scholarly journals Prevention of chronic kidney disease progression in patients with acute decompensation of chronic heart failure

2019 ◽  
Vol 24 (3) ◽  
pp. 76-81
Author(s):  
V. V. Davydov ◽  
E. L. Arekhina
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Chronic Heart Failure ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Prevention Program ◽  
Ckd Progression ◽  
Acute Decompensation ◽  
Group 2 ◽  
Group 1

Aim.To assess the efficiency of the program of prevention of chronic kidney disease (CKD) progression in patients with acute decompensation of chronic heart failure (CHF). The program included the use of nitrendipine, a calcium channel antagonist, and the replacement of single intravenous bolus dosing of furosemide with a prolonged intravenous infusion in the early stage of the disease.Material and methods.One hundred twenty five patients with decompensation of CHF were examined and divided into 2 groups. Group 1 received standard therapy. In the group 2, an additional prevention program was carried out. The criterion of CKD progression was the change in glomerular filtration rate (GFR) in accordance with the KDIGO guidelines (2012). GFR was calculated by two methods: serum creatinine and cystatin C levels. The parameters were monitored and compared with baseline levels at admission to the hospital and on the 10th day of therapy. For the initial level was taken the patient’s GFR, calculated by the serum creatinine level prior to the present hospitalization on the background of a satisfactory condition.Results.At admission to the hospital, in group 1 CKD progression was established in 33,3% of patients, in group 2 — in 29,3%. On the 10th day, CKD progression was noted in 47,4% of patients in group 1, in group 2 — in 23,4%.Conclusion.The prevention program allows to reduce the number of cases of CKD progression in patients with decompensation of CHF by 2 times.

scholarly journals Changes in Glomerular Filtration Rate and Its Relation to Serum Calcium Level in Advanced Stages of Chronic Kidney Disease

2015 ◽  
Vol 1 (1) ◽  
pp. 15-17
Author(s):  
Gobinda Chandra Saha ◽  
M Akhtaruzzaman ◽  
Ekramul Mustafa ◽  
Asif Mahmud ◽  
Sunil Kumar Sikder
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Calcium ◽  
Control Group ◽  
Control Serum ◽  
Advanced Stages ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: The progression of CKD occurs in five different stages in which there are gradual changes of GFR, serum creatinine and serum calcium.Objective: The study was undertaken to determine GFR in advanced stages of CKD and its relation with s. creatinine and s. calcium and also to find out the correlation between s. creatinine and s. calcium.Methodology: This study was carried out in the departments of Physiology and Nephrology, Rajshahi Medical College. All the advanced stage chronic kidney disease patients were taken as comparison. Apparently healthy persons were taken as control. Serum Creatinine was measured by alkaline picrate method; estimation of GFR was done by using Cockcroft- Gault formula and serum calcium was performed by analyzer.Result: In this study a total number of 120 subjects were included, out of which 30 were healthy control and 90 were diagnosed cases of advanced stages of CKD. Among the patients, 55 (61.12%) were male and 35 (38.88%) were female. Mean age (±SD) of the patients were 45 ± 11.16 (Range 20-65 years). While comparing between groups of CKD patients, it was found that s. creatinine of control group was significantly lower than that of group 1. Again s. creatinine of Group 1 was significantly lower than that of group 2 and similarly, s. creatinine of group 2 was significantly lower than that of group 3. On the other hand, s. calcium of control group was significantly higher than group 1, likewise s. calcium of group 1 was significantly higher than that of group 2 and s. calcium of group 2 was significantly higher than that of group 3.Conclusion: From this study the inference could be drawn that serum calcium had a positive correlation with GFR and a negative correlation with s. creatinine.J. Natl Inst. Neurosci Bangladesh 2015;1(1):15-17

Clinical impact of the determination of natriuretic peptides on long-term follow-up of patients treated in the Heart Failure Unit

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Perea Armijo ◽  
J Lopez Aguilera ◽  
C Duran Torralba ◽  
J.C Castillo Dominguez ◽  
M Anguita Sanchez
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Natriuretic Peptides ◽  
Left Ventricular Ejection ◽  
Heart Failure Unit ◽  
Group 2 ◽  
Group 1

