scholarly journals The effect of chronic usage of Renin-Angiotensin-Aldosterone System Blocking Agents on Incidence of Contrast-Induced Nephropathy in patients with Diabetes Mellitus and Renal Insufficiency. A Restropesctive Cohort Study

2019 ◽  
Vol 40 (1) ◽  
Author(s):  
Astika Widy Utomo ◽  
Dwi Aris agung Nugrahaningsih ◽  
Iwan Dwiprahasto
Keyword(s):  
Diabetes Mellitus ◽  
Renal Insufficiency ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Contrast Induced Nephropathy ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Blocking Agents ◽  
Patients With Diabetes

Background: This study was to investigate the effect of long term use of Renin-Angiotensin-Aldosterone System(RAAS) blocking agents on the incidence of Contrast-Induced Nephropathy(CIN) on patients with Diabetes Mellitus(DM) and renal insufficiency underwent Percutaneous Coronary Intervention (PCI). Methods:A total 281 of  subjects were included in this study and divided into two groups based on prior use of RAAS blocking agents (RAAS +, n = 146; RAAS -, n = 135). CIN was defined as an increase of ≥25% in creatinin over baseline value 48-72 hours after PCI. Result: Total incidence of CIN was 14,95%. There was no difference in the incidence of CIN between 2 study groups (p = 0,952) and relatif risk for CIN was 1,02. Left Ventricular ejection Fraction (LVEF) ≤ 40 % (OR 2,300; 95% CI 1,028 – 5,143; p = 0,043), anemia (OR 2,628; 95% CI 1,274 – 5,422; p = 0,009) and Glomerular Filtration rate (GFR) pre PCI ≤ 60 mL/menit (OR 2,782; 95% CI 1,293 – 5,987; p = 0,009) were important predictors of CIN. Conclusion: Long term use of RAAS blocking agents do not  increase the incidence of CIN on patients with DM and renal insufficiency underwent PCI.

scholarly journals Impact of diabetes mellitus on mortality in patients with acute heart failure: a prospective cohort study

2020 ◽  
Author(s):  
Min Gyu Kong ◽  
Se Yong Jang ◽  
Jieun Jang ◽  
Hyun-Jai Cho ◽  
Sangjun Lee ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Glycemic Control ◽  
Ejection Fraction ◽  
Acute Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inadequate Glycemic Control ◽  
Long Term Mortality

Abstract Background Although more than one third of the patients with acute heart failure (AHF) have diabetes mellitus (DM), it is unclear whether DM exerts adverse impact on clinical outcomes. This study aimed to compare the outcomes in patients hospitalized for AHF in accordance with DM and left ventricular ejection fraction (LVEF). Methods The Korean Acute Heart Failure registry prospectively enrolled and completed follow-up of 5,625 patients from March 2011 to February 2019. Primary endpoints were in-hospital and overall all-cause mortality. We evaluated the impact of DM on these mortalities according to HF subtypes and glycemic control. Results DM was significantly associated with increased long-term mortality (adjusted hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.02-1.22) even after adjusting for potential confounders. In subgroup analysis according to LVEF, DM was associated with higher long-term mortality in only HF with reduced ejection fraction (HFrEF) (adjusted HR, 1.14; 95% CI, 1.02-1.27). Inadequate glycemic control defined by HbA1c ≥ 7.0% within 1 year after discharge was significantly associated with higher long-term mortality compared to adequate glycemic control (HbA1c <7.0%) (44.0% vs. 36.8%; Log-rank p =0.016). Conclusions This large registry data showed that DM and inadequate glycemic control were significantly associated with increased long-term mortality in AHF, especially HFrEF. Tight glucose control is required to mitigate long-term mortality.

