Atherosclerotic renovascular disease

2020 ◽  
pp. 5044-5048
Author(s):  
Philip A. Kalra ◽  
Diana Vassallo
Keyword(s):  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Controlled Trial ◽  
Antihypertensive Agents ◽  
Antiplatelet Agents ◽  
Uncontrolled Hypertension ◽  
Rapid Decline ◽  
Renovascular Disease ◽  
Converting Enzyme Inhibitors ◽  
Atherosclerotic Renovascular Disease

Atherosclerotic renovascular disease (ARVD) refers to atheromatous narrowing of one or both renal arteries and frequently coexists with atherosclerotic disease in other vascular beds. Patients with this condition are at high risk of adverse cardiovascular events, with mortality around 8% per year. Many patients with ARVD have chronic kidney disease, but only a minority progress to endstage kidney disease, suggesting that pre-existing hypertensive and/or ischaemic renal parenchymal injury is the usual cause of renal dysfunction. Many patients with ARVD are asymptomatic, but there can be important complications such as uncontrolled hypertension, rapid decline in kidney function, and recurrent acute heart failure (flash pulmonary oedema). Management—patients with ARVD should receive medical vascular protective therapy just like other patients with atheromatous disease. This involves antiplatelet agents such as aspirin, statins, antihypertensive agents (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the drugs of choice), optimization of glycaemic control in diabetic patients, and advice/help to stop smoking. On the basis of randomized controlled trial data, they should not be offered revascularization by angioplasty/stenting for the purpose of improving blood pressure control or stabilizing/improving renal function. However, there is evidence that a subgroup of patients with specific complications of ARVD (as previously mentioned) may benefit from revascularization.

Atherosclerotic renovascular disease

2010 ◽  
pp. 4078-4078
Author(s):  
P A Kalra ◽  
J D Firth
Keyword(s):  
Heart Failure ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Uncontrolled Hypertension ◽  
Rapid Decline ◽  
Renovascular Disease ◽  
Vascular Beds ◽  
End Stage ◽  
Parenchymal Injury ◽  
Atherosclerotic Renovascular Disease

Atherosclerotic renovascular disease (ARVD) refers to atheromatous narrowing of one or both renal arteries and frequently co-exists with atherosclerotic disease in other vascular beds. Patients with this condition are at high risk of adverse cardiovascular events, with mortality around 8% per year. Many patients with ARVD have chronic kidney disease, but only a minority progress to end-stage kidney disease (ESKD), suggesting that pre-existing hypertensive and/or ischaemic renal parenchymal injury is the usual cause of renal dysfunction. Many patients with ARVD are asymptomatic, but there can be important complications such as uncontrolled hypertension, rapid decline in kidney function and recurrent acute heart failure (flash pulmonary oedema)....

Abstract P097: Low Medication Adherence is Related to Poor Hypertension Control among Patients with Chronic Kidney Disease

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Suma Vupputuri ◽  
Paul Muntner ◽  
Wolfgang C Winkelmayer ◽  
David H Smith ◽  
Gregory A Nichols
Keyword(s):  
Chronic Kidney Disease ◽  
Medication Adherence ◽  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Medication Possession Ratio ◽  
Uncontrolled Hypertension ◽  
Improve Medication Adherence ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
The Mean

