhanveer Singh 3, Prachi Sharma 4, Avriti Baweja 5 1Assistant Professor,
More informationLaunch Meeting 3 rd April 2014, Lucas House, Birmingham
Angiotensin Converting Enzyme inhibitor (ACEi) / Angiotensin Receptor Blocker (ARB) To STOP OR Not in Advanced Renal Disease Launch Meeting 3 rd April 2014, Lucas House, Birmingham Prof Sunil Bhandari
More informationRenal Dysfunction, Cardiovascular Risk, and the Response to Ace Inhibition in Patients After Myocardial Infarction
Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 2006 Renal Dysfunction, Cardiovascular Risk, and the Response to Ace
More informationFive chapters 1. What is CVD prevention 2. Why is CVD prevention needed 3. Who needs CVD prevention 4. How is CVD prevention applied 5. Where should CVD prevention be offered Shorter, more adapted to clinical
More informationOptimal Use of Iodinated Contrast Media In Oncology Patients. Focus on CI-AKI & cancer patient management
Optimal Use of Iodinated Contrast Media In Oncology Patients Focus on CI-AKI & cancer patient management Dr. Saritha Nair Manager-Medical Affairs-India & South Asia GE Healthcare Context Cancer patients
More informationEnd stage renal disease (ESRD) is the irreversible deterioration of renal function
28 Journal of the association of physicians of india JANUARY 2014 VOL. 62 Original Article Echocardiographic Assessment of Cardiac Dysfunction in Patients of End Stage Renal Disease on Haemodialysis Mukesh
More informationCHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH
CHRONIC KIDNEY DISEASE UPDATE: WHAT THE GENERALIST NEEDS TO KNOW MICHAEL G. SHLIPAK, MD, MPH SCIENTIFIC DIRECTOR KIDNEY HEALTH RESEARCH COLLABORATIVE - UCSF CHIEF - GENERAL INTERNAL MEDICINE, SAN FRANCISCO
More informationLab Values Explained. working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.
Patient Education Lab Values Explained Common Tests to Help Diagnose Kidney Disease Lab work, urine samples and other tests may be given as you undergo diagnosis and treatment for renal failure. The test
More informationClassification of CKD by Diagnosis
Classification of CKD by Diagnosis Diabetic Kidney Disease Glomerular diseases (autoimmune diseases, systemic infections, drugs, neoplasia) Vascular diseases (renal artery disease, hypertension, microangiopathy)
More informationRenal Disease and PK/PD. Anjay Rastogi MD PhD Division of Nephrology
Renal Disease and PK/PD Anjay Rastogi MD PhD Division of Nephrology Drugs and Kidneys Kidney is one of the major organ of drug elimination from the human body Renal disease and dialysis alters the pharmacokinetics
More informationAnalytical Methods: the Kidney Early Evaluation Program (KEEP) The Kidney Early Evaluation program (KEEP) is a free, community based health
Analytical Methods: the Kidney Early Evaluation Program (KEEP) 2000 2006 Database Design and Study Participants The Kidney Early Evaluation program (KEEP) is a free, community based health screening program
More informationAcknowledgements. National Kidney Foundation of Connecticut Mark Perazella. Co-PI Slowing the progression of chronic kidney disease to ESRD
A Practical Approach to Chronic Kidney Disease Management for the Primary Care Practioner: A web-site sponsored by the National Kidney Foundation of Connecticut Robert Reilly, M.D. Acknowledgements National
More informationWhat s In the New Hypertension Guidelines?
