Abstract 321: Impact Of Chronic Kidney Disease On Heart Failure Outcomes In A Minority Cohort

BACKGROUND: Heart failure (HF) and Chronic kidney disease (CKD) are major public health problems that often co-exist with a resultant high mortality and morbidity. Most of the studies evaluating their reciprocal prognostic impact have focused on mortality in majority populations. There is limited literature on the impact of CKD on HF morbidities in ethnic minorities. AIMS: Our study seeks to compare HF outcomes in patients with or without CKD in an African-American predominant cohort. METHODS: We obtained data from the NGH at Meharry Heart Failure Cohort; a comprehensive retrospective HF database comprised of patient care data (HF admissions, non-HF admissions, and emergency room visits) were assessed from January 2006 to December 2008. The study group consist of 306 subjects with a mean age of 65±15 years. 81% were African-American (AA), 19% Caucasian and 48.5% are females. Following the NKF KDOQI guidelines, 5 stages of CKD were outlined based on GFR. RESULTS: The overall prevalence of CKD in this population is 54.2%. CKD stage 1 was most prevalent with 45.8%, prevalence for stages 2-5 are 21.6%, 18.3%, 9.5% and 4.9% respectively. The comparison of the mean of ER visits, non HF hospitalizations and HF hospitalizations between normal and CKD patients was done using independent t-test and showed no significant difference in the mean number of ER visits (p=0.564), or HF hospitalizations(p=0.235). However, there is a statistically significant difference in the mean number of non -HF hospitalizations between normal and CKD patients (p=0.031). CONCLUSION: This study shows that the prevalence of CKD in this minority -predominant HF cohort is similar to prior studies in majority populations. However, only the non-HF hospitalizations were significantly increased in the CKD group. Future prospective studies will be needed to define the implications of this in the management of HF patients with CKD.

Download Full-text

P0949EFFECT OF DIETARY PHOSPHORUS RESTRICTION ON FIBROBLAST GROWTH FACTOR,KLOTHO AND BODY COMPOSITION IN CHRONIC KIDNEY DISEASE PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0949 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Trisha Sachan ◽

Anita Saxena ◽

Amit Gupta

Keyword(s):

