P0836ROLE OF THE NEPHROLOGIST AS A CONSULTANT FOR VASCULAR SURGERY SERVICE IN A UNIVERSITY HOSPITAL

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Orlando Siverio Morales ◽  
Edduin Martin ◽  
Virginia Dominguez ◽  
Carlos Marin ◽  
Ana Aragao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Surgery ◽  
Vascular Access ◽  
University Hospital ◽  
Hospitalised Patients ◽  
Number Of Patients ◽  
Clinical Conditions

Abstract Background and Aims The clinical profile and complexity of hospitalised patients from Vascular Surgery are similar to those from Nephrology. Also, the majority of patients with peripheral vascular disease has some degree of chronic kidney disease. Therefore, the collaboration of nephrologist as consultants could have a significant impact on the adequate attention of these patients. Our aim was to analyze the epidemiological and clinical characteristics of the vascular surgery patients admitted in a public university hospital of 1000 beds that were attended by a nephrologist during their hospitalization. Method Observational study of a retrospective cohort of 138 patients in a 1 year period (January 1st to December 31st 2018). The following data were considered: nature of the consultation (“Urgent” LESS THAN 24 H TO BE ATTENDER OR “Standar”), reason for consultation/nephrological diagnosis, cause of admission, follow-up period, age, sex, presence of : Diabetes Mellitus (DM), Hypertension (HT) and/or Chronic Kidney Disease (CKD) presence. Results 138 patients, Mean age was 67,8 y (range 35-92 y). 76,81% were men and 23,19% were women. Most frequent cause for consultations were: 1. Patients on Hemodialysis treatment (66 = 47,83%); 2. Exhacerbations of CKD (29 = 21,01%); 3. Acute Kidney Failure (18 = 13,04%); 4. Kidney transplantation (11 = 7,97%); 5. Ionic alterations (7 = 5,07%); 6. Advanced CKD (6=4,35%). Cause of admission: 1. Chronic lower limb ischemia (68=49,27%); 2. Problems related to arteriovenous fistula (Creation of vascular access: 10=7,25% and complications of vascular access: 16=11,59%); 3. Aneurysmatic complications (14=10,14%); 4. Diabetic foot (11=7,97%); 5. Infections (7=5,07%); 6. Deep venous thrombosis (6=4,35%). About 75.35% had DM, 91.30% were hypertensive and 62.32% had both clinical conditions. The average follow-up time was 72 days (range 1-223 days) and 92,03 % need to be follow-up more than 24 hours. About 49,27% of the consultation were urgent. Conclusion The number of patients admitted to vascular surgery department requiring nephrology attention are high and represents an important percentage of the clinical activities and resources demanding to the nephrology service. Exhacerbations of CKD, Diabetes Mellitus and Hypertension are constant clinical conditions in patients admitted to vascular surgery requiring nephrology assessment. Based on these data is important to improve the coordination between both departments and to stablish a specific training program for nephrologist and vascular surgeons in order to optimize the management of this patients.

scholarly journals An Elderly Comorbid Patient with Atrial Fibrillation: What is Important to Know and What Should be Considered When Prescribing Anticoagulants?

2020 ◽  
Vol 16 (6) ◽  
pp. 1031-1038
Author(s):  
T. V. Pavlova
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Randomized Clinical Trials ◽  
Simple Algorithm ◽  
Cardiovascular Complications ◽  
Efficacy And Safety ◽  
Risk Of Bleeding ◽  
Number Of Patients

Anticoagulant therapy in elderly patients with atrial fibrillation and concomitant diseases is often the challenge for clinicians. The high risk of stroke is inherent in atrial fibrillation, and it increases when combined with coronary heart disease and chronic kidney disease. On the other hand, the comorbidity increases the risk of bleeding. Older age is also the risk factor of thrombotic and hemorrhagic complications. As a consequence, the choice of specific anticoagulant should be based on a solid evidences, obtained both from randomized clinical trials and from daily clinical practice. In the ROCKET AF trail the direct oral anticoagulant rivaroxaban showed a tendency to reduce the risk of thromboembolism by 20% compared with warfarin in the patients aged 75 years and older. The safety of rivaroxaban has been evaluated in the XANTUS POOLED program. According to the follow-up results for 12 months, more than 96% of patients didn't have any adverse event, and the number of patients with major bleeding was 1.5%. Several meta-analyzes reported a reduction of cardiovascular complications in patients treated by rivaroxaban. In the ROCKET AF trail, a “renal” dose of rivaroxaban (15 mg OD) was studied in patients with chronic kidney disease. The efficacy and safety of rivaroxaban were validated in this patients, and a simple algorithm for selecting the dose of this drug in patients with chronic kidney disease was provided. 

