scholarly journals Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease: Efficacy and Safety

2016 ◽  
Vol 41 (1-3) ◽  
pp. 166-170 ◽  
Author(s):  
Andrew S. Bomback
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Mineralocorticoid Receptor ◽  
Left Ventricular ◽  
Efficacy And Safety ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Mineralocorticoid receptor antagonists (MRAs) that block aldosterone's effects on both epithelial and non-epithelial receptors have become a mainstay of therapy for chronic heart failure. Given that cardiovascular events remain the leading cause of death for patients with end-stage renal disease (ESRD), the question of whether these MRAs can be employed in dialysis patients arises. This review summarizes the rationale for blocking aldosterone in patients with chronic and end-stage kidney disease and surveys the data on both the efficacy and safety of using MRAs in the ESRD population. A small but growing body of literature suggests that use of MRAs by ESRD patients is associated with lower blood pressure, reduced left ventricular (LV) mass, and improved LV ejection fraction. Recently, a large randomized trial found an overall 3-year mortality rate of 6.4% in ESRD patients on spironolactone 25 mg daily vs. 19.7% in ESRD patients on no MRA therapy (p = 0.002), without a significantly increased risk of hyperkalemia.

Effect of Ultrafiltration on Sleep Apnea and Cardiac Function in End-Stage Renal Disease

2020 ◽  
Vol 51 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Toru Inami ◽  
Owen D. Lyons ◽  
Elisa Perger ◽  
Azadeh Yadollahi ◽  
John S. Floras ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Renal Disease ◽  
Cardiac Function ◽  
End Stage Renal Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systolic And Diastolic Function ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Rationale: End-stage renal disease (ESRD) patients have high annual mortality mainly due to cardiovascular causes. The acute effects of obstructive and central sleep apnea on cardiac function in ESRD patients have not been determined. We therefore tested, in patients with ESRD, the hypotheses that (1) sleep apnea induces deterioration in cardiac function overnight and (2) attenuation of sleep apnea severity by ultrafiltration (UF) attenuates this deterioration. Methods: At baseline, ESRD patients, on conventional hemodialysis, with left ventricular ejection fraction (LVEF) >45% had polysomnography (PSG) performed on a non-dialysis day to determine the apnea-hypopnea index (AHI). Echocardiography was performed at the bedside, before and after sleep. Isovolumetric contraction time divided by left ventricular ejection time (IVCT/ET) and isovolumetric relaxation time divided by ET (IVRT/ET) were measured by tissue doppler imaging. The myocardial performance index (MPI), a composite of systolic and diastolic function was also calculated. One week later, subjects with sleep apnea (AHI ≥15) had fluid removed by UF, followed by repeat PSG and echocardiography. ­Results: Fifteen subjects had baseline measurements, of which 7 had an AHI <15 (no–sleep-apnea group) and 8 had an AHI ≥15 (sleep-apnea group). At baseline, there was no overnight change in the LVEF in either the no-sleep-apnea group or the sleep-apnea group. In the no-sleep-apnea group, there was also no overnight change in MPI, IVCT/ET and IVRT/ET. However, in the sleep-apnea group there were overnight increases in MPI, IVCT/ET and IVRT/ET (p = 0.008, 0.007 and 0.031, respectively), indicating deterioration in systolic and diastolic function. Following fluid removal by UF in the sleep-apnea group, the AHI decreased by 48.7% (p = 0.012) and overnight increases in MPI, IVCT/ET and IVRT/ET observed at baseline were abolished. Conclusions: In ESRD, cardiac function deteriorates overnight in those with sleep apnea, but not in those without sleep apnea. This overnight deterioration in the sleep-apnea group may be at least partially due to sleep apnea, since attenuation of sleep apnea by UF was accompanied by elimination of this deleterious overnight effect.

scholarly journals Clinical Manifestations of Cardiac Disease in Patients with End Stage Renal Disease Under Maintenance Hemodialysis in a Tertiary Level Hospital of Nepal

