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Mabel Aoun, Randa Tabbah
Beta-blockers have numerous indications in the general population and are strongly recommended in heart failure, post-myocardial infarction and arrhythmias. In hemodialysis patients, their use is based on weak evidence because of the lack of a sufficient number of randomized clinical trials. The strongest evidence is based on two trials. The first showed better survival with carvedilol in hemodialysis patients with four sessions per week and systolic heart failure. The second found reduced cardiovascular morbidity with atenolol compared to lisinopril in mostly black hypertensive hemodialysis patients...
February 1, 2019: Néphrologie & Thérapeutique
Mary C Mallappallil, Steven Fishbane, Rimda Wanchoo, Edgar Lerma, Andrea Roche-Recinos, Moro Salifu
BACKGROUND: There are no guidelines for transitioning patients from chronic kidney disease stage 5 to hemodialysis. We conducted this study to determine if there are uniform patterns in how nephrologists transition patients to dialysis. METHODS: We designed an electronic survey with 39 questions and sent it to a database of practicing nephrologists at the National Kidney Foundation. Factors that were important for transitioning a patient to hemodialysis were evaluated, including medication changes on dialysis initiation, dry weight and dialysis prescription...
June 22, 2018: BMC Nephrology
Angelo Karaboyas, Hairong Xu, Hal Morgenstern, Francesco Locatelli, Michel Jadoul, Kosaku Nitta, Indranil Dasgupta, Francesca Tentori, Friedrich K Port, Bruce M Robinson
The benefits of renin angiotensin-aldosterone system inhibitors (RAASi) are well-established in the general population, particularly among those with diabetes, congestive heart failure (CHF), or coronary artery disease (CAD). However, conflicting evidence from trials and concerns about hyperkalemia limit RAASi use in hemodialysis patients, relative to other antihypertensive agents, including beta blockers and calcium channel blockers. Therefore, we investigated prescription patterns and associations with mortality for RAASi and other antihypertensive agents using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS)...
September 2018: Kidney International
Amith Roy Shamir, Ameet Karembelkar, Jonathan Yabes, Yi Yao, Dana Miskulin, Jennifer Gassman, David Ploth, Lavinia Negrea, Susan Paine, Mahboob Rahman, Raymond Y Kwong, Philip Zager, Manisha Jhamb
BACKGROUND/AIMS: Intradialytic hypertension (IDH), or paradoxical rise in blood pressure (BP) during hemodialysis (HD) is associated with increased morbidity and mortality. The association between IDH and increased left ventricular mass (LVM), a well-known risk factor for adverse cardiovascular outcomes in HD patients, has not been studied. The aim of our study is to evaluate the cross-sectional association of intradialytic change in BP with cardiac structure and function measured by cardiac MRI in hypertensive HD patients enrolled in the multi-center Blood Pressure in Dialysis (BID) clinical trial...
2018: Kidney & Blood Pressure Research
Vieux Momeme Mokoli, Ernest Kiswaya Sumaili, François Bompeka Lepira, Fiston Ikwa Ndol Mbutiwi, Jean Robert Rissassy Makulo, Justine Busanga Bukabau, Patrick Parmba Izeidi, Jeannine Losa Luse, Stéphane Kalambay Mukendi, Désiré Kulimba Mashinda, Nazaire Mangani Nseka
BACKGROUND: Decreased residual urine volume (RUV) is associated with higher mortality in hemodialysis (HD). However, few studies have examined RUV in patients on HD in Sub-Saharan Africa. The aim of this study was to identify predictors of RUV among incident hemodialysis patients in Kinshasa. METHODS: This historical cohort study enrolled 250 patients with ESRD undergoing hemodialysis between January 2007 and July 2013 in two hemodialysis centers in Kinshasa. RUV were collected over 24 h at the initiation of HD and 6 and 12 months later during the interdialytic period...
March 20, 2018: BMC Nephrology
Matthew A Weir, Charles A Herzog
For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular sequelae. However, the evidence supporting their use in patients receiving hemodialysis is sparse and the heterogeneity of the beta blocker class makes it difficult to prescribe these medications with confidence...
May 2018: Seminars in Dialysis
Chakradhari Inampudi, Paulino Alvarez, Rabea Asleh, Alexandros Briasoulis
BACKGROUND: Several risk factors including Ischemic heart disease, uncontrolled hypertension, high output Heart Failure (HF) from shunting through vascular hemodialysis access, and anemia, contribute to development of HF in patients with End-Stage Renal Disease (ESRD). Guidelinedirected medical and device therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) has not been extensively studied and may have limited safety and efficacy in patients with ESRD. RESULTS: Maintenance of interdialytic and intradialytic euvolemia is a key component of HF management in these patients but often difficult to achieve...