Effect of pre-existing chronic kidney disease, anaemia and diabetes mellitus on mid-term mortality in patients with STEMI treated with primary PCI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Rubartelli ◽  
M Bruzzone ◽  
F Ariel Sanchez ◽  
E Bologna ◽  
A Iannone ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Synergistic Effect ◽  
Female Gender ◽  
Primary Pci ◽  
Prognostic Effect ◽  
Coronary Syndromes ◽  
Prognostic Importance

Abstract Background The negative prognostic effect of chronic kidney disease (CKD), anaemia and diabetes in patients with acute coronary syndromes is well known. However, data about the prevalence and the prognostic importance of these comorbidities in unselected, contemporary STEMI patients treated with primary PCI are limited. Purpose We sought to investigate the prevalence of CKD, anaemia and diabetes mellitus in this patient population, as well as possible interactions between these comorbidities. Methods Between January 2006 and December 2018, 3395 consecutive patients with STEMI underwent primary PCI in two centres. Hb and creatinine were determined on a blood test obtained immediately upon the arrival at the Hospital and eGFR was estimated with the CKD-EPI equation. Renal impairment (RI) was defined as stage 3B or worse CKD (eGFR ≤44 ml/min/1.73m2). Anaemia was defined as Hb <13 g/dl in males and <12 g/dl in females. The outcome measure was overall mortality at a median follow-up of 1.9 years. Results The age of patients was (mean±SD) 67.2±12.9 years and 27.3% of them were females. Diabetes was present in 22.1%, anaemia in 18.1%, and RI in 9.8% of patients. The presence of diabetes, anemia or RI, individually or in various combination, was associated with higher mortality (see figure). Interestingly, these comorbidities presented an addictive, but non synergistic, effect (P for interaction = NS for all combinations). The covariates associated with mortality are shown in the Table. Notably, female gender was independently associated with lower mortality. Conclusions In contemporary patients treated with primary PCI, diabetes, anaemia and RI are frequently present, individually or in combination. All these comorbidities are strong independent predictors of mortality, and the coexistence of more conditions has addictive, but not synergistic, effect. The identification of patients at higher risk could promote a closer follow-up and more stringent measures of secondary prevention. Funding Acknowledgement Type of funding source: None

scholarly journals Myocardial characterization in pre-dialysis chronic kidney disease: a study of prevalence, patterns and outcomes

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anna M. Price ◽  
Manvir K. Hayer ◽  
Ravi Vijapurapu ◽  
Saad A. Fyyaz ◽  
William E. Moody ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ckd Stage ◽  
Multiplicative Risk

Abstract Background Late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) characterizes myocardial disease and predicts an adverse cardiovascular (CV) prognosis. Myocardial abnormalities, are present in early chronic kidney disease (CKD). To date there are no data defining prevalence, pattern and clinical implications of LGE-CMR in CKD. Methods Patients with pre-dialysis CKD (stage 2–5) attending specialist renal clinics at University Hospital Birmingham (UK) who underwent gadolinium enhanced CMR (1.5 T) between 2005 and 2017 were included. The patterns and presence (LGEpos) / absence (LGEneg) of LGE were assessed by two blinded observers. Association between LGE and CV outcomes were assessed. Results In total, 159 patients received gadolinium (male 61%, mean age 55 years, mean left ventricular ejection fraction 69%, left ventricular hypertrophy 5%) with a median follow up period of 3.8 years [1.04–11.59]. LGEpos was present in 55 (34%) subjects; the patterns were: right ventricular insertion point n = 28 (51%), mid wall n = 18 (33%), sub-endocardial n = 5 (9%) and sub-epicardial n = 4 (7%). There were no differences in left ventricular structural or functional parameters with LGEpos. There were 12 adverse CV outcomes over follow up; 7 of 55 with LGEpos and 5 of 104 LGEneg. LGEpos was not predicted by age, gender, glomerular filtration rate or electrocardiographic abnormalities. Conclusions In a selected cohort of subjects with moderate CKD but low CV risk, LGE was present in approximately a third of patients. LGE was not associated with adverse CV outcomes. Further studies in high risk CKD cohorts are required to assess the role of LGE with multiplicative risk factors.