Chronic Kidney Disease ◽

Body Composition ◽

Renal Function ◽

Kidney Disease ◽

Urinary Protein ◽

Dietary Phosphorus ◽

Ckd Stage ◽

Significant Difference ◽

The Mean ◽

Fgf 23

Abstract Background and Aims Changes in dietary phosphorus regulate serum FGF-23, parathyroid hormone, 1,25(OH)(2)D and Klotho concentrations . Cardiovascular disease (CVD) is the principal killer of patients with chronic kidney disease and hyperphosphetemia is a potent risk factor it. Of many causative factors for CVD in CKD, dietary interventions involving restriction of dietary phosphorous intake can help reduce onset of CVD at early stages of CKD with other corrective measures. Muscle wasting is a consequence of uremic syndrome which alters body composition. The aim of the study was to study effect of dietary phosphorous restriction on FGF-23, iPTH, Klotho, 1,25(OH)(2)D and body composition in chronic kidney disease patients. Method This is a longitudinal study with 12 months intervention, approved by Ethics Committee of the institute. A total 132 subjects were recruited (66 healthy controls, 66 CKD patient. of 66 patients 33 were in CKD stage 1 and 33 in stage 2. GFR was calculated with the help of MDRD formula. Biochemical parameters of subjects were evaluated at baseline, 6 and 12 months along with the anthropometric measurements (body weight, height, mid upper arm circumference (MUAC), and skin folds). Three days dietary recall was taken to evaluate energy, protein and phosphorous intake. CKD patients whose dietary phosphorous intake was more than 1000 mg/day, were given intense dietary counseling and prescribed dietary modifications by restricting dietary phosphorous between 800-1000 mg/day. Results The mean age of controls and patients was 37.01±9.62 and 38.27±12.06 and eGFR of 136.94±11.77 and 83.69±17.37 respectively. One way ANOVA showed significant difference among controls and the study groups in hemoglobin (p<0.001), s albumin (p<0.001), FGF-23 (p<0.001), klotho (p<0.001), urinary protein (p<0.001) and Nephron Index (p<0.001).The mean energy intake (p = 0.001) and dietary phosphorous intake (p<0.001) of the CKD patients decreased significantly with the decline in the renal function along with the anthropometric measures i.e. BMI (p = 0.041),WHR (p = 0.015) and all four skin folds (p<0.001). On applying Pearson’s correlation, eGFR correlated negatively with urinary protein (-0.739, 0.000), FGF-23 (-0.679, 0.000) and serum phosphorous (-0.697, 0.000) and positively with klotho (0.872, 0.000). FGF-23 correlated negatively with klotho (-0.742, 0.000). Dietary phosphorous was found to be positively correlated with urinary protein (0.496, 0.000), serum phosphorous (0.680, 0.000) and FGF-23 (0.573, 0.000) and negatively with Klotho (-0.602, 0.000). Nephron index revealed a positive correlation with eGFR (0.529, 0.000). Urinary protein correlated negatively with klotho (-0.810, 0.000). A multiple linear regression was run to predict eGFR from anthropometric variables such as BMI, WHR, MUAC, skin folds thickness and handgrip strength. All anthropometric variables predicted decline in eGFR (p<0.05, R2 =0.223). At 6 and 12 months; repeated ANOVAs analysis showed a statistically significant difference in serum creatinine (p=0.000), serum phosphorous (p=0.000), FGF-23(p=0.000) and klotho (p=0.000). Conclusion Elevated levels of FGF-23 and decreased Klotho levels, with the moderate decline in renal function improved with the restricted phosphorous diet at 6 and 12 months emphasizing the importance of phosphorus restriction at an early stage.

Download Full-text

Analysing the impact of a guideline for the use of new potassium binders for treatment of chronic hyperkalaemia to maximise inhibition of renin–angiotensin–aldosterone system (RAAS) within the general nephrology clinic?

10.21203/rs.3.rs-56113/v1 ◽

2020 ◽

Author(s):

Priyank Patel ◽

Andrew Frankel

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin ◽

Ckd Stage ◽

The Mean ◽

Potassium Binders ◽

The Impact ◽

Chronic Use

Abstract Background Renin–angiotensin–aldosterone system (RAAS) inhibitors provide significant cardiorenal benefits with improved long-term outcomes for patients. This is most significant for patients receiving maximal RAAS inhibition, but some patients are unable to tolerate this therapy because of hyperkalaemia. Recently published National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommended using sodium zirconium cyclosilicate (SZC) and patiromer for patients with chronic kidney disease (CKD) stage 3b to 5 or heart failure with reduced ejection fraction, who are not taking an optimised dosage of RAAS inhibitor because of hyperkalaemia. Objective Determine the impact of a locally produced guideline on effective implementation of NICE recommendation for use of SZC or patiromer to help maximise inhibition of the renin–angiotensin–aldosterone system within the general nephrology clinic. Methods A local guideline to practically support the implementation of recommendations made by NICE in the chronic use of new potassium binders was produced. One hundred sequential patients in a general nephrology clinic with non-immune chronic kidney disease (CKD 3 to 5) had their electronic records reviewed. Those with an indication for RAAS inhibition were identified. Results Of the 100 consecutive patients audited, 46 were female and 54 were male. The mean age of these patients was 64 and the mean estimated glomerular filtration rate (eGFR) was 33. Sixty-eight patients had an indication for being on RAAS inhibition with only 10 on maximal doses. Of the remaining 58 patients, 26 (45%) were limited by hyperkalaemia. Of these 26 patients, 12 of these patients (46%) had hyperkalaemia associated with an episode of acute kidney injury (AKI). Therefore, 14% of patients attending a general nephrology clinic were identified suitable for SZC and patiromer. Conclusions A significant proportion (14%) of unselected patients attending a general nephrology clinic were not on optimum RAAS inhibition due to hyperkalaemia. These patients would meet the criteria established within a working guideline for the implementation of the chronic use of SZC or patiromer and are likely to attain prognostic long-term benefit by using these new potassium binders to maximise RAAS inhibition. This analysis has implications for renal centres across the UK.