Abstract Introduction The use of natriuretic peptides has spread in recent years as a diagnostic tool in patients with heart failure (HF). However, its influence on the prognosis of these patients has not been clearly established. Thus, our main aim was to know the characteristics of patients with increased levels of NT-proBNP and to analyze its impact on long-term prognosis in terms of mortality and readmissions due to heart failure. Material and methods We selected cases from the heart failure unit at HURS which had a NT-proBNP determination at first consultation. Patients were divided into two groups: GROUP 1 (NT-ProBNP <10000) and GROUP 2 (NT-ProBNP >10000). Clinical, echocardiographic and treatment variables were collected and patients were followed up for readmissions due to heart failure and all-cause mortality. Results A total of 280 patients were selected. The mean age of the cohort was 66.74±13.88 years and was male-dominated (64%). In group 1, there was a higher initial left ventricular ejection fraction (LVEF) (43.19% vs 40.36%; p=0.057), lower basal creatinine (1.13 mg/dL vs 1.53 mg/dL; p=0.001), lower creatinine at the end of follow-up (1.27 mg/dL vs 1.79 mg/dL; p=0.001) and a lower NT-proBNP at the end of follow-up (4039 pg/mL vs 17140 pg/mL; p=0.000) than in group 2. In addition, group 2 showed a higher percentage of chronic kidney disease (55% vs 29%; p=0.000) than group 1, with no differences in their main variables. With 110 months of follow-up, patients with NT-proBNP levels>10000 had a similar hospital readmission rate compared to the group with lower NT-proBNP levels (81.2% vs 84.8% log rank p=0.133).With a mean of 130.01±9.11 months of follow-up, patients with NT-proBNP levels>10000 had a tendency to higher mortality from any cause than those with lower NT-proBNP levels (84.4% vs 48.4%, log rank p=0.000). Conclusion Patients with NT-proBNP levels>10000 are associated with a lower LVEF at baseline and a higher proportion of chronic kidney disease. In the long term, patients with NT-proBNP levels>10000 had the same rate of readmissions for heart failure but a higher rate of death from any cause. Kaplan-Meier analysis Funding Acknowledgement Type of funding source: None

scholarly journals Evolution Of Moderate Chronic Kidney Disease In The Elderly

2012 ◽  
Vol 18 (1) ◽  
pp. 41-45
Author(s):  
Liliana Ana Tuţă ◽  
Alina Stăniguţ ◽  
B. Câmpineanu ◽  
Raluca Zica
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Repeated Measures ◽  
The Elderly ◽  
Mdrd Equation ◽  
Group 2 ◽  
One Year ◽  
Group 1

AbstractRecently, there is an increased interest in the detection of Chronic Kidney Disease (CKD) in the general population, especially . A classification of CKD, based on several stages of the estimated glomerular filtration rate (eGFR), has been established from almost 10 years. In our study we monitored eighthy patients older than 65 years, clinically and biochemically, during one year. A number of 80 clinically stable patients, with a median age of 74 years, recruited between october and december 2010, were followed up during one year. We separated them in two groups: Group 1: 40 patients with serum creatinine < = 1,2 mg/dl (range 0,7- 1,2) and with no proteinuria; and Group 2: 40 patients with serum creatinine > 1.2 mg/dl (range 1,2-3,5) and with proteinuria < 3,5 g/24 hours. We measured serum creatinine and eGFR at the time of recruitment and after one year of follow up using abreviated MDRD equation. Statistical comparisons were made using the general lineal model for repeated measures of the SPSS 11.0 program. The most frequent comorbidities were cardio-vascular(> 75%) and infections (25%). 13.75% of the patients died during the follow up, especially from group 2. Only 25% of group 2 patients needed erithropoietin (EPO) treatment. Estimated GFR and proteinuria remained relatively stable at the end of one year in patients from group 1, but survivors from group 2 registered a median decrease of 9 mL/min.

scholarly journals Chronic kidney disease stage stratifies short- and long-term outcomes after aortic root replacement

2020 ◽  
Author(s):  
Tsuyoshi Yamabe ◽  
Yanling Zhao ◽  
Paul A Kurlansky ◽  
Suzuka Nitta ◽  
Saveliy Kelebeyev ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Confidence Interval ◽  
Aortic Root Replacement ◽  
Mortality Hazard ◽  
Group 3 ◽  
Group 2 ◽  
Mortality Hazard Ratio ◽  
Group 1

