Chronic Kidney Disease and Sudden Death: Strategies for Prevention

McCullough, Peter A.; Sandberg, Keisha R.

doi:10.1159/000074934

Cited by 47 publications

(32 citation statements)

References 40 publications

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“…19 Kidney dysfunction may cause structural changes of the heart, including left ventricular hypertrophy, left ventricular systolic and diastolic dysfunction, and cardiac fibrosis, all of which may contribute to the increased arrhythmic risk. 20,21 In addition, autonomic dysfunction, myocyte dysfunction, and altered electrolyte metabolism may contribute to arrhythmic risk in patients with kidney dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

et al. 2008

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Abstract-We evaluated the association between kidney dysfunction and sudden cardiac death risk among ambulatory women with coronary heart disease. The Heart and Estrogen Replacement Study evaluated the effects of hormone treatment on cardiovascular events among 2763 postmenopausal women with coronary heart disease. Kidney dysfunction was categorized by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation. Multivariate proportional hazards models were used to adjust for cardiovascular risk factors, congestive heart failure, and myocardial infarction. At baseline, 37% (nϭ1027) had an eGFR of Ͼ60 mL/min, 54% (nϭ1503) had an eGFR of 40 to 60 mL/min, and 8% (nϭ230) had an eGFR of Ͻ40 mL/min. During the 6.8-year follow-up period, there were 136 adjudicated sudden cardiac deaths. The rate of sudden cardiac death was higher in those with lower kidney function (0.5% per year among those with an eGFR Ͼ60; 0.6% per year with an eGFR between 40 and 60; and 1.7% per year with an eGFR Ͻ40 mL/min; P for trend Ͻ0.001). After multivariate analysis with baseline risk factors, eGFR at 40 to 60 mL/min was not a significant predictor, but eGFR at Ͻ40 mL/min remained strongly associated with sudden cardiac death (hazard ratio: 3.2; 95% CI: 1.9 to 5.3); adjustment for incident congestive heart failure and myocardial infarction during follow-up diminished this association (hazard ratio: 2.3; 95% CI: 1.3 to 3.9), suggesting that congestive heart failure and myocardial infarction mediated only part of the association between kidney dysfunction and sudden cardiac death. Advanced kidney dysfunction is an independent predictor of sudden cardiac death among women with coronary heart disease. Key Words: kidney dysfunction Ⅲ women Ⅲ sudden cardiac death S udden cardiac death (SCD) is an important clinical and public health problem: Ͼ450 000 Americans died in 1998 from SCD, defined as a sudden pulseless death attributed to cardiovascular disease occurring outside of the hospital. 1 The proportion of cardiovascular deaths caused by SCD has increased over time, as have absolute rates of SCD among women aged 35 to 44 years. 2 The presence and severity of underlying heart disease, including coronary heart disease, chronic heart failure, and depressed left ventricular ejection fraction, are the most predictive risk factors for the future occurrence of SCD. [3][4][5][6] In addition, 1 population-based study among women has demonstrated an association between traditional coronary heart disease risk factors and SCD. 2 Another population at high risk for SCD are persons with end-stage renal disease. 7 According to the US Renal Data System, Ϸ22% of all deaths are caused by SCD, and the incidence increases with age: 2% per year for ages 20 to 44 years, 3.7% per year for ages 45 to 64 years, and 7% per year for ages 65 years and older. 7,8 Despite the high risk for SCD in patients with end-stage renal disease, few studies have evaluated the association between less severe reductions in kidney function and SCD...

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Section: Discussionmentioning

confidence: 99%

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

et al. 2008

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“…Primarni plan lečenja podrazumeva primenu medikamenata i prilagođavanje uslova hemodijalize bolesniku. Primenjuju se lekovi kojima se ostvaruje optimalna kontrola faktora rizika (inhibitori angiotenzin konvertujućeg enzima, beta blokatori, blokatori receptora za angiotenzin 2, aktivni metaboliti vitamina D, kalcimimetici, eritropoetin), povećava promenljivost frekvencije srčanog rada (beta blokatori, inhibitori angiotenzin konvertujućeg enzima), stabilizuju aterosklerotski plakovi (antiagregacioni lekovi, statini) i smanjuje hipertrofija leve komore (beta blokatori, inhibitori angiotenzin konvertujućeg enzima, eritropoetin), tabela 2 (40)(41)(42)(43)(44)(45)(46).…”

Section: Tabela 2 Preporuke Za Faktore Kardiovaskularnog Rizika Kod unclassified

“…Oni smanjuju aktivnost simpatikusa u miokardu, smanjuju učestalost komorskih poremećaja srčanog ritma, povećavaju promenljivost frekvencije srčanog rada i povećavaju osetljivost baroreceptora (40)(41)(42)(43)(44)(45)(46). Karvedilol popravlja ejekcionu frakciju leve komore i preživljavanje bolesnika koji boluju od srčane slabosti (NYHA II/NYHA III) i leče se ponavljanim hemodijalizama (47,48).…”

