Association of Kidney Function With Coronary Atherosclerosis and Calcification in Autopsy Samples From Japanese Elders: The Hisayama Study

Nakano, Toshiaki; Ninomiya, Toshiharu; Saito, Shinji; Fujii, Hiroshi; Doi, Yasufumi; Hirakata, Hideki; Tsuruya, Kazuhiko; Iida, Mitsuo; Kiyohara, Yutaka; Sueishi, Katsuo

doi:10.1053/j.ajkd.2009.06.034

Cited by 162 publications

(103 citation statements)

References 35 publications

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“…Kardiovaskuliniai įvykiai yra viena dažniausių mirties priežasčių tarp galutinės stadijos inkstų liga sergančių pacientų, sudaro ~ 45 proc. visų mirčių priežasčių [2,3]. Ūmus koronarinis sindromas nustatomas remiantis klinikiniais simptomais, eletrokardiografiniais pokyčiais ir širdies specifinių žymenų tyrimu [4].…”

Section: įVadasunclassified

Didelio Jautrumo Troponino Padidėjimas Tarp Dializuojamų Pacientų. Vilniaus Miesto Klinikinės Ligoninės Duomenys

Kubiliūtė¹,

Gruodytė²

2015

Medicinos Teorija Ir Praktika

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SANTRAUKAReikšminiai žodžiai: troponinas, lėtinė inkstų liga, hemodializė, ūminis koronarinis sindromas. Kardiovaskuliniai įvykiai yra viena dažniausių mirties priežasčių tarp galutinės stadijos inkstų liga sergančių pacientų ir sudaro ~ 45 proc. visų mirčių priežasčių. Tokiems pacientams ūminių koronarinių sindromų diagnostika dažniausiai yra sudėtin-ga, kadangi sergant lėtine inkstų liga, troponino kiekis yra padidėjęs ir nesant miokardo išemijos požymių. Darbo tikslas. Įvertinti Vilniaus miesto klinikinės ligoninės Dializių poskyrio pacientų troponino kiekį, palyginti su laboratoriniais ir širdies echoskopijos rodikliais. Tyrimo medžiaga ir metodai. 2015 m. rugpjūčio mėnesį atliktas skerspjūvio tyrimas. Įtraukimo kriterijai: stabilūs, tyrimo metu ūminiu koronariniu sindromu ir ūmine infekcija nesergantys pacientai. Ištirtas 41 pacientas, iš jų 24 vyrai (57,1 proc.) ir 17 moterų (40,5 proc.), amžiaus vidurkis -66,7 metų (SD -13,6 metų). Analizuoti kraujo tyrimai: hemoglobino kiekis, troponino, kreatinino, šlapalo, elektrolitų, C reaktyvaus baltymo koncentracija kraujo serume. Širdies struktūriniam pažei-dimui įvertinti naudoti per pastaruosius metus atliktos širdies echoskopijos duomenys. Vertintas troponino kiekio kraujo serume ryšys su kraujo rodikliais ir širdies struktūriniu pažeidimu. Rezultatai. Ištirtų dializuojamų pacientų vidutinis troponino kiekis kraujo serume 87,9 ng/l (SD -66,1 ng/ml). Analizuojant troponino kiekio sąsajas su dializuojamų pacientų amžiumi, hemodializės trukme, laboratoriniais rodikliais, širdies struktūriniais pokyčiais statistiškai reikšmingo skirtumo tarp grupių nenustatyta, tačiau pažymėtina, kad penktoje didžiausio troponino kiekio grupėje buvo daugiausia persirgusių miokardo infarktu pacientų (90 proc.), skirtumas statistiškai patikimas (p = 0,03). Silpnas tiesioginis ryšys nustatytas tarp troponino kiekio ir CRB (r = 0,2) -didėjant C reaktyvaus baltymo kiekiui, didėja ir troponino kiekis, tačiau gautas ryšys nėra statistiškai patikimas (p > 0,05). Statistiškai patikimas (p < 0,05), vidutinio stiprumo atvirkštinis ryšys (r -0,345) gautas lyginant troponino kiekį ir kairiojo skilvelio išmetimo frakciją -mažėjant kairiojo skilvelio išmetimo frakcijai, didėja troponino kiekis. Išvados. Padidėjęs troponino kiekis kraujo serume nustatytas visiems lėtine inkstų liga sergantiems ir dializuojamiems pacientams. Reikšmingai didesnis troponino kiekis nustatytas pacientams, turintiems struktūrinių širdies pakitimų (sumažėjusi kairiojo skilvelio išmetimo frakcija, persirgtas miokardo infarktas). Didėjant didelio jautrumo troponinui, nereikšmingai didėja C reaktyvus baltymas. ABSTRACTKey words: troponin, chronic kidney disease, hemodialysis, acute coronary sindrome. Cardiac disease is the major cause of death in patients with end-stage renal disease, accounting for ~45 % of all deaths. Diagnosing an acute coronary syndrome in these patients is often difficult because the troponin levels are increased in patients with renal failure in the absence of clinical myocardial ischemia symptoms. Ob...

