Continuous Ambulatory Peritoneal Dialysis in High-Risk Patients: Patients with Cardiovascular Diseases -Role of the Nurse

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 499-503
Author(s):  
Marie-Christine Z. Lambert ◽  
Holger Schilling
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Ventricular Hypertrophy ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Therapeutic Success ◽  
Risk Patients ◽  
Continuous Peritoneal Dialysis ◽  
Artery Disease

Most patients receiving renal replacement therapy have cardiovascular disease. The most frequent conditions are left ventricular hypertrophy and coronary artery disease. Hemodialysis is associated with a characteristic spectrum of acute complications (such as hypotension, sudden death) that can be explained by typical dialysis -induced effects on the heart. With continuous peritoneal dialysis (CAPO) some of the cardiovascular complications are ameliorated owing to slow ultrafiltration and absence of an arteriovenous fistula. CAPO might be concluded to be the preferable option in patients with cardiovascular disease, but a few disadvantages, such as hyperlipidemia and hyperinsulinemia, also exist. Nurses also play an important role in the therapeutic success and outcomes of these patients.

“ A STUDY OF CARDIOVASCULAR ABNORMALITY IN HYPERTENSIVE PATIENTS”

2021 ◽  
pp. 23-26
Author(s):  
Balendra Shekhar Deepankar ◽  
Saurabh Singh Thakur ◽  
Vimlesh Patidar
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Risk Factor ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Study Group ◽  
Hypertensive Patients ◽  
Cardiovascular Abnormality ◽  
Artery Disease

Introduction: Hypertension is a common health problem in developed countries and a major risk factor for cardiovascular diseases. Hypertension exhibits an iceberg phenomenon where unknown morbidity exceeds the known morbidity. Genetic and environmental factors are also reported to play a key role in hypertension, 90% of which are better classied as idiopathic. The cause of cardiovascular diseases in the hypertensive patient is blood pressure raised which is present chronically however the cause of elevated BP are different. In adults, 90% of hypertension cases are of essential hypertension .The Remaining 10% of hypertension cases with chronically elevated BP accounts for secondary cause. In hypertensive patient, the risk of cardiovascular disease is increases in men and women. Hypertension and diabetes mellitus are among the most common chronic non-communicable diseases and multifactorial disorders affecting both developed and developing countries and occur at a higher prevalence in the older age group and result from both genetic and environmental etiological factors. The aim of Study of Cardiovascular Abnormality in the Hypertension Patient. Methods: A prospective observational study consists of 95 cases of hypertension is undertaken to study the cardiovascular abnormality by ECG and ECHO. The study will be conducted on patients suffering from hypertension. A written informed consent will be taken from all the patients who are included in study group. All the data of the patients will be recorded on a pretested Performa. Preliminary data like name, age, sex, occupation, residence, date will be recorded. Detailed lipid prole study will be done to nd the correlation in patients with hypertension. All data will be statistically analyzed. Results: Out of 95 cases in the study group, 51 were female cases and 44 were males, 31 cases (7th decade), 40 cases (6th decade), 14 cases (5th decade), 8 cases(4th decade), 2 cases (< 3rd decade). Abnormal ECG changes which constitutes 85 patients, ST elevation was present in 12 patients and T-wave inversion was present in 47 patients, followed by 16 patients were shows left ventricular hypertrophy, 8 cases of cardiomyopathy which shows low voltage complexes. Coronary artery disease was predominant nding in the patients of hypertensive cardiovascular disease which was present in 54 cases out of 95 cases, of which 31 were male patients and 23 were female patients. CAD in hypertension (57%), the incidence of CAD was more in elderly and other abnormalities in hypertensive patients were left ventricular hypertrophy(11.6%), heart failure{due to cardiomyopathy(8.2%) and CAD} and valvular heart disease(4.2%). Conclusion: Cardiovascular abnormality in hypertensive patients encompasses a broad spectrum including coronary artery disease, asymptomatic LVH (either a concentric or an eccentric pattern) and clinical heart failure (with either a preserved or a reduced LVEF) stroke, heart failure, cardiomyopathy, arrhythmia, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis. Elderly age, smoking habits, chronic alcoholism and long standing history of DM have emerged as important risk factor for cardiovascular disease in hypertensive patients.

scholarly journals Npt2a as a target for treating hyperphosphatemia

2022 ◽  
Author(s):  
Linto Thomas ◽  
Jessica A. Dominguez Rieg ◽  
Timo Rieg
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Function ◽  
Ventricular Hypertrophy ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Potential Treatment ◽  
Elevated Plasma ◽  
Pi Homeostasis ◽  
Reduced Kidney Function

