The conundrum of the complex relationship between acute kidney injury and cardiac arrhythmias

Genovesi, Simonetta; Regolisti, Giuseppe; Burlacu, Alexandru; Covic, Adrian; Combe, Christian; Mitra, Sandip; Basile, Carlo

doi:10.1093/ndt/gfac210

Cited by 7 publications

(4 citation statements)

References 155 publications

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“…Vit D-resistant rickets has been associated to a highly unusual occurrence of fetal atrial flutter. 27 The adverse hospital outcome for AMI patients above the age of 50 years was significantly associated with Vit D status (p<0.001) with normal Vit D status developing heart failure with Vit D deficiency. Vit D deficiency was more common in HF patients than in the control group, according to research by Bahrami Leila Sadat et al 28 Vit D can also influence cardiac function through its effects on parathyroid hormone and serum calcium levels.…”

Section: Discussionmentioning

confidence: 94%

Association of Serum Vit D level with in-Hospital Outcome in Patients with Acute Myocardial Infarction

Din,

Haq,

Adeel

et al. 2023

PJMHS

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Background: Low Vitamin D (Vit D) level is associated with disease severity amongst critical acute myocardial infarction (AMI) patients. This leads to the hypothesis that Vit D plays a role in the emergence of cardiac risk factors, contributing to worsening AMI patients' short- and long-term prognoses. Therefore, there is still unclear data showing the potential impact of Vit D insufficiency or deficiency on the morbidity and mortality of AMI patients. So far, there has been no research conducted in Pakistan examining whether or not Vit D status are association to the outcome of hospitalization for coronary artery disease. Objective: The objective of the study is to examine the relationship between Vit D status on hospital admission and subsequent mortality and morbidity among patients with acute myocardial infarction. Study Design: Cross sectional observational study Study Setting: This study was conducted in the department of Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi from Ist August 2022 to 31st January 2023. Methodology: Total 250 subjects were enrolled in the study and divided in to two groups. Group A with normal Vit D (30ng/ml or above) and Group B included lower Vit D level than 30ng/ml, all patients were suffering from AMI. Baseline demographic characteristics, including age, and gender (male/female), was recorded. The patients were tested for Vit D status and distributed in their respective groups. The history, complications, and clinical data were included. The stay in the hospital and any adverse outcomes that appeared during the stay were also recorded. The clinical results include HDL, TG, and troponin I of every patient were noted for the clinical correlation of AMI patients with adequate and deficiency of Vit D level. All the data was collected in the form of a questionnaire. The statistical analysis was done by using SPSS version 20. Results: Participants' mean ages were 53.8 and 5.9 years old. Group A (patients with low Vit D status) averaged 59.6 years of age, whereas Group B (58.9 years) had normal Vit D status. The analysis showed a statistically non- significant (p>0.05) difference in average age between the groups. There were 250 patients, with male 43.6% and female 56.4%. Men (63.2%) and women (36.8%) were in Group A. There were 71.4% males and 28.6% females in Group B. We found out the 137(60.6%) significant adverse hospital outcomes (p<0.001) in Group B and had a more significant proportion of patients with diabetes mellitus and who had smoked (p = 0.002 and 0.001, respectively). In a multivariate logistic regression smoking, diabetes, Troponin I and low vitamin showed the significant risk association (p<0.001). Practical Implication: There is still a lack of conclusive evidence on the relationship between vitamin D insufficiency or deficiency and the morbidity and mortality of AMI patients. Until far, there has been no research in Pakistan linking serum vitamin D levels to in-hospital outcomes for patients suffering from acute myocardial infarction. Conclusion: The research shows an association between low Vit D status, adverse outcomes, and clinical parameters after AMI. A low blood Vit D level is independently associated to an increased risk of developing severe clinical outcomes during hospitalization, including death after an AMI. Keyword: Vit D, AMI, Vit D deficiency, low Vit D, Cardiovascular disease

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Section: Discussionmentioning

confidence: 94%

Association of Serum Vit D level with in-Hospital Outcome in Patients with Acute Myocardial Infarction

Din,

Haq,

Adeel

et al. 2023

PJMHS

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“…Therefore, complex arrhythmias have become a serious complication of AKI-induced cardiac injury and myocardial dysfunction. In turn, arrhythmias also increase the risk of renal failure [ 118 ].…”

Section: Molecular Mechanisms Of Crs3mentioning

confidence: 99%

The Molecular Mechanism and Therapeutic Strategy of Cardiorenal Syndrome Type 3

Liu¹,

Xu²,

Shao³

et al. 2023

Rev. Cardiovasc. Med.