Section: Tabela 2 Preporuke Za Faktore Kardiovaskularnog Rizika Kod unclassified

10.5937/mckg48-4123 = Diastolic heart failure in patients on hemodialysis: Etiopathogenesis, diagnostics and therapy

Nedeljković¹,

Miloradović²,

Radovanović³

et al. 2014

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UVODBolesti srca su vodeći uzrok smrti bolesnika koji se leče redovnim hemodijalizama. Kod ovih bolesnika prisutni su brojni faktori rizika kao što su povišen arterijski krvni pritisak, poremećaj metabolizma lipida, oksidativni stres, mikroinflamacija, hiperhomocisteinemija, anemija, povećan protok krvi kroz vaskularni pristup za hemodijalizu, sekundarni hiperparatireoidizam, a koji su odgovorni za razvoj kardiovaskularnih komplikacija (1). Hipertrofija leve komore, ishemijska bolest srca i srčana slabost su najčešće kardiovaskularne komplikacije kod bolesnika na hemodijalizi (1, 2). PREGLED SAŽETAK

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“…It is beyond the scope of this article to speculate on the wide range of basic mechanisms (e.g., inflammation, oxidative stress, disordered calcium-phosphorous-parathyroid hormone balance) that have been implicated in this potentially unique and serious form of CHD that occurs in ESRD (9). It should be recognized that, as a result, most patients with ESRD have significant CAD and structural heart disease (left ventricular hypertrophy and cardiac fibrosis) and therefore are at increased risk for sudden death that is triggered by myocardial ischemia, electrolyte shifts, sepsis, and other events (10). In addition, most patients with ESRD have extensive coronary, aortic, and valvular calcification (aortic and mitral), which may influence interventional and medical management (11).…”

Section: Esrd: More Than a Coronary Heart Risk Equivalentmentioning

confidence: 99%

Coronary Artery Disease

McCullough

2007

Clinical Journal of the American Society of Nephrology

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Coronary heart disease is the most common cause of death in the general population and in patients with ESRD. The principles of cardiovascular risk assessment and management apply to both populations. Advances in noninvasive coronary artery imaging have improved early detection of subclinical disease. The goals of medical management of coronary disease are to modify the natural history of disease and to improve the symptoms of angina. Coronary revascularization poses a different risk and benefit equation in the ESRD population. In stable ESRD with multivessel coronary artery disease, coronary bypass surgery, despite the upfront risks of stroke, myocardial infarction, and chest wound infection, seems to be a favored approach. In patients with ESRD and acute coronary syndromes, percutaneous coronary intervention on the target vessel has been associated with the most favorable outcomes. This article explores the clinical issues with respect to coronary artery disease in patients with ESRD.Clin J Am Soc Nephrol 2: 611-616, 2007611-616, . doi: 10.2215 C oronary heart disease is the leading cause of death in the US general population. With the obesity pandemic and the expected worsening of cardiovascular risk factors in the general population, the incidence and the prevalence of heart disease is expected to rise. Coronary artery disease (CAD) is the leading cause of death in patients with chronic kidney disease (CKD): Of the more than 320,000 patients with ESRD that requires dialysis or kidney transplantation in the United States, half will die from cardiovascular causes, and patients with milder degrees of CKD are more likely to die of CAD than to develop kidney failure that requires renal replacement therapy (1).The observational studies concerning CAD and ESRD have revealed the following: (1) By the time patients reach dialysis, approximately 70% have significant coronary artery calcification indicative of coronary atherosclerosis, (2) patients with CAD and ESRD have markedly increased mortality over the general population, (3) treatment with disease-modifying therapy that is proved to reduce rates of (MI) or death (e.g., aspirin, ␤ adrenergic receptor blockers [BB], angiotensin-converting enzyme inhibitors [ACEI], 3-methylglutaryl CoA reductase inhibitors or statins) are used less frequently in patients with ESRD than in the general population, (4) noninvasive imaging seems to have less precision and accuracy in patients with ESRD, and (5) patients who have ESRD and are selected for revascularization with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) have improved survival compared with those who are treated with medical therapy alone (2-6). Table 1 presents a summary of CAD risk reduction, diagnosis, and management principles. Recommendations in Table 1 present a task list for optimal (not minimal) clinical goals and go beyond many current professional society guidelines concerning the individual treatment targets. ESRD: More Than a Coronary Heart Risk EquivalentPatients with ES...

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Chronic Kidney Disease and Sudden Death: Strategies for Prevention

Cited by 47 publications

References 40 publications

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

10.5937/mckg48-4123 = Diastolic heart failure in patients on hemodialysis: Etiopathogenesis, diagnostics and therapy

Coronary Artery Disease

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