scholarly journals Treatment With Vasopressor Agents for Cardiovascular Shock Patients With Poor Renal Function; Results From the Japanese Circulation Society Cardiovascular Shock Registry

2021 ◽  
Vol 8 ◽  
Author(s):  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Eizo Tachibana ◽  
Naohiro Yonemoto ◽  
Kazuo Sakamoto ◽  
...  
Keyword(s):  
Renal Function ◽  
Secondary Analysis ◽  
Disease Classification ◽  
First Line ◽  
Unique Identifier ◽  
Clinical Trial Registration ◽  
Hospital Arrival ◽  
Poor Renal Function ◽  
Vasopressor Agent ◽  
Vasopressor Agents

According to the guidelines for cardiogenic shock, norepinephrine is associated with fewer arrhythmias than dopamine and may be the better first-line vasopressor agent. This study aimed to evaluate the utility of norepinephrine vs. dopamine as first-line vasopressor agent for cardiovascular shock depending on the presence and severity of renal dysfunction at hospitalization. This was a secondary analysis of the prospective, multicenter Japanese Circulation Society Cardiovascular Shock Registry (JCS Shock Registry) conducted between 2012 and 2014, which included patients with shock complicating emergency cardiovascular disease at hospital arrival. The analysis included 240 adult patients treated with norepinephrine alone (n = 98) or dopamine alone (n = 142) as the first-line vasopressor agent. Primary endpoint was mortality at 30 days after hospital arrival. The two groups had similar baseline characteristics, including estimated glomerular filtration rate (eGFR), and similar 30-day mortality rates. The analysis of the relationship between 30-day mortality rate after hospital arrival and vasopressor agent used in patients categorized according to the eGFR-based chronic kidney disease classification revealed that norepinephrine as the first-line vasopressor agent might be associated with better prognosis of cardiovascular shock in patients with mildly compromised renal function at admission (0.0 vs. 22.6%; P = 0.010) and that dopamine as the first-line vasopressor agent might be beneficial for cardiovascular shock in patients with severely compromised renal function [odds ratio; 0.22 (95% confidence interval 0.05–0.88; P = 0.032)]. Choice of first-line vasopressor agent should be based on renal function at hospital arrival for patients in cardiovascular shock.Clinical Trial Registration:http://www.umin.ac.jp/ctr/, Unique identifier: 000008441.

Abstract 429: First-Line Vasopressor Agent for Cardiogenic Shock Due to Acute Myocardial Infarction: Results From Tokyo CCU Network Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tadashi Ashida ◽  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Norihiro Kuroki ◽  
Tadateru Takayama ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Renal Function ◽  
Mortality Rate ◽  
Cardiogenic Shock ◽  
First Line ◽  
Poor Renal Function ◽  
Vasopressor Agent ◽  
Significant Difference ◽  
All Cause Mortality

Background: In the guidelines for cardiogenic shock, norepinephrine, as compared with dopamine, was associated with fewer cases of arrhythmia and may be a better first-line vasopressor agent. However, few clinical studies have investigated the effects of optimal first-line vasopressor agents for patients with poor renal function. Methods: From a multicenter, prospective, cohort registry of emergency cardiovascular patients in Tokyo between 2013 and 2016, we identified adult patients with cardiogenic shock due to acute myocardial infarction (AMI) who received either norepinephrine, dopamine or both as a vasopressor agent without mechanical circulatory supports. Study patients were divided into 4 groups according to estimated glomerular filtration rate (eGFR). The primary endpoint was all-cause mortality at 30 days after admission. Results: Of the 4,034 patients with cardiogenic shock due to AMI, 665 were eligible for this study; 419 received norepinephrine (N group), 154 dopamine (D group), and 92 both agents (B group). There was a significant difference in the all-cause mortality rate between the three groups in the whole cohort (16.0% in the N group, 9.7% in the D group and 40.2% in the B group, P<0.001). In addition, there was a significant difference in the all-cause mortality rate between the three groups in the subgroups of patients with eGFR stage 3a and 3b. (Figure). After adjustment of independent factors for mortality, the odds ratio of the D group (reference, the N group) was 0.51 (95%CI 0.26-0.99, p=0.049). Conclusion: Compared with norepinephrine, dopamine was associated with a lower all-cause mortality rate for patients with cardiogenic shock due to AMI, especially patients with poor renal function.