Role of the Renin-Angiotensin-Aldosterone System and the Glutathione S-Transferase Mu, Pi and Theta Gene Polymorphisms in Cardiotoxicity after Anthracycline Chemotherapy for Breast Carcinoma

2013 ◽  
Vol 28 (4) ◽  
pp. 336-347 ◽  
Author(s):  
Daniela Vivenza ◽  
Mauro Feola ◽  
Ornella Garrone ◽  
Martino Monteverde ◽  
Marco Merlano ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Polymorphisms ◽  
Left Ventricular ◽  
Detoxification Enzymes ◽  
Left Ventricular Ejection ◽  
Glutathione S Transferase ◽  
Renin Angiotensin Aldosterone System ◽  
Ventricular Ejection Fraction ◽  
Renin Angiotensin ◽  
Anthracycline Chemotherapy

Background Anthracyclines are among the most active drugs against breast cancer, but can exert cardiotoxic effects eventually resulting in congestive heart failure (CHF). Identifying breast cancer patients at high risk of developing cardiotoxicity after anthracycline therapy would be of value in guiding the use of these agents. Aims We determined whether polymorphisms in the renin-angiotensin-aldosterone system (RAAS) and in the glutathione S-transferase (GST) family of phase II detoxification enzymes might be useful predictors of left ventricular ejection fraction (LVEF) kinetics and risk of developing CHF. We sought correlations between the development of cardiotoxicity and gene polymorphisms in 48 patients with early breast cancer treated with adjuvant anthracycline chemotherapy. Methods We analyzed the following polymorphisms: p.Met235Thr and p.Thr174Met in angiotensinogen ( AGT), Ins/Del in angiotensin-converting enzyme ( ACE), A1166C in angiotensin II type-1 receptor ( AGTR1A), c.-344T>C in aldosterone synthase ( CYP11B2), p.Ile105Val in GSTP1. Additionally, we analyzed the presence or absence of the GSTT1 and GSTP1 genes. A LVEF <50% was detected at least once during the 3 years of follow-up period in 13 out of 48 patients (27.1%). Conclusion RAAS gene polymorphisms were not significantly associated with the development of cardiotoxicity. GSTM1 may be useful as a biomarker of higher risk of cardiotoxicity, as demonstrated in our cohort of patients (p=0.147).

Abstract 3705: Risk factors and Clinical Outcomes for Contrast Induced Nephropathy Post Percutaneous Coronary Intervention in Patients with Normal baseline Renal Function

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Eric Chong ◽  
Liang Shen ◽  
Yiong H Chan ◽  
Huay C Tan
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Clinical Predictors ◽  
Contrast Induced Nephropathy ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary ◽  
Baseline Renal Function

Background: Contrast induced nephropathy (CIN) is an important complication post percutaneous coronary intervention (PCI). We examine the risk factors for developing CIN in patients with normal baseline renal function so that prophylactic measures may be undertaken to prevent its development. Methods: A cohort of 5086 patients with normal baseline renal function (defined as serum creatinine <1.5mg/dl) who did not receive prophylactic treatment while undergoing PCI (primary or elective) between May 1996 to March 2007 in our centre was enrolled in the study. We examine the occurrence of CIN (defined as >25% increase from baseline creatinine within 48 hours post PCI) in 3036 subjects of this cohort with available creatinine data and aim to identify the clinical predictors. Results: CIN occurred in 7.3% of the patients. The mean age of these patients was 57.5 yrs, 78.7% were men, and 34.6% had diabetes mellitus. Clinical predictors for CIN were age (OR 6.4, 95% CI 0.1–13.3, p=0.042), female gender (OR 2.0, 95% CI 1.5–2.7, p=0.001), lower left ventricular ejection fraction (OR 1.02, 95% CI 1.01–1.04, p=0.01), anemia with hemoglobin <11mg/dl (OR 1.5 (95% CI 1.01–2.4, p=0.044) and systolic hypotension with blood pressure <100mmHg on admission(OR 1.5, 95% CI 1.01–2.2, p=0.004). While there was no increase in the incidence of CIN among diabetics and nondiabetics (8.2% vs 6.8%, p=0.18), those who are on insulin therapy are at the highest risk compared with diabetics on diet control and oral hypoglycemic drugs (18.9% vs 3.6% vs 6.8%, p=0.001). There was no significant difference between patients who underwent primary vs elective PCI (7.0% vs. 6.6% p=0.75). Patients who developed CIN had higher mortality rate at 1 month (14.5% vs 1.1%, p<0.001) and 6 month (17.8% vs 2.2%, p<0.001) Conclusion: Patients with normal baseline renal function undergoing PCI are also at risk of developing CIN with resultant higher mortality. Age, female, insulin dependent diabetes mellitus, hypotension, anemia, low left ventricular ejection fraction are predictors of CIN. Such patients should also be considered CIN prophylactic therapy.