scholarly journals Myocardial Characterization in Pre-Dialysis Chronic Kidney Disease: A Study of Prevalence, Patterns and Outcomes

2019 ◽  
Author(s):  
Anna M Price ◽  
Manvir K Hayer ◽  
Ravi Vijapurapu ◽  
Saad A Fyyaz ◽  
William E Moody ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ckd Stage ◽  
Multiplicative Risk

Abstract Background Late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) characterizes myocardial disease and predicts an adverse cardiovascular (CV) prognosis. Myocardial abnormalities, are present in early chronic kidney disease (CKD). To date there are no data defining prevalence, pattern and clinical implications of LGE-CMR in CKD.Methods Patients with pre-dialysis CKD (stage 2-5) attending specialist renal clinics at University Hospital Birmingham (UK) who underwent gadolinium enhanced CMR (1.5T) between 2005 and 2017 were included. The patterns and presence (LGEpos) / absence (LGEneg) of LGE were assessed by two blinded observers. Association between LGE and CV outcomes were assessed.Results In total, 159 patients received gadolinium (male 61%, mean age 55 years, mean left ventricular ejection fraction 69%, left ventricular hypertrophy 5%) with a median follow up period of 3.8 years [1.04-11.59]. LGEpos was present in 55 (34%) subjects; the patterns were: right ventricular insertion point n=28 (51%), mid wall n=18 (33%), sub-endocardial n=5 (9%) and sub-epicardial n=4 (7%). There were no differences in left ventricular structural or functional parameters with LGEpos. There were 12 adverse CV outcomes over follow up; 7 of 55 with LGEpos and 5 of 104 LGEneg. LGEpos was not predicted by age, gender, glomerular filtration rate or electrocardiographic abnormalities.Conclusions In a selected cohort of subjects with moderate CKD but low CV risk, LGE was present in approximately a third of patients. LGE was not associated with adverse CV outcomes. Further studies in high risk CKD cohorts are required to assess the role of LGE with multiplicative risk factors.

Diabetes Mellitus and Renal Function: Current Medical Research and Opinion

2021 ◽  
Vol 17 ◽  
Author(s):  
Moyad Shahwan ◽  
Nageeb Hassan ◽  
Rima Ahd Shaheen ◽  
Ahmed Gaili ◽  
Ammar Jairoun ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Current Medical Research ◽  
Vitamin D Insufficiency ◽  
The Body ◽  
Diabetic Patients ◽  
High Blood Glucose ◽  
Number Of Patients ◽  
Patients At Risk

Abstract:: Diabetes mellitus (DM) which is defined as high blood glucose level is a major public health worldwide. While discussing DM, the knowledge in this field is unlimited hence a syndrome that populations are living with for more than a decade is always an important matter to keep searching for updates on it. Challenges are always present in different means as comorbidities, poorly controlled DM especially type 2 Diabetes mellitus(T2DM) is considered as a risk factor for a lot of different diseases including but not limited to chronic kidney Disease (CKD). Complications might appear through time, as the aging process changes the body functions, while a significant number of antidiabetic medications are cleared eventually by the kidney; this increase the burden on kidney function placing the diabetic patients at risk. The significant high number of patients with uncontrolled diabetes resulting with kidney disease mirror the importance of this condition on patient’s quality of life. This review presents an overview, pathophysiology, etiology and prevalence of Chronic Kidney Disease (CKD) and abnormal renal parameters correlated with poorly controlled T2DM, with emphasis on and clinical studies involving the association between vitamin D Insufficiency/Deficiency and chronic kidney disease among patients with T2DM.