Hyperphosphatemia results from an imbalance in phosphate (Pi) homeostasis. In patients with and without reduced kidney function, hyperphosphatemia is associated with cardiovascular complications. The current mainstays in the management of hyperphosphatemia are oral Pi binder and dietary Pi restriction. Although these options are employed in patients with chronic kidney disease (CKD), they seem inadequate to correct elevated plasma Pi levels. In addition, a paradoxical increase in expression of intestinal Pi transporter and uptake may occur. Recently, studies in rodents targeting the renal Na+/Pi cotransporter 2a (Npt2a), responsible for ∼70% of Pi reabsorption, have been proposed as a potential treatment option. Two compounds (PF-06869206 and BAY-767) have been developed which are selective for Npt2a. These Npt2a inhibitors significantly increased urinary Pi excretion consequently lowering plasma Pi and PTH levels. Additionally, increases in urinary excretions of Na+, Cl− and Ca2+ have been observed. Some of these results are also seen in models of reduced kidney function. Responses of FGF23, a phosphaturic hormone that has been linked to the development of left ventricular hypertrophy in CKD, are ambiguous. In this review, we discuss the recent advances on the role of Npt2a inhibition on Pi homeostasis as well as other pleiotropic effects observed with Npt2a inhibition.

The Clinical and Epidemiological Aspects of Vascular Mortality in Chronic Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 80-83 ◽  
Author(s):  
Philip Kam-Tao Li ◽  
Kai Ming Chow
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Ventricular Hypertrophy ◽  
Residual Renal Function ◽  
Left Ventricular ◽  
Clinical Aspects ◽  
Published Data ◽  
Dialysis Patients ◽  
Reverse Epidemiology ◽  
Vascular Mortality

This article reviews the clinical aspects of and epidemiological links between vascular mortality and the dialysis population, and emphasizes areas that warrant further clarification. In particular, we highlight potential pitfalls in interpretation of published observational and clinical studies, notably some of the issues related to reverse epidemiology of risk factors for cardiovascular disease. Recent published data from our own center in the Prince of Wales Hospital relating to the significance of residual renal function, inflammation, valvular calcification, as well as left ventricular hypertrophy were highlighted. Actions are needed to tackle both the traditional and the nontraditional factors for cardiovascular disease in order to treat this problem causing the highest mortality in peritoneal dialysis patients.

scholarly journals ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part II – Management of Various Cardiovascular Complications

2015 ◽  
Vol 35 (4) ◽  
pp. 388-396 ◽  
Author(s):  
Angela Yee Moon Wang ◽  
K. Scott Brimble ◽  
Gillian Brunier ◽  
Stephen G. Holt ◽  
Vivekanand Jha ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiovascular Mortality ◽  
Lifestyle Modification ◽  
Specific Area ◽  
Arterial Disease ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Future Research ◽  
Artery Disease ◽  
Peripheral Arterial

Cardiovascular mortality has remained high in patients on peritoneal dialysis (PD) due to the high prevalence of various cardiovascular complications including coronary artery disease, left ventricular hypertrophy and dysfunction, heart failure, arrhythmia (especially atrial fibrillation), cerebrovascular disease, and peripheral arterial disease. In addition, nearly a quarter of PD patients develop sudden cardiac death as the terminal life event. Thus, it is essential to identify effective treatment that may lower cardiovascular mortality and improve survival of PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendation statements regarding lifestyle modification, assessment and management of various cardiovascular risk factors, and management of the various cardiovascular complications to be published in 2 guideline documents. This publication forms the second part of the guideline documents and includes recommendation statements on the management of various cardiovascular complications in adult chronic PD patients. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. We also define areas where evidence is clearly deficient and make suggestions for future research in each specific area.

scholarly journals The Role of Oxidative Stress and Inflammation in Cardiovascular Aging

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Junzhen Wu ◽  
Shijin Xia ◽  
Bill Kalionis ◽  
Wenbin Wan ◽  
Tao Sun
Keyword(s):  
Oxidative Stress ◽  
Cardiovascular Disease ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Low Grade ◽  
Oxygen Species ◽  
Age Related ◽  
Vascular Elasticity ◽  
Low Grade Inflammation

Age is an independent risk factor of cardiovascular disease, even in the absence of other traditional factors. Emerging evidence in experimental animal and human models has emphasized a central role for two main mechanisms of age-related cardiovascular disease: oxidative stress and inflammation. Excess reactive oxygen species (ROS) and superoxide generated by oxidative stress and low-grade inflammation accompanying aging recapitulate age-related cardiovascular dysfunction, that is, left ventricular hypertrophy, fibrosis, and diastolic dysfunction in the heart as well as endothelial dysfunction, reduced vascular elasticity, and increased vascular stiffness. We describe the signaling involved in these two main mechanisms that include the factors NF-κB, JunD, p66Shc, and Nrf2. Potential therapeutic strategies to improve the cardiovascular function with aging are discussed, with a focus on calorie restriction, SIRT1, and resveratrol.

scholarly journals Cardiovascular complications in end stage renal disease in a tertiary hospital in Nepal