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Cardiorenal syndrome type 3 (CRS3) is defined as acute kidney injury (AKI)-induced acute cardiac dysfunction, characterized by high morbidity and mortality. CRS3 often occurs in elderly patients with AKI who need intensive care. Approximately 70% of AKI patients develop into CRS3. CRS3 may also progress towards chronic kidney disease (CKD) and chronic cardiovascular disease (CVD). However, there is currently no effective treatment. Although the major intermediate factors that can mediate cardiac dysfunction remain elusive, recent studies have summarized the AKI biomarkers, identified direct mechanisms, including mitochondrial dysfunction, inflammation, oxidative stress, apoptosis and activation of the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS), inflammasome, as well as indirect mechanisms such as fluid overload, electrolyte imbalances, acidemia and uremic toxins, which are involved in the pathophysiological changes of CRS3. This study reviews the main pathological characteristics, underlying molecular mechanisms, and potential therapeutic strategies of CRS3. Mitochondrial dysfunction and inflammatory factors have been identified as the key initiators and abnormal links between the impaired heart and kidney, which contribute to the formation of a vicious circle, ultimately accelerating the progression of CRS3. Therefore, targeting mitochondrial dysfunction, antioxidants, Klotho, melatonin, gene therapy, stem cells, exosomes, nanodrugs, intestinal microbiota and Traditional Chinese Medicine may serve as promising therapeutic approaches against CRS3.

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“…Hyperkalemia is common in end-stage renal-failure patients and is considered a life-threatening complication, associated with catastrophic anomalies of cardiac conduction [10,11]. Acute kidney injury, which is very common in acute patients [12], giving rise to myriad electrolyte imbalances, is associated with increased risk of cardiac arrythmias, beyond those directly inflicted by derangements of potassium [13]. Hypomagnesemia is also common in acutely ill patients and is associated with worse clinical outcomes in general [14] and increased risk of cardiac arrythmia in particular [15].…”

Section: Introductionmentioning

confidence: 99%

Six-Lead Electrocardiography Enables Identification of Rhythm and Conduction Anomalies of Patients in the Telemedicine-Based, Hospital-at-Home Setting: A Prospective Validation Study

Sharabi,

Abutbul,

Grossbard

et al. 2023

Sensors

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Background: The hospital-at-home (HAH) model is a viable alternative for conventional in-hospital stays worldwide. Serum electrolyte abnormalities are common in acute patients, especially in those with many comorbidities. Pathologic changes in cardiac electrophysiology pose a potential risk during HAH stays. Periodical electrocardiogram (ECG) tracing is therefore advised, but few studies have evaluated the accuracy and efficiency of compact, self-activated ECG devices in HAH settings. This study aimed to evaluate the reliability of such a device in comparison with a standard 12-lead ECG. Methods: We prospectively recruited consecutive patients admitted to the Sheba Beyond Virtual Hospital, in the HAH department, during a 3-month duration. Each patient underwent a 12-lead ECG recording using the legacy device and a consecutive recording by a compact six-lead device. Baseline patient characteristics during hospitalization were collected. The level of agreement between devices was measured by Cohen’s kappa coefficient for inter-rater reliability (Ϗ). Results: Fifty patients were included in the study (median age 80 years, IQR 14). In total, 26 (52%) had electrolyte disturbances. Abnormal D-dimer values were observed in 33 (66%) patients, and 12 (24%) patients had elevated troponin values. We found a level of 94.5% raw agreement between devices with regards to nine of the options included in the automatic read-out of the legacy device. The calculated Ϗ was 0.72, classified as a substantial consensus. The rate of raw consensus regarding the ECG intervals’ measurement (PR, RR, and QT) was 78.5%, and the calculated Ϗ was 0.42, corresponding to a moderate level of agreement. Conclusion: This is the first report to our knowledge regarding the feasibility of using a compact, six-lead ECG device in the setting of an HAH to be safe and bearing satisfying agreement level with a legacy, 12-lead ECG device, enabling quick, accessible arrythmia detection in this setting. Our findings bear a promise to the future development of telemedicine-based hospital-at-home methodology.

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The conundrum of the complex relationship between acute kidney injury and cardiac arrhythmias

Cited by 7 publications

References 155 publications

Association of Serum Vit D level with in-Hospital Outcome in Patients with Acute Myocardial Infarction

Association of Serum Vit D level with in-Hospital Outcome in Patients with Acute Myocardial Infarction

The Molecular Mechanism and Therapeutic Strategy of Cardiorenal Syndrome Type 3

Six-Lead Electrocardiography Enables Identification of Rhythm and Conduction Anomalies of Patients in the Telemedicine-Based, Hospital-at-Home Setting: A Prospective Validation Study

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