scholarly journals Diabetes and Renin-Angiotensin-Aldosterone System: Pathophysiology and Genetics

2021 ◽  
Author(s):  
A.H.M. Nurun Nabi ◽  
Akio Ebihara
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Diseases ◽  
Kidney Diseases ◽  
Association Studies ◽  
Plasma Renin ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Genome Wide ◽  
Renal Vascular

Diabetes mellitus (DM) is a metabolic disorder and characterized by hyperglycemia. Being a concern of both the developed and developing world, diabetes is a global health burden and is a major cause of mortality world-wide. The most common is the type 2 diabetes mellitus (T2DM), which is mainly caused by resistance to insulin. Long-term complications of diabetes cause microvascular related problems (eg. nephropathy, neuropathy and retinopathy) along with macrovascular complications (eg. cardiovascular diseases, ischemic heart disease, peripheral vascular disease). Renin-angiotensin-aldosterone system (RAAS) regulates homeostasis of body fluid that in turn, maintains blood pressure. Thus, RAAS plays pivotal role in the pathogenesis of long-term DM complications like cardiovascular diseases and chronic kidney diseases. T2DM is a polygenic disease, and the roles of RAAS components in insulin signaling pathway and insulin resistance have been well documented. Hyperglycemia has been found to be associated with the increased plasma renin activity, arterial pressure and renal vascular resistance. Several studies have reported involvement of single variants within particular genes in initiation and development of T2D using different approaches. This chapter aims to investigate and discuss potential genetic polymorphisms underlying T2D identified through candidate gene studies, genetic linkage studies, genome wide association studies.

scholarly journals Use of sodium zirconium cyclosilicate for up-titration of renin–angiotensin–aldosterone system inhibitor therapy in patients with heart failure: a case series

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Rhys Williams ◽  
Alexander James ◽  
Moira Ashton ◽  
Sian Vaughan ◽  
Aaron Wong
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Case Series ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Additional Patient ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Sodium Zirconium ◽  
Sodium Zirconium Cyclosilicate

Abstract Background Patients often receive suboptimal dosing of renin–angiotensin–aldosterone system inhibitor (RAASi) therapy over concerns of hyperkalaemia. However, studies have shown associations between suboptimal dosing or interruptions to therapy and adverse clinical events. Therefore, effective treatments for hyperkalaemia that can enable optimal RAASi therapy are needed. This case series examines eight patients whose commencement on the novel potassium binder sodium zirconium cyclosilicate (SZC) allowed for the initiation and/or up-titration of RAASi therapy. Case summary Eight patients aged 64–87 years with heart failure (HF) with reduced ejection fraction all developed hyperkalaemia (serum potassium (sK+) &gt;5.0 mmol/L) while receiving RAASi therapy. Following initiation of SZC, all patients experienced eventual stabilization of sK+ levels. All patients were able to initiate, restart, or up-titrate RAASi therapy with five patients achieving optimal medical therapy. Left ventricular ejection fraction improved in four patients, two patients are now re-classified as New York Heart Association Class I, and an additional patient had improved exercise tolerance. Follow-up for Patient 8 is still ongoing. Discussion These real-world cases demonstrate that use of SZC to manage hyperkalaemia in patients with HF is feasible and allows optimization of RAASi therapy.

scholarly journals In-Hospital Outcome of Patients with Diabetes Mellitus after CTO Recanalization with Third-Generation Drug-Eluting Stents