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Section: įVadasunclassified

Didelio Jautrumo Troponino Padidėjimas Tarp Dializuojamų Pacientų. Vilniaus Miesto Klinikinės Ligoninės Duomenys

Kubiliūtė¹,

Gruodytė²

2015

Medicinos Teorija Ir Praktika

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“…12,13 The strong link between chronic kidney disease and cardiovascular disease has been documented in both the general and chronic kidney disease populations. [13][14][15][16] The prevalence of cardiovascular morbidity and mortality is greater in the patients with renal failure, especially those with end-stage renal disease, and the cardiovascular events often lead to death with chronic kidney disease more so than with individuals without chronic kidney disease. 17,18 The chronic kidney disease and cardiovascular disease continuum involves 3 phases: the first phase, with its different stages; progressing toward end-stage renal disease, which is the second phase, which requires chronic renal replacement therapies that may lead in some, but not all, patients to kidney transplant; and the third phase, after which the renal allograft is lost to chronic allograft dysfunction and a return of the patient to dialysis, or death of the recipient predominantly from cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] The chronic kidney disease and cardiovascular disease continuum amplifies with time according to the duration of each of the phases that may last from months to years. [15][16][17] It results from the interaction of several genetic, ethnic, environmental, and demographic factors that contribute to the Abbreviations: AGEs, advance glycosylated end products; Ca, calcium; CKD, chronic kidney disease; ESRD, end-stage renal disease; HTN, hypertension; PAI, plasminogen activator inhibitor; PTH, parathyroid hormone Chronic kidney disease-cardiovascular disease continuum is a process that usually starts or can even precede the diagnosis of the chronic kidney disease. It will amplify with the time duration of each of the stages that may last from months to years.…”

Section: Introductionmentioning

confidence: 99%

“…Most of these factors continue to progress during the end-stage renal disease phase, during which new additional ones enter into play such as the increase incidence of infections, creation of an arteriovenous fistula, worsening hypervolemia, and both vascular and tissue calcifications, leading to an exaggeration in aortic stiffness, left ventricular hypertrophy, and diastolic dysfunction. [15][16][17]35 Shortening the process through preemptive kidney transplant leads to early reversal of many of the continuum's components. This could explain the superior short-term and long-term kidney allograft and patient survival associated with preemptive transplant from a living donor compared with transplant after being on dialysis.…”

Section: Introductionmentioning

confidence: 99%

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Posttransplant Hypertension: Multipathogenic Disease Process

Barbari

2013

Exp Clin Transplant

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Arterial hypertension is prevalent among kidney transplant recipients. The multifactorial pathogenesis involves the interaction of the donor and the recipient's genetic backgrounds with several environmental parameters that may precede or follow the transplant procedure (eg, the nature of the renal disease, the duration of the chronic kidney disease phase and maintenance dialytic therapy, the commonly associated cardiovascular disease with atherosclerosis and arteriosclerosis, the renal mass at implantation, the immunosuppressive regimen used, life of the graft, and de novo medical and surgical complications that may occur after a transplant). Among calcineurin inhibitors, tacrolimus seems to have a better cardiovascular profile. Steroid-free protocols and calcineurin inhibitor-free regimens seem to be associated with better blood pressure control. Posttransplant hypertension is a major amplifier of the chronic kidney disease-cardiovascular disease continuum. Despite the adverse effects of hypertension on graft and patient survival, blood pressure control remains poor because of the high cardiovascular risk profile of the donor-recipient pair. Although the optimal blood pressure level remains unknown, it is recommended to maintain the blood pressure at < 130/80 mm Hg and < 125/75 mm Hg in the absence or presence of proteinuria.

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“…9 An autopsy study showed that, despite the overall plaque area being comparable, patients with ESRD have greater coronary calcification and medial thickness compared with more fibroatheromatous plaques in patients without kidney disease. 10 The quest for the optimal noninvasive modality to detect obstructive CAD has been contentious. Selecting patients with advanced CKD for noninvasive evaluation is particularly challenging for clinicians because of a variety of influencing factors, including frequent lack of typical anginal symptoms; structural/physiologic considerations affecting stress testing, such as marked left ventricular hypertrophy and impaired coronary reserve; and high prevalence of baseline troponin levels in asymptomatic patients.…”

mentioning

confidence: 99%

Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations

Shroff

Herzog

2016

JASN

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Coronary revascularization decisions for patients with CKD stage 5D present a dilemma for clinicians because of high baseline risks of mortality and future cardiovascular events. This population differs from the general population regarding characteristics of coronary plaque composition and behavior, accuracy of noninvasive testing, and response to surgical and percutaneous revascularization, such that findings from the general population cannot be automatically extrapolated. However, this high-risk population has been excluded from all randomized trials evaluating outcomes of revascularization. Observational studies have attempted to address long-term outcomes after surgical versus percutaneous revascularization strategies, but inherent selection bias may limit accuracy. Compared with percutaneous strategies, surgical revascularization seems to have long-term survival benefit on the basis of observational data but associates with substantially higher short-term mortality rates. Percutaneous revascularization with drug-eluting and bare metal stents associates with a high risk of in-stent restenosis and need for future revascularization, perhaps contributing to the higher long-term mortality hazard. Off-pump coronary bypass surgery and the newest generation of drugeluting stent platforms offer no definitive benefits. In this review, we address the nuances, complexities, and tradeoffs that clinicians face in determining the optimal method of coronary revascularization for this high-risk population.

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Association of Kidney Function With Coronary Atherosclerosis and Calcification in Autopsy Samples From Japanese Elders: The Hisayama Study

Abstract: The autopsy findings presented here suggest that CKD is associated significantly with severity of coronary atherosclerosis. Patients with CKD should be considered a high-risk population for advanced coronary atherosclerosis.

Cited by 162 publications

References 35 publications

Didelio Jautrumo Troponino Padidėjimas Tarp Dializuojamų Pacientų. Vilniaus Miesto Klinikinės Ligoninės Duomenys

Didelio Jautrumo Troponino Padidėjimas Tarp Dializuojamų Pacientų. Vilniaus Miesto Klinikinės Ligoninės Duomenys

Posttransplant Hypertension: Multipathogenic Disease Process

Coronary Revascularization in Patients with CKD Stage 5D: Pragmatic Considerations

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