2016 ◽  
Vol 15 (1) ◽  
pp. 61-65
Author(s):  
Kumar Roka ◽  
Pratibha Bista Roka
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Low Voltage ◽  
Clinical Manifestations ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Introduction: End stage renal disease presents with multiple clinical and systemic manifestations. The aim of the present study was to identify the early cardiac and other morbidities in end stage renal disease (ESRD) patients who were under maintenance hemodialysis.Methods: This was an observational, prospective study conducted in fifty established ESRD patients of 20 to 74 years under maintenance hemodialysis in Nephrology unit of Shree Birendra Hospital. Clinical examination, laboratory parameters, electrocardiogram and echocardiography findings were used to identify the morbidities. Results: Among all patients enrolled in the study 88.7% had anemia, 64.2 % systolic murmurs, 62.26 % pedal edema, 73.6 % fatiguability, 71.7 % angina, 24.4 % palpitations and 13.2 % had breathlessness on exertion.  62.26% of the patients had hypertension and 13.20 % had diabetes. In the electrocardiogram, prolonged QTc was observed in 10.4%, followed by T wave inversion in 9.4 % and finally low voltage complex comprised 7.6 %. The echocardiogram showed left ventricular diastolic dysfunction in 58.5 %, left ventricular hypertrophy (overall type) 49 % and valvular lesion like mitral regurgitation and tricuspid regurgitation 83 % and 58.5 % respectively. Conclusion: Cardiac co-morbidities are common in patients diagnosed with ESRD on maintenance hemodialysis.

scholarly journals Intradialytic Arrhythmias Among Patients with End Stage Renal Disease on Maintenance Hemodialysis at Muhimbili National Hospital

2021 ◽  
Author(s):  
Wailesy Adam ◽  
Tumaini Nagu ◽  
Reuben Mutagaywa ◽  
Onesmo Kisanga
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Ventricular Hypertrophy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Clinically Significant ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract BackgroundArrhythmias are responsible for almost 2 out of 3 cardiac deaths among patients on hemodialysis. We report the prevalence and risk factors for clinically significant arrhythmias among end stage renal disease (ESRD) patients on maintenance dialysis at a tertiary dialysis facility in Tanzania. MethodsCross-sectional study, involving consenting adults with ESRD was conducted September 2019 to February 2020. Arrhythmias were assessed using standard 5-leads Holter electrocardiography placed 15 minutes before dialysis and connected throughout dialysis. Clinically Significant Arrhythmias (CSA) was defined as ectopic beats in excess of 10 per hour or any of the ventricular tachycardia or Pause lasting for at least 2.5 seconds or paroxysmal supraventricular tachycardia or atrial flutter or atrial fibrillation. ResultsA total of 71 (44.4%) participants had CSA. Factors associated with increased risk for CSA were: age older than 60 years (OR 34; 95% CI: 5.15-236; P< 0.001), intradialytic blood pressure change of ≥ 10mmHg (OR 3.85; 95% CI: 1.27-11.7; P=0.017) and the presence of Left Ventricular Hypertrophy (OR 5.84; 95% CI: 1.85-18.4; P< 0.01). On the contrary, three dialysis sessions per week (OR 0.14; 95% CI: 0.03-0.67; P=0.013) and use of beta-blockers (OR 0.18; 95% CI: 0.05-0.68; P=0.011) were significantly associated with a decreased risk of CSA. ConclusionClinically significant arrhythmias are not uncommon in ESRD patients undergoing maintenance haemodialysis. We recommend increasing vigilance for CSA among older patients (>60 years) as well as those with left ventricular hypertrophy. Beta blockers among hypertensive ESRD patients with ventricular hypertrophy could be helpful.

Prevalence of Left Ventricular Diastolic Dysfunction by Tissue Doppler Imaging in Patients with End Stage Renal Disease undergoing Regular Dialysis with Preserved Systolic Function