Inadequately controlled blood pressure (BP) is an important risk factor for the progression of chronic kidney disease (CKD). Few data are available on the association between adherence to antihypertensive medications and BP control among patients with CKD. We investigated the association of adherence to angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) with BP levels and BP control among CKD patients (n=3077) at Kaiser Permanente Georgia (an insurer and health care provider). Patients were required to have 2 outpatient diagnoses of CKD in 2008-2009, at least 2 fills of ACEi/ARBs, be 18+ years of age, with at least 1 year of continuous membership and prescription benefits prior to 01/01/08 and have no history of end-stage renal disease. We defined uncontrolled BP as systolic/diastolic of ≥140/90 mmHg and also ≥130/80 mmHg. As a measure of adherence we calculated the medication possession ratio (MPR): # of days medication supplied between the first and last prescription fills Duration from first to last prescription date + days supply from last prescription The mean age of our sample was 64.1 ±11.9 years; 53.1% were female, and 57.6% African-American. In this sample, 22.6% and 8.9% had low and very low medication adherence, respectively; while 25.6% and 58.6% had systolic/diastolic BP of ≥140/90 and ≥130/80 mmHg, respectively. The mean BPs and odds ratios (ORs) for uncontrolled BP associated with level of adherence to antihypertensive medications are given in the table . In conclusion, among patients with CKD, poor medication adherence to antihypertensive medications was consistently associated with uncontrolled hypertension. Targeting interventions to improve medication adherence among patients with CKD may be an important strategy to improve BP control and, in turn, slow the progression of CKD. Medication Adherence p-trend High (MPR: ≥0.8) N=2109 Low (MPR: 0.5 to <0.8) N=694 Very low (MPR: <0.5) N=274 Mean systolic BP, mmHg 131.3 (13.0) 134.0 (14.7) 137.5 (15.4) <0.0001 Mean diastolic BP, mmHg 72.5 (8.12) 75.7 (9.21) 78.7 (10.1) <0.0001 OR for SBP/DBP ≥140/90 mmHg Age, race, sex adjusted 1.0 (ref) 1.40 (1.14, 1.73) 2.30 (1.73, 3.06) <0.0001 Multivariate adjusted * 1.0 (ref) 1.24 (0.97, 1.57) 1.96 (1.40, 2.75) <0.0001 OR for SBP/DBP ≥130/80 mmHg Age, race, sex adjusted 1.0 (ref) 1.21 (1.00, 1.46) 1.81 (1.33, 2.45) <0.0001 Multivariate adjusted * 1.0 (ref) 1.11 (0.89, 1.38) 1.43 (1.01, 2.01) 0.04 * Adjusted for age, race, sex, socioeconomic status, co-morbidities, clinical measures, and number of medication classes.

Intraoperative Hyperkalemia

2018 ◽  
pp. 269-274
Author(s):  
M. Angele Theard ◽  
Alexandra Bastien
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Close Monitoring ◽  
Converting Enzyme Inhibitors ◽  
Renin Inhibitors ◽  
Increased Risk ◽  
Receptor Blockers

Patients with hypertension, diabetes, and heart disease are at risk for chronic kidney disease and therefore require close monitoring of potassium (K+) levels in order to avoid some of the more concerning consequences of hyperkalemia. Medical therapy in these patients, which often includes angiotensin converting enzyme inhibitors, angiotensin receptor blockers, renin inhibitors, and mineralocorticoid receptor antagonists, while helpful in managing some of the aforementioned comorbidities and ameliorating chronic kidney disease in these patients, places them at increased risk for unwanted K+ elevations. Symptoms of hyperkalemia maybe nonspecific (fatigue, weakness, and gastrointestinal upset), requiring attention therefore to preoperative laboratory analysis to avert the potentially lethal intraoperative consequences of hyperkalemia like asystole and ventricular fibrillation. Emergency surgery in these patients after trauma complicated by crush injury is particularly challenging requiring that the anesthesiologist be well-versed in recognizing the signs of and managing intraoperative hyperkalemia.