scholarly journals Locomotor Kinematics and Kinetics Following High-Intensity Stepping Training in Variable Contexts Poststroke

2020 ◽  
Vol 34 (7) ◽  
pp. 652-660
Author(s):  
Marzieh M. Ardestani ◽  
Christopher E. Henderson ◽  
Gordhan Mahtani ◽  
Mark Connolly ◽  
T. George Hornby
Keyword(s):  
High Intensity ◽  
Secondary Analysis ◽  
Principal Component ◽  
Joint Kinematics ◽  
Locomotor Training ◽  
Unique Identifier ◽  
Clinical Trial Registration ◽  
Paretic Limb ◽  
Principal Component Analyses ◽  
Kinematics And Kinetics

Background and Purpose. Previous studies suggest that individuals poststroke can achieve substantial gains in walking function following high-intensity locomotor training (LT). Recent findings also indicate practice of variable stepping tasks targeting locomotor deficits can mitigate selected impairments underlying reduced walking speeds. The goal of this study was to investigate alterations in locomotor biomechanics following 3 different LT paradigms. Methods. This secondary analysis of a randomized trial recruited individuals 18 to 85 years old and >6 months poststroke. We compared changes in spatiotemporal, joint kinematics, and kinetics following up to 30 sessions of high-intensity (>70% heart rate reserve [HRR]) LT of variable tasks targeting paretic limb and balance impairments (high-variable, HV), high-intensity LT focused only on forward walking (high-forward, HF), or low-intensity LT (<40% HRR) of variable tasks (low-variable, LV). Sagittal spatiotemporal and joint kinematics, and concentric joint powers were compared between groups. Regressions and principal component analyses were conducted to evaluate relative contributions or importance of biomechanical changes to between and within groups. Results. Biomechanical data were available on 50 participants who could walk ≥0.1 m/s on a motorized treadmill. Significant differences in spatiotemporal parameters, kinematic consistency, and kinetics were observed between HV and HF versus LV. Resultant principal component analyses were characterized by paretic powers and kinematic consistency following HV, while HF and LV were characterized by nonparetic powers. Conclusion. High-intensity LT results in greater changes in kinematics and kinetics as compared with lower-intensity interventions. The results may suggest greater paretic-limb contributions with high-intensity variable stepping training that targets specific biomechanical deficits. Clinical Trial Registration. https://clinicaltrials.gov/ Unique Identifier: NCT02507466

Abstract 13004: The Effect of Vasopressor Agents in the Treatment of Cardiovascular Shock

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tsukasa Yagi ◽  
Eizo Tachibana ◽  
Yasushi Ueki ◽  
Kazuo Sakamoto ◽  
Hiroshi Imamura ◽  
...  
Keyword(s):  
Renal Function ◽  
Normal Renal Function ◽  
Mortality Rates ◽  
First Line ◽  
Double Blind ◽  
Two Agents ◽  
Frequent Use ◽  
The Status ◽  
Vasopressor Agents ◽  
Reduced Renal Function