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed A Elkaialy ◽  
Walid M Sallam ◽  
Sameh S Thabet ◽  
Magdy A Gharieb
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
Tissue Doppler Imaging ◽  
End Stage Renal Disease ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background Left ventricular hypertrophy (LVH) is the principal myocardial alteration in patients with ESRD due to multiple preload and afterload factors related to hemodialysis leading to left ventricular diastolic dysfunction manifested by signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The use of echocardiography and tissue Doppler imaging is essential to detect diastolic dysfunction in ESRD patients undergoing hemodialysis as the prevalence of diagnosing HFpEF in ESRD patients is under-estimated. Objective To evaluate the possible impact of renal replacement therapy in the form of regular dialysis provided to end stage renal disease patients on left ventricular diastolic function by implementing tissue doppler imaging. Patients and Methods The study included 100 ESRD patients on regular dialysis presenting to the dialysis unit in Ain Shams University Hospitals. The inclusion criterion was end stage renal disease patients with GFR &lt; 15 ml/min/1.73 m2 on regular dialysis for more than 6 months. Excluded patients were those above than 80 yrs old, with hemodynamic instability, arrhythmias, valvular diseases, ischemic conditions, and LV systolic dysfunction. After the hemodialysis session, ECG gated echocardiography was done applying pulsed wave Doppler on mitral valve to detect E/A ratio, continuous wave Doppler on tricuspid valve to calculate TR vmax, and tissue Doppler on lateral mitral annulus to detect e’ and E/e’ ratio. Moreover, left atrial volume index (LAVI) and other standard echocardiographic parameters were measured. Full history and clinical examination including ECG recording was done and blood samples were taken to measure hemoglobin levels. Patients were then stratified according to their diastolic dysfunction grading. Results Seventy eight percent (78%) of the patients showed diastolic dysfunction including 46 % showed grade I diastolic dysfunction, 26 % showed grade II diastolic dysfunction and 6% showed grade III diastolic dysfunction. Hemoglobin levels showed significant negative correlation with E, E/A, E/E’, LAVI and TR Vmax (r = -0.25, -0.37, -0.29, -0.23 and -0.31 with p 0.012, &lt;0 .001, &lt; 0.003, 0.002 & &lt;0 .001 respectively). Multiple regression analysis revealed smoking, DM, Hb, LVPWd, EF, E/A, LAVI and TR Vmax presented the important determinants of diastolic filling (β = -0.16, 0.15, -0.20, -0.27, -0.25, 0.16, 0.39 & 0.27 and p = 0.002, 0.045, &lt; 0.001, 0.022, &lt; 0.001, 0.039, &lt; 0.001 & &lt; 0.001 respectively). Comparing E/A ratio with E/e’ ratio sensitivities revealed E/A ratio was 28.2% while E/e’ ratio was 74.3%. This was statistically significant showing a difference between the two modalities (χ2 = 33.2526 and p = &lt; 0 .0001). Conclusion In ESRD patients, maladaptive events leading to LVH and diastolic dysfunction occur frequently. Thus, early identification and treatment of factors involved in order to prevent this devastating process. Now it seems that TDI and E, E/A and E/E’ parameters are good instruments for the early detection of LVH and diastolic dysfunction as they are important risk factors for cardiovascular morbidity and mortality in CKD. In comparison with the conventional Doppler techniques, tissue Doppler is a vital tool in diagnosing diastolic dysfunction.

Identification of Iron Agglomerates by T2* MRI In Major Organs of Patients with End-Stage Renal Disease Who Receive Regularly Erythropoietin with Intravenous Iron

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2058-2058
Author(s):  
Hussam Ghoti ◽  
Orly Goitein ◽  
Raid Jaber ◽  
ze’Ev Katzir ◽  
Eli Konen ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Iron Supplementation ◽  
Left Ventricular ◽  
Iron Deposition ◽  
Iv Iron ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
T2 Mri

Abstract Abstract 2058 The anemia of patients with end-stage renal disease (ESRD) undergoing hemodialysis is significantly improved following treatment with recombinant human erythropoietin (rHuEpo). However, the optimal response is determined by the availability of iron for erythropoiesis, particularly when it is administered intravenously (iv). Consequently, the use of iv iron in conjunction with rHuEpo has become standard practice in most hemodialysis programs worldwide to increase Hb levels >11gm/dl. Currently, the used parameters for judicious determination of iron supplementation and body iron status still rely on measurements of serum ferritin (SF) and percent transferrin saturation (TSAT). These measurements might be misleading since SF is an acute phase reactant, increased by inflammation, which is frequent in ESRD patients, while TSAT levels are subject to diurnal fluctuations. Moreover, following administration of iv iron, the values of TSAT are artificially increased since standard clinical assays assume all plasma iron is bound to transferrin, including iron forms administrated with iv supplements. While in plasma, these forms transiently generate labile plasma iron (LPI), which is redox active and prone to generate oxidative damage of plasma components, as previously demonstrated following iv iron saccharate administration in ESRD patients. The kinetics of utilization of iron supplements indicate that at any given time a major fraction of the iron is withdrawn from plasma into the reticuloendothelial system (spleen and liver) and that the dwelling time of the iron in tissue might expose those organs to deleterious effects mainly in chronic conditions. Iron processing might be further delayed due to blockage of iron export evoked by hepcidin-mediated repression of ferroportin. As T2* MRI sequence has been validated as a reliable, reproducible methodology for non-invasive assessment of iron agglomerates, it has been used for assessing pathological iron accumulation in organs of iron overloaded (IO) patients. The present study measured by T2* MRI the organ distribution of iron agglomerates in 12 ESRD patients (7 males and 5 females, mean age 61.5 years; mean Hb level of 9.0g/dl) undergoing dialysis for at least 1 year (range 1–12) treated with rHuEpo and 100mg of iron saccharate (Venofer) given iv once a week. Serum samples were collected 7 days after iv iron. The median SF level was 2883 ng/ml (range 1756–6820) and mean TSAT was 70.5% (range 41–122). The patients are nearly 10% from a group of 140 dialyzed patients treated in a single hemodialysis facility, characterized by chronic inflammatory state with refractory anemia to rHuEpo without regular iron supplementation. MRI (1.5T, GE MRI system) sequences included: steady-state free precession (SSFP) for left ventricular ejection fraction (LVEF) evaluation; breath-hold T2* multi echo gradient for iron load quantification, sampled across regions of interest in the left ventricular septum, liver, spleen and pancreatic parenchyma. The results showed major iron deposition in the liver, (median 1.95ms, range 1–15) and spleen (median 2.8ms, range 1–15) while cardiac function was normal and no iron deposition in the heart (median 36ms, range 29–42) (table 1). Pancreas T2* measurements (normal values 41±7ms) were obtained only in 4/11 patients due to their inability to sustain sufficient breath holds. In 2/4 of the patients the median T2* of 8.5ms, (range 8–9) in pancreas was indicative of major iron accumulation. LPI levels were detected in 4/11 patients (range 0.2–0.7μM) with SF levels >3000ng/ml. These results indicate that in dialyzed ESRD patients (1-12 years) with chronic inflammation with mean SF levels of 2883 ng/ml and mean TSAT of 70.5% that received weekly iv iron, major iron deposition was demonstrated in liver and spleen but none in the heart. Implementation of T2* MR imaging was able to detect iron agglomerates which might reflect transitory iron-saccharate particles in the process of solubilization or residual particles accumulating due to inability of the system to process them. However, they might also reflect a more persistent state of regional IO with deleterious implications that need further exploration. Disclosures: No relevant conflicts of interest to declare.