Download Full-text

P200 Arterial stiffness in patients with mild-to-moderate renal impairment

European Heart Journal ◽

10.1093/ehjci/ehz872.072 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

A B Md Radzi ◽

S S Kasim

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Stiffness ◽

Medical Center ◽

Linear Regression Analysis ◽

Younger Age ◽

Stage 4 ◽

Ckd Stage ◽

Significant Difference ◽

The Mean

Abstract Background Arterial damage in chronic kidney disease (CKD) is characterized by aortic stiffness. This is seen in elderly patients with advanced CKD. The association between arterial stiffness and early CKD is not well established. Objective: We aimed to study arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease (CKD) stage 2 to 4 and normal renal function in younger-age population. Design and Method: Patients with confirmed CKD stage 2 to 4 were recruited from various clinics from Universiti Teknologi MARA Medical Center, Sungai Buloh, Malaysia from 1st August 2015 until 31st January 2018. Sociodemographic and anthropometric indices were recorded on recruitment. Each patient underwent carotid-femoral (aortic) PWV measurement to determine arterial stiffness. PWV is determined using a one-probe device (SphygmoSore XCEL). Results: 87 patients with CKD stage 2–4 and 87 control patients were recruited. The mean age was 47 ± 5.4 years. CKD patients had a higher mean PWV (7.8 m/s ± 1.7) than healthy controls (5.6 m/s ± 1.0) (p < 0.001, 95% CI –2.59, –1.77). There was significant difference of mean PWV between control (5.6 m/s ± 1.0) and CKD stage 2 (7.6 m/s ± 1.5) (p < 0.001, 95% CI –2.40, –1.49). Our results showed a stepwise increase in PWV from control subjects, CKD stage 2 through stage 4 (p < 0.001). The mean difference of PWV between CKD stage 2 (7.6 m/s, ± 1.5) and stage 4 (9.0 m/s, ± 0.8) was 1.43 (p < 0.001, 95% CI –2.50, -0.35). There was significant difference of mean PWV between diabetes mellitus (DM) (8.2 m/s ± 1.8) and non-DM (7.3 m/s ± 1.3) patients with CKD stage 2–4 (p = 0.022, 95% CI –1.50, –0.12). Mutiple linear regression analysis showed only age (β = 0.078, p = 0.014), mean arterial pressure (MAP) (β = 0.031, p = 0.007) and diuretics usage as the combination antihypertensive medication (β = 0.839, p = 0.018) were independently associated with PWV (r2 = 0.249, p < 0.001). Conclusions: This study shows that arterial stiffness as assessed by PWV occurs early in CKD patient and increased arterial stiffness occurs in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger age population.

Download Full-text

The Copenhagen chronic kidney disease echo study (COInCYDE)

European Heart Journal ◽

10.1093/ehjci/ehaa946.3326 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Landler ◽

S Bro ◽

B Feldt-Rasmussen ◽

D Hansen ◽

A.L Kamper ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cardiac Function ◽