Background: Various vasopressor agents are used for the treatment of cardiovascular shock. According to a randomized double-blind comparison study reported in 2010, norepinephrine is more useful than dopamine for patients in cardiovascular shock. In Japan, although both norepinephrine and dopamine are used as first-line vasopressor agents, the status of use and usefulness of the two agents have not yet been clarified. Methods: The Japanese Circulation Society (JCS) Shock Registry was a prospective, observational, multi-center, cohort study between May 2012 and June 2014.Of the patients registered in the JCS-Shock Registry, data of those who received norepinephrine or dopamine as a vasopressor agent, without the use of intra-aortic ballon pumping or cardiopulmonary bypass, were examined. The primary end point of the study was the rate of death at 30 days. Results: Of the 980 patients registered in the JCS-Shock Registry, the data of 320 patients were included in this analysis, after exclusion of patients who had not received the two agents and patients meeting the exclusion criteria. Of the 320 patients, 98 had received norepinephrine (N group), 142 had received dopamine (D group), and 80 had received both agents (N+D group). The acute mortality rates were 26.5, 25.4 and 46.2% in the N, D and N+D groups, respectively (p = 0.003). In a stratified analysis according to the renal function (eGFR [median: 43] ≥43 [normal renal function] versus eGFR <43 [reduced renal function]) at the time of admission, the acute mortality rates in the patients of the N, D and N+D groups with normal renal function were 7.8, 21.1 and 41.2%, respectively (p = 0.001), being significantly lower in the N group. On the other hand, the acute mortality rates in the patients of the N, D and N+D groups with reduced renal function were 46.8, 29.6 and 50.0%, respectively (p = 0.049), being significantly lower in the D group. Conclusion: Although norepinephrine is recommended as the first-line treatment, a trend towards more frequent use of dopamine was found in Japan. In addition, norepinephrine appeared to contribute to a reduction of the acute mortality in patients with normal renal function, while dopamine appeared to contribute to a reduction of the acute mortality in patients with reduced renal function.

scholarly journals Renal functional improvement after pediatric pyeloplasty in kidneys with split renal function less than 20%: a single institute experience

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Elsayed Salih ◽  
Ibrahim Abdelmaksoud ◽  
Mohamed Elfeky ◽  
Gamal Selmy ◽  
Hussein Galal ◽  
...  
Keyword(s):  
Renal Function ◽  
Statistical Significance ◽  
Functional Improvement ◽  
Renal Unit ◽  
Poor Renal Function ◽  
Split Renal Function ◽  
Renal Function Deterioration ◽  
Number Of Patients ◽  
The Mean

Abstract Background Pediatric pyeloplasty in ureteropelvic junction obstruction (UPJO) is indicated in renal impaired drainage or renal function deterioration. The improvement of renal function after pediatric pyeloplasty is still controversial in poorly functioning kidneys. Past studies on poorly functioning kidneys had a variable SRF specification, and these studies often had a limited number of patients so that they did not achieve statistical significance. The study aims to detect the renal functional improvement after pediatric Anderson-Hynes pyeloplasty (AHP) with split renal function (SRF) less than 20% (poor renal function). Results A retrospective study included 46 pediatric patients with unilateral UPJO who underwent open AHP with SRF < 20% on a renal isotope scan from August 2012 to October 2018. Success was defined based on either improvement in symptoms, improvement in drainage on postoperative renography, and/or improvement or stability in SRF on the renal scan done 6 months postoperatively and yearly thereafter. Deterioration of SRF by more than 5% was deemed to be deterioration. An increase in SRF of more than 5% was deemed to be an improvement. A total of 46 patients with a mean age of 32 months with poor renal function on isotope renogram (SRF < 20%) were included. All patients had an obstructive pattern on the preoperative radionuclide scans. The median preoperative SRF was 9.26%. The mean (range) follow-up was 30 months. The success rate was 91.3%. Three patients underwent redo pyeloplasty, whereas a secondary nephrectomy was necessary for one. The remaining (42) patients showed stability or improvement of SRF with no further symptoms. Renal scintigraphy at 6 and 12 months after surgery revealed significantly increased SRF compared to preoperative one. Conclusion Poorly functioning renal unit with SRF < 20% can show functional improvement and recoverability after pediatric pyeloplasty.