HFrEF pharmacological treatment: ACEIs and/or ARBs

ESC CardioMed ◽  
2018 ◽  
pp. 1844-1848
Author(s):  
Marc A. Pfeffer
Keyword(s):  
Heart Failure ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Drug Effects ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Reduced Ejection Fraction

Several classes of inhibitors of the renin–angiotensin system were developed as antihypertensive agents. Following the early observations of favourable haemodynamic effects of angiotensin-converting enzyme inhibitors (ACEIs) in patients with congestive heart failure, a series of major randomized outcome trials demonstrated morbidity and mortality benefits of these agents across the spectrum of patients with heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor blockers (ARBs) were then also shown to have similar benefits with a suggestion of some incremental improvements when used together. However, in the trials that randomized patients to a proven dose of an ACEI plus either placebo or an ARB, the combination of the two inhibitors of the renin–angiotensin system resulted in more adverse drug effects without a meaningful improvement in clinical outcomes. This chapter reviews the fundamental underpinnings for use of either an ACEI or ARB to improve prognosis of patients with HFrEF.

scholarly journals Intensity of hydration changes the role of renin–angiotensin–aldosterone system blockers in contrast-induced nephropathy risk after coronary catheterisation in patients with chronic kidney disease

2017 ◽  
Vol 18 (2) ◽  
pp. 147032031770889 ◽  
Author(s):  
Xiao-sheng Guo ◽  
Deng-xuan Wu ◽  
Wei-jie Bei ◽  
Hua-long Li ◽  
Kun Wang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Body Weight ◽  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Group Versus ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Potential Effect ◽  
Contrast Induced Nephropathy ◽  
Converting Enzyme Inhibitors

Objective: This study evaluated the potential effect of hydration intensity on the role of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) on contrast-induced nephropathy in patients with renal insufficiency. Methods: All eligible patients were included and stratified according to hydration intensity defined as saline hydration volume to body weight tertiles: <10.21 mL/kg, 10.21 to <17.86 mL/kg, and ⩾17.86 mL/kg. Results: In total, 84 (6.7%) of 1254 patients developed contrast-induced nephropathy: 6.2% in the ACEI/ARB group versus 10.8% in the non-ACEI/ARB group ( P=0.029), with an adjusted odds ratio (OR) of 0.89 (95% confidence interval (CI) 0.46–1.73, P=0.735). The incidence of contrast-induced nephropathy was lower in the ACEI/ARB group than in the non-ACEI/ARB group in the second tertile ( P=0.031), while not significantly different in the first ( P=0.701) and third ( P=0.254) tertiles. ACEIs/ARBs were independently associated with a lower contrast-induced nephropathy risk (OR 0.26, 95% CI 0.09–0.74, P=0.012) and long-term all-cause death (hazard ratio 0.461, 95% CI 0.282–0.755, P=0.002) only in the second hydration volume to body weight tertile. Conclusion: The effects of ACEIs/ARBs on contrast-induced nephropathy risk vary according to saline hydration intensity in chronic kidney disease patients, and may further reduce contrast-induced nephropathy risk in patients administered moderate saline hydration.

scholarly journals Risk factors for acute kidney injury among patients with chikungunya: a multi-center experience from the 2017 chikungunya outbreak in Dhaka, Bangladesh

2019 ◽  
Vol 9 (3) ◽  
pp. 193-196
Author(s):  
Shahana Zaman ◽  
Muhammad Abdur Rahim ◽  
Mehruba Alam Ananna ◽  
Ishrat Jahan ◽  
Tufayel Ahmed Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Significant Risk ◽  
Kidney Injury ◽  
Febrile Illness ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Adult Patients ◽  
Converting Enzyme Inhibitors

Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile illness may have acute life-threating features including cardiomyopathy and encephalitis. Acute kidney injury (AKI) is less well described complication of chikungunya. This study was designed to evaluate risk factors for AKI among patients with chikungunya virus infection. Methods: This case-control study was done in 3 different centers in Dhaka, Bangladesh from July to October 2017. Adult patients (>18 years) with confirmed diagnosis of chikungunya were included in this study. AKI was diagnosed as per Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury. Patients suffering from chikungunya complicated by AKI were cases and those without AKI were controls. Results: Total patients were 107 (male 61) with a mean age of 35.6 (range 19-84) years. Common comorbidities were diabetes mellitus (DM) (20.6%), hypertension (17.8%) and chronic kidney disease (CKD) (12.1%). Common presentations included fever (86.9%) or recent history of fever (13.1%), joint pain (88.8%), rash (23.4%), pruritus (15.9%), gastro-intestinal (GI) features like diarrhea and/or vomiting (28%), lymphadenopathy (12.1%), gum swelling/oral ulcer (4.1%) and oedema (8.4%). Fourteen (13.1%) patients required hospitalization. Eleven (10.3%) cases were complicated by AKI. Among the risk factors for AKI, comorbidities like DM (OR 28.73, 95% CI 5.57-148.10, p 0.0001) and CKD (OR 31.0, 95% CI 2.94-326.7, p <0.0001), GI features (OR 16.07, 95% CI 3.22-80.14, p 0.0007), requirement of hospitalization (OR 23.10, 95% CI 2.37-226.31, p <0.0001) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) (OR 6.65, 95% CI 1.77-24.98, p 0.005) were significant. Conclusions: One-tenth of adult patients suffering from chikungunya were complicated by AKI in this study. DM, CKD, diarrhea and/or vomiting, hospitalization and use of ACEIs/ARBs appeared as significant risk factors for AKI. Birdem Med J 2019; 9(3): 193-196

scholarly journals The quality of life of chronic kidney disease patients with hypertension treated with angiotensin system-related agents

2020 ◽  
Vol 11 (4) ◽  
pp. 6633-6639
Author(s):  
Mohammed Salim KT ◽  
Saravanakumar RT ◽  
Dilip C ◽  
Amrutha KP
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
The Impact

The chronic kidney disease (CKD) co-exist with hypertension in approximately 80 to 85 per cent of patients. The CKD stages can be defined by glomerular filtration rate (GFR), and the deterioration of kidney function or reduction in GFR has observed in those with uncontrolled blood pressure (BP). We had conducted a prospective study to analyse the impact of the angiotensin system-related agents on the quality of life of CKD patients with hypertension. The SF-36 questionnaire, direct patients interview and medical records were the sources for retrieval of information. We observed that male patients were more prone to CKD than female. Hypertension was the primary (77.8%) aetiology behind the incidence of CKD. The angiotensin-converting enzyme inhibitors (ACEI) was responsible for very low (58%) and low (44%) health disabilities to the patients. In contrast, the angiotensin receptor blockers (ARB) even though it has a limited adverse effect, the patients complained of medium (9%) and high disabilities than the ACEIs. The discontinuation of the antihypertensive drugs by the CKD patients was almost negligible (3.4%). The study concludes that a balanced diet and reasonable blood pressure control is essential to prevent the progression of CKD and to improve the quality of life.

scholarly journals Antisense Oligonucleotide: A Potential Therapeutic Intervention for Chronic Kidney Disease

2022 ◽  
Vol 2 (1) ◽  
pp. 16-37
Author(s):  
Yalin Li ◽  
Yuqin Tan ◽  
Rui Zhang ◽  
Tao Wang ◽  
Ning Na ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antisense Oligonucleotide ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Public Health Issue ◽  
Global Public Health ◽  
Converting Enzyme Inhibitors ◽  
Development Platform

Chronic kidney disease (CKD) is a global public health issue that places an increasing burden on the healthcare systems of both the developed and developing countries. CKD is a progressive and irreversible condition, affecting approximately 10% of the population worldwide. Patients that have progressed to end-stage renal disease (ESRD) require expensive renal replacement therapy, i.e., dialysis or kidney transplantation. Current CKD therapy largely relies on the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs). However, these treatments by no means halt the progression of CKD to ESRD. Therefore, the development of new therapies is urgently needed. Antisense oligonucleotide (ASO) has recently attracted considerable interest as a drug development platform. Thus far, eight ASO-based drugs have been granted approval by the US Food and Drug Administration for the treatment of various diseases. Herein, we review the ASOs developed for the identification of CKD-relevant genes and/or the simultaneous development of the ASOs as potential therapeutics towards treating CKD.

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