American College of Physicians Ohio/Air Force Chapters 2018 Scientific Meeting Columbus, OH October 5, 2018 What s In the New Hypertension Guidelines? Max C. Reif, MD, FACP Objectives: At the end of the
More informationPatients with end-stage renal disease who require dialysis
Annals of Internal Medicine Article Association of Renal Insufficiency with Treatment and Outcomes after Myocardial Infarction in Elderly Patients Michael G. Shlipak, MD, MPH; Paul A. Heidenreich, MD,
More informationT. Suithichaiyakul Cardiomed Chula
T. Suithichaiyakul Cardiomed Chula The cardiovascular (CV) continuum: role of risk factors Endothelial Dysfunction Atherosclerosis and left ventricular hypertrophy Myocardial infarction & stroke Endothelial
More informationSeung Hyeok Han, MD, PhD Department of Internal Medicine Yonsei University College of Medicine
Seung Hyeok Han, MD, PhD Department of Internal Medicine Yonsei University College of Medicine Age and Kidney Weight renal weight and thickening of the vascular intima Platt et al. Gerentology 1999;45:243-253
More informationPrevalence and Impact of Renal Insufficiency on Clinical Outcomes of Patients Undergoing Coronary Revascularization
Circ J 2007; 71: 1299 1304 Prevalence and Impact of Renal Insufficiency on Clinical Outcomes of Patients Undergoing Coronary Revascularization Qiang Zhang; Chang-Sheng Ma; Shao-Ping Nie; Xin Du; Qiang
More informationManaging HTN in the Elderly: How Low to Go
Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular
More informationBIOL 2402 Renal Function
BIOL 2402 Renal Function Dr. Chris Doumen Collin County Community College 1 Renal Clearance and GFR Refers to the volume of blood plasma from which a component is completely removed in one minute by all
More informationImpaired renal function predicts short term prognosis in patients with acute pulmonary embolism
Impaired renal function predicts short term prognosis in patients with acute pulmonary embolism Kostrubiec Maciej, Łabyk Andrzej, Pedowska-Włoszek Jusyna, Pacho Szymon, Jankowski Krzysztof, Koczaj-Bremer
More informationCHRONIC KIDNEY DISEASE (CKD) is a
Cardiovascular Outcomes and All-Cause Mortality: Exploring the Interaction Between CKD and Cardiovascular Disease Daniel E. Weiner, MD, MS, Sayed Tabatabai, MD, Hocine Tighiouart, MS, Essam Elsayed, MD,
More information1.2 Synonyms There are several synonyms e.g. diaminomethanal, but in a medical context, this substance is always referred to as urea.
Urea (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Urea 1.2 Synonyms There are several synonyms e.g. diaminomethanal, but in a medical context, this substance is always referred
More informationChronic Kidney Disease. Dr Mohan B. Biyani A. Professor of Medicine University of Ottawa/Ottawa Hospital
Chronic Kidney Disease Dr Mohan B. Biyani A. Professor of Medicine University of Ottawa/Ottawa Hospital Health Seminar Series Date 12 May 2013 Objectives Normal functioning of Kidneys. Risk factors to
More informationSupplementary Online Content
Supplementary Online Content Kavousi M, Leening MJG, Nanchen D, et al. Comparison of application of the ACC/AHA guidelines, Adult Treatment Panel III guidelines, and European Society of Cardiology guidelines
More informationCKD and CVD. Jamal Salameh, MD, FACP, FASN First Coast Nephrology
CKD and CVD Jamal Salameh, MD, FACP, FASN First Coast Nephrology An Epidemic of Kidney Disease Prevalence CKD stages 1-4 10% 1988-94 13% 1999-2004 Coresh, JAMA 298:2038, 2007 Stage 5: GFR
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE General practice Indicators for the NICE menu
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE General practice Indicators for the NICE menu Indicator area: Pulse rhythm assessment for AF Indicator: NM146 Date: June 2017 Introduction There is evidence
More informationReducing proteinuria
Date written: May 2005 Final submission: October 2005 Author: Adrian Gillin Reducing proteinuria GUIDELINES a. The beneficial effect of treatment regimens that include angiotensinconverting enzyme inhibitors
More informationRikshospitalet, University of Oslo
Rikshospitalet, University of Oslo Preventing heart failure by preventing coronary artery disease progression European Society of Cardiology Dyslipidemia 29.08.2010 Objectives The trends in cardiovascular
More informationKEEP 2.0 Annual Data Report Chapter Five
KEEP 2. Annual Data Report Chapter Five Figure 5.1 percent distribution of KEEP participants with elevated serum creatinine levels, overall & by age 16 Percent of participants 12 8 4 All
More informationDiabetes and the Heart
Diabetes and the Heart Association of Specialty Professors April 4, 2013 Jorge Plutzky, MD Co-Director, Preventive Cardiology Director, The Lipid Clinic Cardiovascular Division Brigham and Women s Hospital
More informationSpecial Challenges and Co-Morbidities
Special Challenges and Co-Morbidities Renal Disease/ Hypertension/ Diabetes in African-Americans M. Keith Rawlings, MD Medical Director Peabody Health Center AIDS Arms, Inc Dallas, TX Chair, Internal Medicine
More informationCardiovascular Complications Of Chronic Kidney Disease. Dr Atir Khan Consultant Physician Diabetes & Endocrinology West Wales Hospital, Carmarthen
Cardiovascular Complications Of Chronic Kidney Disease Dr Atir Khan Consultant Physician Diabetes & Endocrinology West Wales Hospital, Carmarthen Markers of kidney dysfunction Raised Albumin / Creatinine
More information