Frequency and Prognostic Significance of Clinical Fluctuations Before Hospital Arrival in Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Jose G. Romano ◽  
Hannah Gardener ◽  
Eric E. Smith ◽  
Iszet Campo-Bustillo ◽  
Yosef Khan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Prognostic Significance ◽  
Final Diagnosis ◽  
Qualitative Assessment ◽  
Stroke Subtype ◽  
Improvement Program ◽  
Unique Identifier ◽  
Hospital Arrival ◽  
Stroke Impact Scale ◽  
Index Stroke

Background and Purpose: Clinical fluctuations in ischemic stroke symptoms are common, but fluctuations before hospital arrival have not been previously characterized. Methods: A standardized qualitative assessment of fluctuations before hospital arrival was obtained in an observational study that enrolled patients with mild ischemic stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score of 0–5) present on arrival to hospital within 4.5 hours of onset, in a subset of 100 hospitals participating in the Get With The Guidelines–Stroke quality improvement program. The number of fluctuations, direction, and the overall improvement or worsening was recorded based on reports from the patient, family, or paramedics. Baseline NIHSS on arrival and at 72 hours (or discharge if before) and final diagnosis and stroke subtype were collected. Outcomes at 90 days included the modified Rankin Scale, Barthel Index, Stroke Impact Scale 16, and European Quality of Life. Prehospital fluctuations were examined in relation to hospital NIHSS change (admission to 72 hours or discharge) and 90-day outcomes. Results: Among 1588 participants, prehospital fluctuations, consisting of improvement, worsening, or both were observed in 35.5%: 25.1% improved once, 5.3% worsened once, and 5.1% had more than 1 fluctuation. Those who improved were less likely and those who worsened were more likely to receive alteplase. Those who improved before hospital arrival had lower change in the hospital NIHSS than those who did not fluctuate. Better adjusted 90-day outcomes were noted in those with prehospital improvement compared to those without any fluctuations. Conclusions: Fluctuations in neurological symptoms and signs are common in the prehospital setting. Prehospital improvement was associated with better 90-day outcomes, controlling for admission NIHSS and alteplase treatment. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT 02072681.

Protein Binding of Diphenylhydantoin and Desmethylimipramine in Plasma from Patients with Poor Renal Function

1971 ◽  
Vol 285 (5) ◽  
pp. 264-267 ◽  
Author(s):  
Marcus M. Reidenberg ◽  
Ingegerd Odar-Cederlöf ◽  
Christer von Bahr ◽  
Olof Borgå ◽  
Folke Sjöqvist
Keyword(s):  
Renal Function ◽  
Protein Binding ◽  
Poor Renal Function

Ototoxic Drugs and Poor Renal Function

JAMA ◽  
1968 ◽  
Vol 206 (9) ◽  
pp. 2119 ◽  
Author(s):  
Gregory J. Matz
Keyword(s):  
Renal Function ◽  
Poor Renal Function ◽  
Ototoxic Drugs

Vasoconstrictor Responses to Vasopressor Agents in Human Pulmonary and Radial Arteries

2014 ◽  
Vol 121 (5) ◽  
pp. 930-936 ◽  
Author(s):  
Dale A. Currigan ◽  
Richard J. A. Hughes ◽  
Christine E. Wright ◽  
James A. Angus ◽  
Paul F. Soeding
Keyword(s):  
Pulmonary Hypertension ◽  
Radial Artery ◽  
Vascular Tone ◽  
Pulmonary Arteries ◽  
Right Heart Failure ◽  
Response Curves ◽  
Vasopressor Agent ◽  
Vasopressor Agents ◽  
Vascular Beds ◽  
Potent Vasoconstrictor