Abstract OBJECTIVES Chronic kidney disease (CKD) is prevalent in patients undergoing cardiovascular surgery, and it negatively impacts procedural outcomes; however, its influence on the outcomes of aortic surgery has not been well studied. This study aims to elucidate the importance of CKD on the outcomes of aortic root replacement (ARR). METHODS Patients who underwent ARR between 2005 and 2019 were retrospectively reviewed (n = 882). Patients were divided into 3 groups based on the Kidney Disease: Improving Global Outcomes criteria: Group 1 [estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2, n = 421); Group 2 (eGFR = 30–59 ml/min/1.73 m2, n = 424); and Group 3 (eGFR &lt; 30 ml/min/1.73 m2, n = 37). To reduce potential confounding, a propensity score matching was also performed between Group 1 and the combined group of Group 2 and Group 3. The primary end point was 10-year survival. Secondary end points were in-hospital mortality and perioperative morbidity. RESULTS Severe CKD patients presented with more advanced overall chronic and acute illnesses. Kaplan–Meier analysis showed a significant correlation between CKD stage and 10-year survival (log-rank P &lt; 0.001). The number of events for Group 1 was 15, Group 2 was 49 and Group 3 was 11 in 10 years. Group 3 had significantly higher in-hospital mortality (13.5% vs 3.5% in Group 2 vs 0.7% in Group 1, P &lt; 0.001) and stroke (8.1% vs 7.1% vs 1.2%, P &lt; 0.001) as well as introduction to new dialysis (27.0% vs 5.4% vs 1.7%, P &lt; 0.001). eGFR was shown to be an independent predictor of mortality (hazard ratio, 0.98; 95% confidence interval, 0.96–0.99). Comparison between propensity matched groups showed similar postoperative outcomes, and eGFR was still identified as a predictor of mortality (hazard ratio, 0.97; 95% confidence interval, 0.95–0.99). CONCLUSIONS Higher stage in CKD negatively impacts the long-term survival in patients who are undergoing ARR.

scholarly journals Analysis of blood gas beyond bicarbonate in outpatients with stage 3–5 chronic kidney disease

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Ilter Bozaci ◽  
Ali Nazmi Can Doğan ◽  
Merve Aktar ◽  
Alev Mahşer ◽  
Gizem Yıldırım ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Metabolic Acidosis ◽  
Kidney Disease ◽  
Odds Ratio ◽  
Mixed Type ◽  
Base Excess ◽  
Blood Gas ◽  
Ckd Progression ◽  
Group 1

AbstractObjectivesMetabolic acidosis is a common disorder seen in course of chronic kidney disease (CKD). In this study, we aimed to investigate the association of Base excess (BE), Anion gap (AG) and Delta Ratio with progression of CKD, renal replacement therapy (RRT) requirement and mortality in patients with stage 3–5 CKD.MethodsA total of 212 patients with stage 3–5 CKD were included in this study. Patients were divided into two groups according to the baseline BE level. Patients were also grouped according to the delta ratio such as non- AG, High AG and mixed type.ResultsMean BE level was significantly lower (−4.7 ± 4.0 vs. −3.3 ± 4.3; p=0.02) in patients with CKD progression. The patients in group 1 (n: 130) (Be<−2.5) revealed more CKD progression (%53 vs. %32; p=0.002), and RRT requirement (%35 vs. %15; p=0.001). Baseline BE <−2.5 (odds ratio, 0.38; 95% CI, 0.16 to 0.91; p<0.05) and baseline GFR (odds ratio, 0.94; 95% CI, 0.90 to 0.97; p<0.001) were independently related to RRT requirement. Delta BE was independently associated with mortality (odds ratio, 0.90; 95% CI, 0.85–0.96; p<0.01).ConclusionsLow BE levels were associated with CKD progression and RRT requirement. BE change is associated with mortality during the follow-up of those patients.

Abstract 17220: Effects of the Oral Adsorbent of AST-120 in Patients with both Chronic Heart Failure and Chronic Kidney Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Miki Imazu ◽  
Masanori Asakura ◽  
Takuya Hasegawa ◽  
Hiroshi Asanuma ◽  
Shin Ito ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Chronic Heart Failure ◽  
Kidney Disease ◽  
Diastolic Dysfunction ◽  
Uremic Toxins ◽  
Control Group ◽  
Blood Levels ◽  
Uremic Toxin ◽  
Oral Adsorbent

