Declining Prevalence of Coronary Artery Disease in Incident Dialysis Patients Over the Past Two Decades

Iwasaki, Masaki; Joki, Nobuhiko; Tanaka, Yuri; Hayashi, Takuma; Kubo, S; Asakawa, Takasuke; Matsukane, Ai; Takahashi, Yasunori; Hirahata, Koichi; Imamura, Yoshihiko; Hase, Hiroki

doi:10.5551/jat.21337

Cited by 7 publications

(9 citation statements)

References 34 publications

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“…Recently, Iwasaki et al examined the prevalence of coronary artery disease in incident dialysis patients over two decades and reported that the prevalence of unidentified coronary artery disease gradually declined from 69% to 25% over 18 years . These investigators also found a significant negative correlation between the prevalence of unidentified coronary artery disease and the ratio of ESA use.…”

Section: Cardiovascular Disease and Mortality At The Initiation Of Hamentioning

confidence: 99%

Anaemia and early phase cardiovascular events on haemodialysis

et al. 2015

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Although the mechanism of the cardio-renal anaemia syndrome (CRAS) has been elucidated in considerable detail over the past decade, cardiovascular disease (CVD) remains a leading cause of death among patients with end-stage kidney disease (ESKD) undergoing haemodialysis, and these patients' cardiovascular mortality is greater than that of the general population. Recent studies have reported that the CVD risk increases with advancing chronic kidney disease (CKD) stage. Furthermore, the incidence of cardiovascular events is highest during the first week after dialysis initiation, with increased risk in incident haemodialysis patients. This accumulated evidence demonstrates that how patients are managed during the pre-dialysis phase may have important implications on long-term outcomes in ESKD. Anaemia, a non-traditional risk factor for CVD, advances exponentially along with declining kidney function due to insufficient erythropoietin production. Anaemia causes functional abnormalities of the heart, as represented by cardiac hypertrophy, which results from increased cardiac workload induced by an increased preload. Left ventricular hypertrophy (LVH), a traditional risk factor for CVD, is especially associated with advanced CKD stage and could be a major risk factor for cardiovascular complications such as ischaemic heart disease, heart failure, and sudden cardiac death. In ESKD, anaemia develops more severely and requires a higher amount of erythropoiesis-stimulating agent (ESA) therapy before dialysis initiation. This suggests that improvement in anaemia management during the pre-dialysis phase may have a beneficial effect on cardiac hypertrophy and contribute to reducing the CVD risk after initiating haemodialysis.

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Section: Cardiovascular Disease and Mortality At The Initiation Of Hamentioning

confidence: 99%

Anaemia and early phase cardiovascular events on haemodialysis

et al. 2015

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“…Iwasaki et al [13] reported that the prevalence of CAD gradually declined from 69 to 25% over 18 years in hemodialysis patients, and the use of ESAs seemed to be associated with this decrease in CAD. Erythropoietin (Epo) and Epo receptor are expressed in a variety of tissues, including the vascular system [14].…”

Section: Discussionmentioning

confidence: 99%

Possible Inhibitory Effect of Erythropoiesis-Stimulating Agents at the Predialysis Stage on Early-Phase Coronary Events after Hemodialysis Initiation

et al. 2016

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Background: We examined whether the use of erythropoiesis-stimulating agents (ESAs) to correct anemia at the predialysis stage could inhibit early-phase coronary events after hemodialysis initiation. Methods: We enrolled 242 patients with chronic kidney disease who had received continued medical treatments and initiated maintenance hemodialysis from 1 September 2000 to 31 December 2014 at Toujinkai Hospital. Patients with a previous history of blood transfusion or any cardiovascular events or interventions were excluded. The coronary events were followed for 1 year after initiation of hemodialysis. Results: Coronary events occurred in 51 of 242 patients: 10 patients had acute coronary syndrome [9 with percutaneous coronary intervention (PCI), 1 without intervention], and 41 had elective coronary revascularization (38 PCI and 3 coronary artery bypass graft). ESA was administered in 118 of 242 patients (48.8%). In stepwise logistic analysis, coronary events were positively associated with nonuse of ESA at the predialysis stage (odds ratio 2.66, p = 0.005) and diabetes mellitus (odds ratio 5.33, p < 0.001). When dividing the patients into 4 subgroups by blood hemoglobin (Hb) level (8.5 g/dl) and the use/nonuse of ESA, coronary event-free survival rates were higher (p = 0.005) in those with Hb ≥8.5 g/dl, ESA+ (86.6%, n = 82) and tended to be higher (p = 0.055) in those with Hb <8.5 g/dl, ESA+ (86.1%, n = 36) than in patients with Hb <8.5 g/dl, ESA- (68.6%, n = 86) in a Kaplan-Meier analysis. Conclusions: The use of ESA to correct anemia at the predialysis stage may inhibit early-phase coronary events after hemodialysis initiation.

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“…The causality underscoring these differences is not well understood, although haemodialysis-specific syndromes such as intradialytic hypotension and myocardial stunning are contributors [ 22 , 23 ]. More recent data suggest that the aggressive management of traditional CV risk factors has led to a decline in the incidence of significant coronary artery disease [ 24 ].…”

Section: Clinical Manifestations Of Crsmentioning

confidence: 99%

Novel Perspectives in Chronic Kidney Disease-Specific Cardiovascular Disease

Xu,

Tsihlis,

Chau

et al. 2024

IJMS

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Chronic kidney disease (CKD) affects > 10% of the global adult population and significantly increases the risk of cardiovascular disease (CVD), which remains the leading cause of death in this population. The development and progression of CVD—compared to the general population—is premature and accelerated, manifesting as coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. CKD and CV disease combine to cause multimorbid cardiorenal syndrome (CRS) due to contributions from shared risk factors, including systolic hypertension, diabetes mellitus, obesity, and dyslipidemia. Additional neurohormonal activation, innate immunity, and inflammation contribute to progressive cardiac and renal deterioration, reflecting the strong bidirectional interaction between these organ systems. A shared molecular pathophysiology—including inflammation, oxidative stress, senescence, and hemodynamic fluctuations characterise all types of CRS. This review highlights the evolving paradigm and recent advances in our understanding of the molecular biology of CRS, outlining the potential for disease-specific therapies and biomarker disease detection.

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Declining Prevalence of Coronary Artery Disease in Incident Dialysis Patients Over the Past Two Decades

Cited by 7 publications

References 34 publications

Anaemia and early phase cardiovascular events on haemodialysis

Anaemia and early phase cardiovascular events on haemodialysis

Possible Inhibitory Effect of Erythropoiesis-Stimulating Agents at the Predialysis Stage on Early-Phase Coronary Events after Hemodialysis Initiation

Novel Perspectives in Chronic Kidney Disease-Specific Cardiovascular Disease

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