2019 ◽  
Author(s):  
Jan-Erik Guelker ◽  
Lars Bansemir ◽  
Rainer Ott ◽  
Thomas Rock ◽  
Rosemarie Guelker ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Drug Eluting Stents ◽  
Complication Rates ◽  
Safe Procedure ◽  
Third Generation ◽  
Hospital Outcome ◽  
Patients With Diabetes ◽  
Drug Eluting

Background: Percutaneous coronary intervention (PCI) of total chronic coronary occlusions (CTOs) still remains a major challenge in interventional cardiology. There is little knowledge in the literature about differences in CTO-PCI between diabetic and nondiabetic patients in the era of third-generation drug-eluting stents (DESs). In this study, we analyzed the impact of diabetes mellitus (DM) on procedural characteristics, complications, and acute outcomes in a cohort of 440 patients. Methods: Between 2012 and 2016, we recruited 440 consecutive patients, 116 of them with DM. All the patients underwent PCI for at least 1 CTO. Antegrade and retrograde CTO recanalization techniques were applied. Only third-generation DESs were used. We used t-tests and the Pearson chi-quadrat test to test the significant differences in the variables between the 2 groups. Results: The patients with DM were older than the nondiabetics (64.5 y vs. 61.1 y; P=0.003), and they suffered more frequently from a chronic kidney disease (7.1% vs. 2.4%; P=0.001). The nondiabetics less frequently had arterial hypertension (75.3% vs. 89.7%; P=0.001); however, they more often had a family liability for CAD (32.1% vs. 22.4%; P=0.050) and had a higher left ventricular  ejection fraction (59.2% vs. 56.7%; P=0.011). The success rate was 85.2% in the patients without DM and 81.2% in the patients with DM (P=0.403). The existence of DM had no impact on the procedural success and complication rates. Conclusion: Our study on 440 patients shows that diabetics and nondiabetics have similar success and complication rates after the recanalization of CTOs using third-generation DESs. It is a feasible and safe procedure and can be recommended as an alternative treatment.   J Teh Univ Heart Ctr 2019;14(2):47-52   This paper should be cited as: Guelker J. E, Bansemir L, Ott R, Rock T, Guelker R, Shin D. I, Klues H. G, Bufe A. In-hospital Outcome of Patients with Diabetes Mellitus after CTO Recanalization with Third-Generation Drug-Eluting Stents. J Teh Univ Heart Ctr 2019;14(2):47-52.

scholarly journals Clinical Implications of Sodium Zirconium Cyclosilicate Therapy in Patients with Systolic Heart Failure and Hyperkalemia

2021 ◽  
Vol 10 (23) ◽  
pp. 5523
Author(s):  
Teruhiko Imamura ◽  
Akira Oshima ◽  
Nikhil Narang ◽  
Koichiro Kinugawa
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Renin Angiotensin Aldosterone System ◽  
Ventricular Ejection Fraction ◽  
Renin Angiotensin

Background: Sodium zirconium cyclosilicate (SZC), a newly introduced specific potassium binder, is introduced to treat hyperkalemia. However, the implications of SZC in up-titrating renin–angiotensin–aldosterone system inhibitors in patients with systolic heart failure remain unknown. Methods and Results: Patients with heart failure with left ventricular ejection fraction <50% and hyperkalemia who had completed 3-month SZC therapy were retrospectively included. Serum potassium levels, the dose of renin–angiotensin–aldosterone system inhibitors, and echocardiographic parameters during the 3-month SZC therapy as compared with the pretreatment 3-month period were investigated. A total of 24 patients (median 77 years old, 71% men, median left ventricular ejection fraction 41%) received a 3-month SZC therapy without any associated adverse events including hypokalemia. Compared with the pretreatment period, serum potassium levels decreased, doses of renin–angiotensin–aldosterone system inhibitors increased, and the left ventricular ejection fraction and plasma B-type natriuretic peptide levels improved following the 3-month SZC therapy (p < 0.05 for all). Conclusions: SZC may be a promising therapeutic option to improve hyperkalemia, indirectly allowing up-titration of renin–angiotensin–aldosterone system inhibitors and facilitating reverse remodeling in patients with heart failure with a left ventricular ejection fraction <50% and hyperkalemia.

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