March 14, 2018: Current Cardiology Reviews
José Luño, Javier Varas, Rosa Ramos, Ignacio Merello, Pedro Aljama, Alejandro MartinMalo, Julio Pascual, Manuel Praga
Introduction: Although several studies suggest that the prognosis of hypertensive dialysis patients can be improved by using antihypertensive drug therapy, it is unknown whether the prescription of a particular class or combination of antihypertensive drugs is beneficial during hemodialysis. Methods: We performed a propensity score matching study to compare the effectiveness of various classes of antihypertensive drugs on cardiovascular (CV) mortality in 2518 incident hemodialysis patients in Spain...
July 2017: KI Reports
Marijana Gulin, Dragan Klarić, Mario Ilić, Josipa Radić, Vedran Kovačić, Milenka Šain
AIMS: This study was aimed at comparing the incidence of arterial hypertension and blood pressure (BP) variance in hospital and out-of-hospital hemodialysis (HD) patients during HD sessions. METHODS: A cross-sectional study was conducted for 1 week at all the HD centers in Dalmatia, Croatia. The pre-, intra-, and post-dialysis BP values were collected for 3 consecutive HD sessions per patient. RESULTS: Of the 399 subjects, 73.9% were hypertensives, who showed higher interdialytic weight gain compared to the normotensives (2...
2017: Blood Purification
Celia R Valverde, Clare R Gregory, Janet E Ilkiw
OBJECTIVE: To document perioperative and anesthetic management of 30 feline renal transplant recipients (1996-1998). STUDY DESIGN: Retrospective clinical study. ANIMALS: Thirty adult cats in end-stage renal failure that underwent heterotopic renal transplantation. MATERIALS AND METHODS: The medical records were reviewed from 30 feline heterotopic renal transplant recipients. Cases were included only if they had been treated for hypertension using a beta-adrenergic antagonist, a calcium channel blocker or hemodialysis...
July 2002: Veterinary Anaesthesia and Analgesia
Jiun-Chi Huang, I-Ching Kuo, Yi-Chun Tsai, Jia-Jung Lee, Lee-Moay Lim, Szu-Chia Chen, Yi-Wen Chiu, Jer-Ming Chang, Hung-Hun Chen
BACKGROUND/AIMS: Heart rate variability (HRV) has been linked to mortality in maintenance hemodialysis (HD) patients, but it is less clear whether HRV is associated with major adverse cardiovascular events (MACEs) and hospitalization. METHODS: This study enrolled 179 maintenance HD patients. HRV was measured to assess its prognostic significance in relation to MACEs and hospitalization. RESULTS: During the follow-up period of 33.3 ± 6.7 months, 36 (20...
2017: Kidney & Blood Pressure Research
Tariq Shafi, Stephen M Sozio, Jason Luly, Karen J Bandeen-Roche, Wendy L St Peter, Patti L Ephraim, Aidan McDermott, Charles A Herzog, Deidra C Crews, Julia J Scialla, Navdeep Tangri, Dana C Miskulin, Wieneke M Michels, Bernard G Jaar, Philip G Zager, Klemens B Meyer, Albert W Wu, L Ebony Boulware
Antihypertensive medications are commonly prescribed to hemodialysis patients but the optimal regimens to prevent morbidity and mortality are unknown. The goal of our study was to compare the association of routinely prescribed antihypertensive regimens with outcomes in US hemodialysis patients.We used 2 datasets for our analysis. Our primary cohort (US Renal Data System [USRDS]) included adult patients initiating in-center hemodialysis from July 1, 2006 to June 30, 2008 (n = 33,005) with follow-up through December 31, 2009...
February 2017: Medicine (Baltimore)
Greicy Mara Mengue Feniman De Stefano, Silméia Garcia Zanati-Basan, Laercio Martins De Stefano, Viviana Rugolo Oliveira E Silva, Patrícia Santi Xavier, Pasqual Barretti, Roberto Jorge da Silva Franco, Jacqueline Costa Teixeira Caramori, Luis Cuadrado Martin
OBJECTIVES: Patients with chronic kidney disease present a higher degree of left ventricular hypertrophy than expected for hypertension levels. In chronic kidney disease the plot between the quotient extracellular water/total body water and aldosterone is shifted up and to the right. There are few studies that verified the role of aldosterone in cardiac remodeling in this set of patients. The aim of this study was to evaluate the relationship between serum aldosterone and left ventricular mass index in patients with chronic kidney disease on hemodialysis...