Left Ventricular ◽

Funding Source ◽

Ckd Stage ◽

Significant Difference ◽

Stage 1

Abstract Background The cardiovascular mortality of patients with chronic kidney disease (CKD) is 2–10 times higher than in the average population. Purpose To estimate the prevalence of abnormal cardiac function or structure across the stages CKD 1 to 5nonD. Method Prospective cohort study. Patients with CKD stage 1 to 5 not on dialysis, aged 30 to 75 (n=875) and age-/sex-matched controls (n=173) were enrolled consecutively. All participants underwent a health questionnaire, ECG, morphometric and blood pressure measurements. Blood and urine were analyzed. Echocardiography was performed. Left ventricle (LV) hypertrophy, dilatation, diastolic and systolic dysfunction were defined according to current ESC guidelines. Results 63% of participants were men. Mean age was 58 years (SD 12.6 years). Mean eGFR was 46.7 mL/min/1,73 m (SD 25.8) for patients and 82.3 mL/min/1,73 m (SD 13.4) for controls. The prevalence of elevated blood pressure at physical exam was 89% in patients vs. 53% in controls. Patients were more often smokers and obese. Left ventricular mass index (LVMI) was slightly, albeit insignificantly elevated at CKD stages 1 & 2 vs. in kontrols: 3.1 g/m2, CI: −0.4 to 6.75, p-value 0.08. There was no significant difference in LV-dilatation between patients and controls. Decreasing diastolic and systolic function was observed at CKD stage 3a and later: LVEF decreased 0.95% (CI: −1.5 to −0.2), GLS increased 0.5 (CI: 0.3 to 0.8), and OR for diastolic dysfunction increased 3.2 (CI 1.4 to 7.3) pr. increment CKD stage group. Conclusion In accordance to previous studies, we observe in the CPHCKD cohort study signs of early increase of LVMI in patients with CKD stage 1 & 2. Significant decline in systolic and diastolic cardiac function is apparent already at stage 3 CKD. Figure 1. Estimated GFR vs. GLS & histogram of GLS Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Capital Region of Denmark

Download Full-text

Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0673 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Hamatani ◽

M Iguchi ◽

Y Aono ◽

K Ishigami ◽

S Ikeda ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Clinical Outcomes ◽

Prognostic Marker ◽

Oral Anticoagulants ◽

Systemic Embolism ◽

The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction <40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P<0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

Download Full-text

Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084370 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4370

Author(s):

A Kim ◽

Hayeon Lee ◽

Eun-Jeong Shin ◽

Eun-Jung Cho ◽

Yoon-Sook Cho ◽

...

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Medication Management ◽

Medication Use ◽

Potentially Inappropriate Medications ◽

Management Service ◽

Ckd Stage ◽

The Impact

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

Download Full-text

Renal Function in Patients with Hypertension Associated Congestive Cardiac Failure Seen in a Tertiary Hospital

International Journal of Nephrology ◽

10.1155/2012/769103 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

C. U. Osuji ◽

C. U. Nwaneli ◽

B. J. Onwubere ◽

E. I. Onwubuya ◽

G. I. Ahaneku

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiac Failure ◽

Tertiary Hospital ◽

Congestive Cardiac Failure ◽

University Teaching ◽

Ethical Review ◽

Serum Urea ◽

Significant Difference ◽

The Mean

Background. Chronic kidney disease is frequently seen in patients with congestive cardiac failure and is an independent risk factor for morbidity and mortality. The aim of this study was to determine the prevalence of chronic kidney disease in patients with hypertension associated congestive cardiac failure.Method. One hundred and fifty patients with hypertension associated congestive cardiac failure were recruited consecutively from the medical outpatient department and the medical wards of the Nnamdi Azikiwe University Teaching Hospital Nnewi over a one year period, January to December 2010. Patients’ biodata and medical history were obtained, detailed physical examination done and each patient had a chest X-ray, 12 lead ECG, urinalysis, serum urea and creatinine assay done. Ethical clearance was obtained from the Ethical Review Board of our institution and data analysed using SPSS-version 16.Results. There were 86 males and 64 females with mean age62.7±12.5years. The mean blood pressures were systolic152.8±28.5 mmHg and diastolic94.3±18 mmHg. 84.7% had blood pressure ≥140/90 mmHg on presentation. The mean GFR was70.1±31.3 mls/min. 76% of subjects had GFR <90 mls/min and no statistical significant difference between males and females,P=0.344. The mean serum urea was7.2±51 mmol/L while the mean serum creatinine was194±416.2 mmol/L.Conclusions. This study has demonstrated that majority of patients presenting with hypertension associated congestive cardiac failure have some degree of chronic kidney disease.