Abstract Background: Vasopressor drugs, commonly used to treat systemic hypotension and maintain organ perfusion, may also induce regional vasoconstriction in specialized vascular beds such as the lung. An increase in pulmonary vascular tone may adversely affect patients with pulmonary hypertension or right heart failure. While sympathomimetics constrict pulmonary vessels, and vasopressin does not, a direct comparison between these drugs has not been made. This study investigated the effects of clinically used vasopressor agents on human isolated pulmonary and radial arteries. Methods: Isolated pulmonary and radial artery ring segments, mounted in organ baths, were used to study the contractile responses of each vasopressor agent. Concentration–response curves to norepinephrine, phenylephrine, metaraminol, and vasopressin were constructed. Results: The sympathomimetics norepinephrine, phenylephrine, and metaraminol caused concentration-dependent vasoconstriction in the radial (pEC50: 6.99 ± 0.06, 6.14 ± 0.09, and 5.56 ± 0.07, respectively, n = 4 to 5) and pulmonary arteries (pEC50: 6.86 ± 0.11, 5.94 ± 0.05 and 5.56 ± 0.09, respectively, n = 3 to 4). Vasopressin was a potent vasoconstrictor of the radial artery (pEC50 9.13 ± 0.20, n = 3), whereas in the pulmonary artery, it had no significant effect. Conclusions: Sympathomimetic-based vasopressor agents constrict both human radial and pulmonary arteries with similar potency in each. In contrast, vasopressin, although a potent vasoconstrictor of radial vessels, had no effect on pulmonary vascular tone. These findings provide some support for the use of vasopressin in patients with pulmonary hypertension.

scholarly journals Incidence and Predictors of Hospitalization in Patients with Atrial Fibrillation: Results from the Chinese Atrial Fibrillation Registry Study

2020 ◽  
Author(s):  
Zhaojie Dong ◽  
Xin Du ◽  
Shangxin Lu ◽  
Chao Jiang ◽  
Shijun Xia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Diseases ◽  
Proportional Hazards Model ◽  
Cox Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Chronic Obstructive ◽  
Unique Identifier ◽  
Clinical Trial Registration

Abstract Background: Patients with atrial fibrillation (AF) underwent a high risk of hospitalization, which, however, has not been paid much attention in clinic. Therefore, we aimed to assess the incidence, causes and predictors of hospitalization in AF patients.Methods: From August 2011 to December 2017, 20,172 AF patients from the Chinese Atrial Fibrillation Registry (China-AF) Study were enrolled in this study. We described the incidence, causes of hospitalization according to age and gender categories. The Cox proportional hazards model was employed to identify predictors of first all-cause and first cause-specific hospitalization. Results: After a mean follow-up of 37.3 ± 20.4 months, 7,512 (37.2%) AF patients experienced one or more hospitalizations. The overall incidence of all-cause hospitalization was 24.0 per 100 patient-years. Patients aged < 65 years were predominantly hospitalized for AF (42.1% of the total frequency of hospitalizations); while patients aged 65-74 and ≥ 75 years were mainly hospitalized for non-cardiovascular diseases (43.6% and 49.3%, respectively). Multivariate Cox model analysis verified the higher risk of hospitalization in patients complicated with heart failure (HF)[hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.08-1.24], established coronary artery disease (CAD) (HR 1.26, 95%CI 1.19-1.34), ischemic stroke/transient ischemic attack (TIA) (HR 1.26, 95%CI 1.18-1.33), diabetes (HR 1.16, 95%CI 1.10-1.22), chronic obstructive pulmonary disease (COPD) (HR 1.41, 95%CI 1.13-1.76), gastrointestinal disorder (HR 1.39, 95%CI 1.23-1.58), and renal dysfunction (HR 1.31, 95%CI 1.16-1.48). Conclusions: More than one-third of AF patients included in this study were hospitalized at least once during almost 3 years of follow-up. The main cause for hospitalization among elderly patients (≥65 years) is non-cardiovascular diseases rather than AF. Multidisciplinary management of comorbidities should be advocated as strategies to reduce hospitalization in AF patients.Clinical Trial Registration: URL: http://www.chictr.org.cn/showproj.aspx?proj=5831. Unique identifier: ChiCTR-OCH-13003729.

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