Background: One of uremic toxins, indoxyl sulfate (IS) is related to the progression of chronic kidney disease (CKD) and the worse cardiovascular outcomes. We have previously reported the relationship between IS levels and the severity of chronic heart failure (CHF), but the question arises as to whether the treatment of uremic toxin is beneficial in patients with CHF. This study aimed to elucidate whether the treatment with the oral adsorbent which reduces uremic toxin improved the cardiac function of the patients with CHF. Methods: First of all, we retrospectively enrolled 49 patients with both CHF and stage ≤3 CKD in our institute compared with the healthy subjects without CHF or CKD in the resident cohort study of Arita. Secondly, we retrospectively enrolled 16 CHF outpatients with stage 3-5 CKD. They were treated with and without the oral adsorbent of AST-120 for one year termed as the treatment and control groups, respectively. We underwent both blood test and echocardiography before and after the treatment. Results: First of all, among 49 patients in CHF patients, plasma IS levels increased to 1.38 ± 0.84 μg/ml from the value of 0.08 ± 0.06 μg/ml in Arita-cho as a community-living matched with gender and eGFR of CHF patients. We found both fractional shortening (FS) and E/e’, an index of diastolic function were decreased (25.0 ± 12.7%) and increased (13.7 ± 7.5), respectively in CHF patients compared with the value of FS and E/e’ in Arita-cho (FS: 41.8 ± 8.3%, E/e’: 8.8 ± 2.1). Secondly, in the treatment group, the plasma IS levels and the serum creatinine and brain natriuretic peptide levels decreased (1.40 ± 0.17 to 0.92 ± 0.15 μg/ml; p<0.05, 1.91 ± 0.16 to 1.67 ± 0.12 mg/dl; p<0.05, 352 ± 57 to 244 ± 49 pg/ml; p<0.05, respectively) and both FS and E/e’ were improved following the treatment with AST-120 (28.8 ± 2.8 to 32.9 ± 2.6%; p<0.05, 18.0 ± 2.0 to 11.8 ± 1.0; p<0.05). However, these parameters did not change in the control group. Conclusions: The treatment to decrease the blood levels of uremic toxins improved not only renal dysfunction but cardiac systolic and diastolic dysfunction in patients with chronic heart failure. Oral adsorbents might be a new treatment of heart failure especially with diastolic dysfunction.

Angiotensin-converting enzyme inhibition restores the diffusing capacity for carbon monoxide in patients with chronic heart failure by improving the molecular diffusion across the alveolar capillary membrane

1999 ◽  
Vol 96 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Marco GUAZZI ◽  
Piergiuseppe AGOSTONI
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Enzyme Inhibition ◽  
Angiotensin Converting Enzyme Inhibition ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibition ◽  
Group 2 ◽  
Alveolar Capillary ◽  
Group 1

Conductance of alveolar capillary membrane (DM) and capillary blood volume (VC) are the subcomponents of the pulmonary diffusing capacity for carbon monoxide (DLco). In chronic heart failure, stress failure of the membrane provides a mechanism for reduced DM and subsequent impairment of DLco. Angiotensin-converting enzyme inhibition improves DLco in patients with chronic heart failure. This study was aimed at investigating which of the two subcomponents of DLco is affected by angiotensin-converting enzyme inhibitors. Twenty-seven patients with NYHA class II to III chronic heart failure (group 1) and 13 age- and sex-matched normal subjects underwent pulmonary function testing with determination of DM and VC, while receiving placebo and 48 ;h and 1 and 2 months after starting enalapril treatment (10 ;mg twice daily). Nine similar patients (group 2) received isosorbide dinitrate (40 ;mg thrice daily) for a month then enalapril for another month, and underwent pulmonary function testing at 48 ;h and 1 month after starting treatments. Effects of angiotensin-converting enzyme inhibition in normal controls were not significant in the short- or mid-term. In group 1 patients, the only change observed at 48 ;h was a reduction in VC (probably due to a decrease in capillary pulmonary pressure). There was a marked increase in DM to a similar extent at 1 and 2 months, resulting in a significant improvement in DLco despite a decrease in VC. In group 2 patients, nitrates failed to improve DLco and DM, whereas enalapril was as effective as in group 1. These observations suggest a modulatory effect of angiotensin-converting enzyme inhibition on the membrane function which emerges gradually and persists over time and is probably dissociated from changes in pulmonary capillary pressure and VC. Chronic heart failure disturbs the alveolar capillary interface and increases gas diffusion resistance; angiotensin-converting enzyme inhibition restores the diffusive properties of the membrane and gas transfer, and protects the lung when the heart is failing.

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