Download Full-text

A Study of Executive Function in Patients with Chronic Kidney Disease before and after a Single Session of Hemodialysis

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1703961 ◽

2020 ◽

Vol 11 (02) ◽

pp. 250-255

Author(s):

Vasantmeghna S. Murthy ◽

Vedant S. Shukla

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Statistical Tests ◽

T Test ◽

Emotional States ◽

Single Session ◽

Dialysis Unit ◽

Before And After ◽

The Mean ◽

The Impact

Abstract Background Executive functions (EFs) are critical to daily life and sensitive to our physiological functioning and emotional states. The number of people living with chronic kidney disease (CKD) on hemodialysis (HD) globally is increasing steadily. We aimed to determine the impact of a single session of HD on EFs in patients with CKD receiving maintenance HD (MHD). Methods This was a quasi-experimental study conducted at the department of psychiatry and dialysis unit of a tertiary hospital. Patients undergoing MHD underwent screening to rule out delirium, using the Confusion Assessment Method prior to EF testing. The tests of EF used were the Trail-Making Test—Part B (TMT-B) and Frontal Assessment Battery (FAB), both of which were administered before and after a session of HD. Statistical tests used were Wilcoxon matched pairs signed ranks test, paired t-test, single sample t-test, and correlation analyses. Results The mean time taken on TMT-B before HD was 195.36 seconds and after HD, 171.1 seconds; difference is significant (p = 0.0001). The mean FAB score was 13.19 before HD and 14.83 after HD; the difference is significant (p < 0.0001). Significant differences were observed on similarities (p = 0.003), lexical fluency (p = 0.02), and go–no go (p = 0.003) subtests of FAB. Mean TMT-B scores before and after HD differed significantly from that of a reference study (reference TMT-B 150.69 seconds), p = 0.0002 and 0.04, respectively. Conclusion We conclude that patients with CKD on MHD, in general, have worse executive cognitive functioning compared with healthy populations. A session of HD results in significant improvement in these functions.

Download Full-text

P5475Essential thrombocytosis is associated with worse hospital outcomes in patients presented with acute myocardial infarction: a propensity score analysis of the National Inpatient Sample

European Heart Journal ◽

10.1093/eurheartj/ehz746.0429 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Wu ◽

B Liu ◽

Y Zheng

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Propensity Score ◽

Matched Control ◽

National Inpatient Sample ◽

Essential Thrombocytosis ◽

The Impact

Abstract Background/Introduction Essential thrombocytosis (ET) is a rare disease characterized by vasomotor symptom, thrombotic event, and hemorrhage. Due to its rare occurrence, limited data are available to examine the impact of ET on acute myocardial infarction (AMI). Purpose To evaluate the impact of ET on hospital outcomes of AMI. Methods We use the 2016 National Inpatient sample database to identify all the admissions with a principal diagnosis of AMI with or without ET. A matched control group was then generated using propensity score from age, sex, race, location, insurance, income, hospital type, hospital location, Charlsoncat Comorbidity Score. Prevalence, baseline characteristic of AMI patient with or without ET was described and compared. Univariable logistic regression was used to measure mortality and the rate of catheterization. Results ET was found in 0.28% (1,814) in total AMI admissions (641,854). Age (69.52 vs 69.70), female percentage (48.04% vs 48.03%) and baseline comorbidities including STEMI (27.49% vs 25.08%), diabetes (33.03% vs 30.51%), heart failure (40.18 vs 45.89%) and chronic kidney disease (22.05% vs 26.28%) was found to be comparable between two groups (p>0.05, table 1). Compared to non ET group, ET is associated with significantly higher hospital mortality (5.74% vs 2.43%, OR 2.44 [1.09–5.48], p=0.03), prolonged length of stay (7.61 vs 4.30 days, p<0.01). Interestingly, ET is also associated with lower utilization of cardiac catheterization (37.46% vs 46.52%, p=0.01). Essential Thrombocytosis and AMI Parameter AMI with ET Matched control: AMI without ET Odds ratio (95% CI) P value (n=1,814) (n=1,814) Age, years 69.52±0.72 69.70±0.70 p>0.05 Female, % 48.04 48.03 p>0.05 STEMI, % 27.49 25.08 p>0.05 Hypertension, % 81.57 83.08 p>0.05 Diabetes, % 33.03 30.51 p>0.05 Heart failure, % 40.18 45.89 p>0.05 Chronic kidney disease, % 22.05 26.28 p>0.05 Mortality, % 5.74 2.43 2.44 (1.09–5.48) p=0.03 Catheterization, % 37.46 46.52 0.68 (0.51–0.91) P=0.01 Length of stay, days 7.61±0.48 4.30±0.21 P<0.01 Values are reported as mean ± S.E. Categorical variables are represented as frequency. Conclusion ET is infrequently observed in patients with AMI. Having ET is associated with higher hospital mortality, longer hospital stay and lower utilization of cardiac catheterization. Acknowledgement/Funding None