2017 ◽  
Vol 13 (2) ◽  
pp. 279-283
Author(s):  
Rajesh Panjiyar ◽  
Rajeev Sharma ◽  
Shankar Laudari ◽  
Madhu Gupta ◽  
Madhav Ghimire ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Left Ventricular Hypertrophy ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Ventricular Hypertrophy ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Stage Renal Disease ◽  
End Stage

Background & Objectives: The cardiovascular complications including morbidity and mortality remains alarmingly high in all stages of chronic kidney disease. Although patients with chronic kidney disease share many of the similar risk factors for cardiovascular disease as the general population, there are a number of uremia related risk factors, such as anemia and alterations in calcium/phosphorus metabolism that also play a role in promoting cardiovascular disease. The objective of the study was to study the cardiovascular complications in end stage renal disease patients on maintenance hemodialysis.Materials & Methods: It is a hospital based cross-sectional observational study conducted at College of Medical Science - teaching Hospital. Hundred patients (n=100) with a diagnosis of end stage renal disease (irrespective of the underlying cause), and those who were on hemodialysis support were studied over a period of one year.Results: One hundred end stage renal disease patients were analyzed. Cardiovascular disease was present in 74% (n=74). the mean age of the patient who had cardiovascular disease was 59.36+14.337 years. The three major causes of end stage renal disease in the study population were hypertension (35%) followed by diabetes(31%) and chronic glomerulonephritis (14%). On electrocardiogram, left ventricular hypertrophy was a major finding 64% (n=64) followed by arrhythmias 30% (n=30). On echocardiography, left ventricular hypertrophy was found in 49% (n=49) followed by left ventricular diastolic dysfunction 38% (n=38). On subgroup analysis, left ventricular hypertrophy was found statistically significant with calcium and phosphorus product > 55 mg2/dl2 (p=0.01). Similarly left ventricular systolic dysfunction, regional wall motion abnormalities and st-t changes was found statistically significant with anemia; p=0.006, p=0.0004 and p=0.02 respectively.Conclusion: Prevalence of cardiovascular complications were common in end stage renal disease patients receiving maintenance hemodialysis. Anemia, calcium and phosphorus product > 55 mg2/dl2 were their independent risk factors.

Observations on the Vascular Pattern of the Septum of Normal and Hypertrophied Human Hearts

1984 ◽  
Vol 24 (2) ◽  
pp. 135-141
Author(s):  
W. O. Odesanmi
Keyword(s):  
Coronary Artery Disease ◽  
Ventricular Hypertrophy ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Vascular Pattern ◽  
Post Mortem ◽  
Immersion Technique ◽  
Artery Disease ◽  
The Right

The arterial vascular pattern of the myocardium of the interventricular septum of normal and hypertrophied human hearts was studied by post-mortem injection of a radio-opaque medium, Colourpaque, and the taking of microradiographs of transverse ventricular slices using the immersion technique. There were large penetrating septal arteries arising from the anterior and posterior descending coronary arteries. The arterial vascular pattern on each side of the septum closely resembled the respective patterns in the right and left ventricular free walls. In the hypertrophied hearts the branching and straight type arteries were of smaller calibre compared to normal hearts and were smallest in the greatly hypertrophied hearts and hearts with asymmetrical left ventricular hypertrophy. The role of the septal intercoronary anastomosis in coronary artery disease is discussed.

scholarly journals Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention

2021 ◽  
Vol 8 ◽  
Author(s):  
Mohapradeep Mohan ◽  
Adel Dihoum ◽  
Ify R. Mordi ◽  
Anna-Maria Choy ◽  
Graham Rena ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Strong Predictor ◽  
Sglt2 Inhibitor ◽  
Renin Angiotensin System ◽  
Left Ventricular ◽  
Cardiovascular Morbidity And Mortality ◽  
Risk Patients

Heart failure is an important manifestation of diabetic heart disease. Before the development of symptomatic heart failure, as much as 50% of patients with type 2 diabetes mellitus (T2DM) develop asymptomatic left ventricular dysfunction including left ventricular hypertrophy (LVH). Left ventricular hypertrophy (LVH) is highly prevalent in patients with T2DM and is a strong predictor of adverse cardiovascular outcomes including heart failure. Importantly regression of LVH with antihypertensive treatment especially renin angiotensin system blockers reduces cardiovascular morbidity and mortality. However, this approach is only partially effective since LVH persists in 20% of patients with hypertension who attain target blood pressure, implicating the role of other potential mechanisms in the development of LVH. Moreover, the pathophysiology of LVH in T2DM remains unclear and is not fully explained by the hyperglycemia-associated cellular alterations. There is a growing body of evidence that supports the role of inflammation, oxidative stress, AMP-activated kinase (AMPK) and insulin resistance in mediating the development of LVH. The recognition of asymptomatic LVH may offer an opportune target for intervention with cardio-protective therapy in these at-risk patients. In this article, we provide a review of some of the key clinical studies that evaluated the effects of allopurinol, SGLT2 inhibitor and metformin in regressing LVH in patients with and without T2DM.

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