Abstract 79: Evidence to Maintain the SBP treatment threshold at 140 mmHg for Stroke Prevention in Persons Aged 60 Years or Older Without Diabetes Mellitus or Chronic Kidney Disease: The Northern Manhattan Study (NOMAS)

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Chuanhui Dong ◽  
Tatjana Rundek ◽  
Chensy Marquez ◽  
Clinton B Wright ◽  
Mitchell S Elkind ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Stroke Risk ◽  
Medication Use ◽  
Population Based ◽  
National Committee ◽  
Stroke Incidence ◽  
Increased Risk

Background: In 2014, the Eighth Joint National Committee recommended increasing target systolic blood pressure (SBP) from 140 to 150 mm Hg in persons aged ≥ 60 years without diabetes mellitus (DM) or chronic kidney disease (CKD). The evidence from population-based studies supporting the change was sparse. In a race/ethnically diverse prospective cohort, we examined incident stroke risk by SBP level in those aged ≥ 60 years without stroke, DM, or CKD at baseline. Methods: In the Northern Manhattan Study, there were 1706 participants aged ≥ 60 years and free of stroke, DM, and CKD at baseline. Incident strokes were identified through annual follow-up and adjudicated by two vascular neurologists. Cox proportional hazard models were used to estimate the multivariable-adjusted hazard ratio (HR) for baseline SBP categories and stroke risk. Results: At baseline, mean age was 72±8 years, 37% were male, 25% non-Hispanic white, 26% non-Hispanic black, and 49% Hispanic; 41% were on antihypertensive medication, and 43% had SBP <140 mm Hg, 20% 140-149 mm Hg, and 37% ≥150 mm Hg. With a median follow-up of 13 years, 167 participants developed a stroke. The crude stroke incidence was greater among individuals with SBP ≥150 mm Hg (10.0 per 1000 person-years) and SBP 140-149 (12.2) compared to those with SBP<140 (6.2). After adjustment for age, sex, race-ethnicity and medication use, participants with SBP 140-149 mm Hg had increased risk of stroke (HR, 1.7; 95% CI, 1.2-2.6) compared with those with SBP <140 mm Hg, and the increased risk remained in those without medication use (1.7; 1.0-3.0). Stratified analysis showed that the increased risk was seen in Hispanics (2.4; 1.3-4.7) and non-Hispanic blacks (2.0; 1.0-4.2) but not in non-Hispanic whites (0.8; 0.3-1.8). Conclusions: In a prospective diverse cohort, SBP 140-149 mm Hg was associated with an increased stroke risk, compared to those with SBP <140 mm Hg, in individuals aged 60 years or older without DM or CKD, in particular in Hispanics and non-Hispanic blacks. Raising the threshold for hypertension treatment could have a detrimental effect on stroke risk reduction especially among minority populations.

scholarly journals The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chia-Ter Chao ◽  
Szu-Ying Lee ◽  
Jui Wang ◽  
Kuo-Liong Chien ◽  
Kuan-Yu Hung
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Propensity Score ◽  
Cardiovascular Morbidity ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Risk Of Mortality

Abstract Background Chronic kidney disease (CKD) introduces an increased cardiovascular risk among patients with diabetes mellitus (DM). The risk and tempo of cardiovascular diseases may differ depending upon their type. Whether CKD differentially influences the risk of developing each cardiovascular morbidity in patients with newly diagnosed DM remains unexplored. Methods We identified patients with incident DM from the Longitudinal Cohort of Diabetes Patients (LCDP) cohort (n = 429,616), and uncovered those developing CKD after DM and their propensity score-matched counterparts without. After follow-up, we examined the cardiovascular morbidity-free rates of patients with and without CKD after DM, followed by Cox proportional hazard regression analyses. We further evaluated the cumulative risk of developing each outcome consecutively during the study period. Results From LCDP, we identified 55,961 diabetic patients with CKD and matched controls without CKD. After 4.2 years, patients with incident DM and CKD afterward had a significantly higher risk of mortality (hazard ratio [HR] 1.1, 95% confidence interval [CI] 1.06–1.14), heart failure (HF) (HR 1.282, 95% CI 1.19–1.38), acute myocardial infarction (AMI) (HR 1.16, 95% CI 1.04–1.3), and peripheral vascular disease (PVD) (HR 1.277, 95% CI 1.08–1.52) compared to those without CKD. The CKD-associated risk of mortality, HF and AMI became significant soon after DM occurred and remained significant throughout follow-up, while the risk of PVD conferred by CKD did not emerge until 4 years later. The CKD-associated risk of ischemic, hemorrhagic stroke and atrial fibrillation remained insignificant. Conclusions The cardiovascular risk profile among incident DM patients differs depending on disease type. These findings can facilitate the selection of an optimal strategy for early cardiovascular care for newly diagnosed diabetic patients.