Download Full-text

Beta-blockers in elderly patients with left ventricular systolic dysfunction and chronic kidney disease: danger or benefit?

European Heart Journal ◽

10.1093/ehjci/ehaa946.3231 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Martinez Milla ◽

M Cortes ◽

M Lopez-Castillo ◽

A Devesa-Arbiol ◽

A.L Rivero-Monteagudo ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Propensity Score ◽

Ejection Fraction ◽

Beta Blockers ◽

Hospital Records ◽

Propensity Score Matching Analysis ◽

The Mean

Abstract Introduction Beta-blockers (BB) have been shown to reduce mortality in patients with HFrEF. However, there is little data on the benefit of these therapies in patients with chronic kidney disease and even less in older patients. The aim of this work is to evaluate the role of beta-blockers in patients ≥75 years along the spectrum of kidney disease. Methods From January 2008 to July 2014, we consecutively enlisted 802 patients aged >75 years that had ejection fraction ≤35%. From this group we included 380 patients that had CKD (defined as a glomerular filtration rate (GFR) ≤60 ml/min/1.73m2). Clinical, echocardiographic and electrocardiographic data were taken from hospital records. Follow-up was made via telephone and hospital records as well. Propensity score matching analysis was made to assess the relationship between treatment with BB and occurrence of major adverse cardiovascular event (MACE) composite of death for any cause or heart failure. hospitalization. Multivariate Cox regression analysis was also made in the different groups of CKD (45–60 ml/min/1.73m2, 30–45 ml/min/1.73m2, <30 ml/min/1.73m2) in order to assess the effect of BB over mortality and CV events in each subgroup. Results 390 patients were included. Male represented 62.3% of all participants, and the mean age was 82.6±4.1 years. The mean ejection fraction was 27.9±6.5%. Ischemic etiology was found in 50.6% of cases. Glomerular filtrate (GF) was 60 to 45 ml/min/1.73 m2 in 50.3% of patients, 45–30 ml/min/1.73 m2 in 37.4% and <30 ml/min/1.73 m2 in 12.3%. At the end of the follow-up, 67.4% of the patients were on beta-blocker treatment. The mean follow-up was 32±23 months. During the study period, 211 patients (54.1%) died and 257 patients (65.9%) had a major cardiovascular event (death or hospitalization for heart failure). After propensity score matching analysis, 178 were considered (89 each group) and they have no significant difference in baseline characteristics. BBs were found to significantly reduce mortality (HR 0.45 (95% CI, 0.27–0.75). When the effect of BB over the different subgroups of CKD was analyzed, it was seen also that BB reduced mortality in patients with eGFR 45–60 ml/min/1.73 m2 (HR 0.47 (95% CI, 0.26–0.86), in patients with eGFR 30–45 ml/min/1.73 m2 (HR 0.55 (95% CI, 0.26–1.06)and in eGFR <30 ml/min/1.73 m2 (HR 0.29 (95% CI, 0.11–0.76) Conclusion The use of beta-blockers in elderly patients with HFrEF and kidney DISEASE was associated with increased survival, regardless of the degree of kidney failure. There is a need to raise awareness of the benefits of beta-blocker use in these patients to promote their use where possible. Funding Acknowledgement Type of funding source: None

Download Full-text