MO735INTERPLAY BETWEEN GDF-15 AND LEFT VENTRICULAR HYPERTROPHY IN END-STAGE RENAL DISEASE PATIENTS ON DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Susana Coimbra ◽  
Cristina Catarino ◽  
Maria do Sameiro Faria ◽  
José Pedro Lopes Nunes ◽  
Susana Rocha ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Ventricular Hypertrophy ◽  
Tissue Injury ◽  
Left Ventricular ◽  
Dialysis Vintage ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background and Aims Cardiovascular disease (CVD) is the major cause of mortality and morbidity in chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients. Left ventricular hypertrophy (LVH) is a common cardiovascular complication in CKD. Growth differentiation factor (GDF)-15 increases in tissue injury and inflammatory states associated with cardiometabolic risk. GDF-15 and N-terminal pro B-type natriuretic peptide (NT-proBNP) are both synthesized by cardiomyocytes and may be associated with cardiorenal dysfunction. Our aim was to study the association of GDF-15 with LVH in ESRD patients on dialysis. Method This study included 196 ESRD patients on dialysis (hemodiafiltration and high-flux hemodialysis). Left ventricular mass (LVM) was evaluated through echocardiographic studies, corrected for body surface area and the values are presented as LVM index (LVMI). LVH was defined by a value of LVMI &gt; 115 g/m2 in men and &gt; 95 g/m2 in women. Patients were divided into two groups - LVH (n=131) and non-LVH (n=65). LVMI, clinical and analytical variables (age, body mass index, dialysis vintage, dialysis adequacy, GDF-15, NT-proBNP and pentraxin (PTX) 3 were evaluated. Results ESRD patients with LVH presented significantly higher levels of NT-proBNP and GDF-15, and a trend towards higher PTX3 values. In LVH patients, GDF-15 correlated positively and significantly with NT-proBNP and PTX3; LVMI correlated positively and significantly with pro-BNP and PTX3 levels; pro-BNP correlated significantly and positively with PTX3. Conclusion Our data show that in ESRD patients on dialysis with LVH, GDF-15 is raised and shows a strong association with NT-proBNP, PTX3 and LVMI. Further studies are needed to clarify if the rise in GDF-15 is a cause or a consequence of LVH development. Acknowledgments This work was supported by Applied Molecular Biosciences Unit-UCIBIO, financed by national funds from FCT/MCTES (UIDB/04378/2020), by North Portugal Regional Coordination and Development Commission (CCDR-N)/NORTE2020/Portugal 2020 (Norte-01-0145-FEDER-000024) and by REQUIMTE-Rede de Química e Tecnologia-Associação in the form of a researcher (S. Rocha) – project Dial4Life co-financed by FCT/MCTES (PTDC/MEC-CAR/31322/2017) and FEDER/COMPETE 2020 (POCI-01-0145-FEDER-031322).

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