October 2016: Therapeutic Advances in Cardiovascular Disease
Alvin Tieu, Maxwell Leither, Bradley L Urquhart, Matthew A Weir
PURPOSE OF REVIEW: To review the current understanding of hemodialysis-mediated clearance of commonly used cardiovascular medications. RECENT FINDINGS: Although cardiovascular drug dialyzability is poorly understood, many drug classes appear to include agents with substantially different degrees of dialyzability. Recent data suggest that more readily dialyzable beta-blockers associate with higher short-term mortality in patients initiating these drugs when on hemodialysis...
May 2016: Current Opinion in Nephrology and Hypertension
Marc Saad, Boutros Karam, Geovani Faddoul, Youssef El Douaihy, Harout Yacoub, Hassan Baydoun, Christine Boumitri, Iskandar Barakat, Chadi Saifan, Elie El-Charabaty, Suzanne El Sayegh
Patients with chronic kidney disease (CKD) are three times more likely to have myocardial infarction (MI) and suffer from increased morbidity and higher mortality. Traditional and unique risk factors are prevalent and constitute challenges for the standard of care. However, CKD patients have been largely excluded from clinical trials and little evidence is available to guide evidence-based treatment of coronary artery disease in patients with CKD. Our objective was to assess whether a difference exists in the management of MI (ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction) among patients with normal kidney function, CKD stage III-V, and end-stage renal disease (ESRD) patients...
2016: International Journal of Nephrology and Renovascular Disease
Yosu Luque, Aurélien Bataille, Guillaume Taldir, Éric Rondeau, Christophe Ridel
Patients undergoing hemodialysis have a 10 to 20 times higher risk of sudden cardiac arrest (SCA) than the general population. Sudden cardiac death is a rare event (approximately 1 event per 10,000 sessions) but has a very high mortality rate. Epidemiological data comes almost exclusively from North American studies; there is a great lack of European data on the subject. Ventricular arrhythmia is the main mechanism of sudden cardiac deaths in dialysis patients. These patients develop increased sensitivity mainly due to a high prevalence of severe ischemic heart disease and left ventricular hypertrophy and to a frequent trigger event: electrolytic and plasma volume shifts during dialysis sessions...
February 2016: Néphrologie & Thérapeutique
Rania Kheder-Elfekih, Alexandra Yannoutsos, Jacques Blacher, Gérard M London, Michel E Safar
Hypertension (HTN) in chronic kidney disease (CKD) is influenced by blood pressure (BP) and the progression of CKD, including hemodialysis and renal transplantation. To date, the efficacy of antihypertensive drug strategies has chiefly been assessed by measuring steady-state systolic, diastolic and mean arterial pressures (MAP). However, recently elucidated features of the BP curve have highlighted other important goals, that is, the specific roles of pulse pressure (PP), arterial stiffness, pulse wave velocity (PWV) and wave reflections as potentially deleterious factors affecting the progression of HTN and CKD...
October 2015: Journal of Hypertension
Maria Angela Magalhães de Queiroz Carreira, André Barros Nogueira, Felipe Montes Pena, Marcio Galindo Kiuchi, Ronaldo Campos Rodrigues, Rodrigo da Rocha Rodrigues, Jorge Paulo Strogoff de Matos, Jocemir Ronaldo Lugon
BACKGROUND: Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality. OBJECTIVE: To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls. METHODS: Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed...
June 2015: Arquivos Brasileiros de Cardiologia
Beata Franczyk-Skóra, Anna Gluba-Brzózka, Jerzy Krzysztof Wranicz, Maciej Banach, Robert Olszewski, Jacek Rysz
The risk of sudden cardiac death (SCD) is high in chronic kidney disease patients, and it increases with the progression of kidney function deterioration. The most common causes of SDC are the following: ventricular tachycardia, ventricular tachyarrhythmia, tachycardia torsade de pointes, sustained ventricular fibrillation and bradyarrhythmia. Dialysis influences cardiovascular system and results in hemodynamic disturbances as well as electrolyte shifts altering myocardial electrophysiology. Studies suggest that this procedure exerts both detrimental (poor volume control can exacerbate hypertension and left ventricle hypertrophy) and beneficial effects (associated with fluid removal and subsequent decrease in left ventricle stretch)...
June 2015: International Urology and Nephrology
Maria Angela Magalhães de Queiroz Carreira, André Barros Nogueira, Felipe Montes Pena, Marcio Galindo Kiuchi, Ronaldo Campos Rodrigues, Rodrigo da Rocha Rodrigues, Jorge Paulo Strogoff de Matos, Jocemir Ronaldo Lugon
BACKGROUND: Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality. OBJECTIVE: To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls. METHODS: Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed...
May 5, 2015: Arquivos Brasileiros de Cardiologia
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