Spinal cord stimulation for ischemic heart disease and peripheral vascular disease

The presence of peripheral vascular disease in chronic kidney disease portends a dismal prognosis due to the increased morbidity and mortality from cardiovascular events. Peripheral vascular disease is asymptomatic in about 40%. The study was designed to identify the prevalence of the peripheral vascular disease in chronic kidney disease, which is a state of accelerated atherosclerosis. A sample of 90 patients of chronic kidney disease attending the outpatient department in medicine and nephrology were assessed for the prevalence of peripheral vascular disease by measuring the Ankle-brachial index and Carotid intima-media thickness. Gender, smoking, hypertension, diabetes and ischemic heart disease profiles of the sample were analyzed for association with peripheral vascular disease. Majority of the patients belonged to the age group 40-50 years. 82 were males, of these 47 were smokers. 6 patients in the sample had symptoms suggestive of peripheral vascular disease. While 21%(n=19) of patients in the sample were diabetics and 21%(n=19) had evidence of ischemic heart disease, hypertension was present in 41%(n=37) of the patients. 50% of the patients belonged to CRF stage 4. The prevalence of the peripheral vascular disease, as determined by ABI<0.9, was 31.1%. CIMT thickness > 0.9mm has a positive correlation with CKD stages and has a statistically significant P value of <0.05. In conclusion, this study revealed that there is an increased prevalence of PVD in smokers, diabetics and in ischemic heart disease compared to those with hypertension.

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Cardiovascular disease after renal transplantation.

Journal of the American Society of Nephrology ◽

10.1681/asn.v71158 ◽

1996 ◽

Vol 7 (1) ◽

pp. 158-165 ◽

Cited By ~ 16

Author(s):

B L Kasiske ◽

C Guijarro ◽

Z A Massy ◽

M R Wiederkehr ◽

J Z Ma

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Heart Disease ◽

Renal Transplantation ◽

Ischemic Heart Disease ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Density Lipoprotein ◽

Ischemic Heart ◽

Peripheral Vascular

Although cardiovascular disease is a major cause of morbidity and mortality after renal transplantation, its pathogenesis and treatment are poorly understood. We conducted separate analyses of risk factors for ischemic heart disease, cerebral, and peripheral vascular disease after 706 renal transplants, all of which functioned for at least 6 months. We used Cox proportional hazards analysis to examine the effects of multiple pretransplant and posttransplant risk factors and included time-dependent variables measured at 3, 6, and 12 months, and annually to last follow-up at 7.0 +/- 4.2 yr. The independent relative risk (RR) of diabetes was 3.25 for ischemic heart disease, 3.21 for cerebral vascular disease, and 28.18 peripheral vascular disease (P < 0.05). The RR of each acute rejection episode was 1.40 for ischemic heart disease and 1.24 for cerebral vascular disease. Among serum lipid levels, high-density lipoprotein cholesterol was the best predictor of ischemic heart disease (RR = 0.80 for each 10 mg/dL). Posttransplant ischemic heart disease was strongly predictive of cerebral (5.80) and peripheral vascular disease (5.22), whereas ischemic heart disease was predicted by posttransplant cerebral (8.25) and peripheral vascular disease (4.58). Other risk factors for vascular disease included age, gender, cigarette smoking, pretransplant splenectomy, and serum albumin. Hypertension and low-density lipoprotein cholesterol had no effect, perhaps because of aggressive pharmacologic treatment. Thus, the incidence of cardiovascular disease continues to be high after renal transplantation, and multiple risk factors suggest a number of possible strategies for more effective treatment and prevention.

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