scholarly journals Cardiac Implantable Electronic Devices in Hemodialysis and Chronic Kidney Disease Patients—An Experience-Based Narrative Review

2021 ◽  
Vol 10 (8) ◽  
pp. 1745
Author(s):  
Krzysztof Nowak ◽  
Mariusz Kusztal
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Access ◽  
Electronic Devices ◽  
Systemic Infection ◽  
Venous Hypertension ◽  
Central Vein ◽  
Cardiac Implantable Electronic Devices ◽  
Number Of Patients ◽  
End Stage

Cardiovascular implantable electronic devices (CIEDs) are a standard therapy utilized for different cardiac conditions. They are implanted in a growing number of patients, including those with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Cardiovascular diseases, including heart failure and malignant arrhythmia, remain the leading cause of mortality among CKD patients, especially in ESKD. CIED implantation procedures are considered minor surgery, typically with transvenous leads inserted via upper central veins, followed by an impulse generator introduced subcutaneously. A decision regarding optimal hemodialysis (HD) modality and the choice of permanent vascular access (VA) could be particularly challenging in CIED recipients. The potential consequences of arteriovenous access on the CIED side are related to (1) venous hypertension from lead-related central vein stenosis and (2) the risk of systemic infection. Therefore, when creating permanent vascular access, the clinical scenario may be complicated by the CIED presence on one side and the lack of suitable vessels for arteriovenous fistula on the contralateral arm. These factors suggest the need for an individualized approach according to different clinical situations: (1) CIED in a CKD patient; (2) CIED in a patient on hemodialysis CIED; and (3) VA in a patient with CIED. This complex clinical conundrum creates the necessity for close cooperation between cardiologists and nephrologists.

scholarly journals Myocardial Characterization in Pre-Dialysis Chronic Kidney Disease: A Study of Prevalence, Patterns and Outcomes

2019 ◽  
Author(s):  
Anna M Price ◽  
Manvir K Hayer ◽  
Ravi Vijapurapu ◽  
Saad A Fyyaz ◽  
William E Moody ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ckd Stage ◽  
Multiplicative Risk

Abstract Background Late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) characterizes myocardial disease and predicts an adverse cardiovascular (CV) prognosis. Myocardial abnormalities, are present in early chronic kidney disease (CKD). To date there are no data defining prevalence, pattern and clinical implications of LGE-CMR in CKD.Methods Patients with pre-dialysis CKD (stage 2-5) attending specialist renal clinics at University Hospital Birmingham (UK) who underwent gadolinium enhanced CMR (1.5T) between 2005 and 2017 were included. The patterns and presence (LGEpos) / absence (LGEneg) of LGE were assessed by two blinded observers. Association between LGE and CV outcomes were assessed.Results In total, 159 patients received gadolinium (male 61%, mean age 55 years, mean left ventricular ejection fraction 69%, left ventricular hypertrophy 5%) with a median follow up period of 3.8 years [1.04-11.59]. LGEpos was present in 55 (34%) subjects; the patterns were: right ventricular insertion point n=28 (51%), mid wall n=18 (33%), sub-endocardial n=5 (9%) and sub-epicardial n=4 (7%). There were no differences in left ventricular structural or functional parameters with LGEpos. There were 12 adverse CV outcomes over follow up; 7 of 55 with LGEpos and 5 of 104 LGEneg. LGEpos was not predicted by age, gender, glomerular filtration rate or electrocardiographic abnormalities.Conclusions In a selected cohort of subjects with moderate CKD but low CV risk, LGE was present in approximately a third of patients. LGE was not associated with adverse CV outcomes. Further studies in high risk CKD cohorts are required to assess the role of LGE with multiplicative risk factors.

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