scholarly journals Folic Acid and Vitamin B12 Administration in CKD, Why Not?

Nutrients ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 383 ◽  
Author(s):  
Irene Capelli ◽  
Giuseppe Cianciolo ◽  
Lorenzo Gasperoni ◽  
Fulvia Zappulo ◽  
Francesco Tondolo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Folic Acid ◽  
Cardiovascular Risk ◽  
Vitamin B12 ◽  
Therapeutic Target ◽  
Direct Action ◽  
Blood Levels ◽  
Traditional Risk Factors ◽  
Stage Renal Disease ◽  
End Stage

Patients affected by chronic kidney disease (CKD) or end-stage renal disease (ESRD) experience a huge cardiovascular risk and cardiovascular events represent the leading causes of death. Since traditional risk factors cannot fully explain such increased cardiovascular risk, interest in non-traditional risk factors, such as hyperhomocysteinemia and folic acid and vitamin B12 metabolism impairment, is growing. Although elevated homocysteine blood levels are often seen in patients with CKD and ESRD, whether hyperhomocysteinemia represents a reliable cardiovascular and mortality risk marker or a therapeutic target in this population is still unclear. In addition, folic acid and vitamin B12 could not only be mere cofactors in the homocysteine metabolism; they may have a direct action in determining tissue damage and cardiovascular risk. The purpose of this review was to highlight homocysteine, folic acid and vitamin B12 metabolism impairment in CKD and ESRD and to summarize available evidences on hyperhomocysteinemia, folic acid and vitamin B12 as cardiovascular risk markers, therapeutic target and risk factors for CKD progression.

The Potential Cardiovascular Benefits of Low-Glucose Degradation Product, Biocompatible Peritoneal Dialysis Fluids: A Review of the Literature

2017 ◽  
Vol 37 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Charlotte E. Grantham ◽  
Katherine L. Hull ◽  
Matthew P.M. Graham-Brown ◽  
Daniel S. March ◽  
James O. Burton
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Interstitial Fibrosis ◽  
Degradation Products ◽  
Controlled Trial ◽  
Membrane Integrity ◽  
Left Ventricular ◽  
Stage Renal Disease ◽  
End Stage

Cardiovascular mortality in the end-stage renal disease (ESRD) population remains the leading cause of death. Targeting traditional cardiovascular risk factors has proven unsuccessful in this patient population, and therefore attention has turned to risk factors related to chronic kidney disease (CKD). The toxicity of high-glucose peritoneal dialysis (PD) solutions has been well documented. The breakdown of glucose into glucose degradation products (GDP) and advanced glycation end-products (AGE) has the ability to alter cell viability and cause premature apoptosis and is strongly correlated with interstitial fibrosis and microvascular sclerosis. Biocompatible solutions have been introduced to combat the hostile milieu to which PD patients are exposed.Given the considerable cardiovascular burden for PD patients, little is known about the cardiovascular impact the new biocompatible solutions may have. This review analyzes the existing literature regarding the mechanisms through which low-GDP solutions may modulate cardiovascular risk. Interventions using low-GDP solutions have provided encouraging changes in structural cardiovascular measures such as left ventricular mass (LVM), although metabolic changes from reduced GDP and AGE exposure yield inconclusive results on vascular remodelling. It is thought that the local effects of reduced glucose exposure may improve membrane integrity and therefore fluid status. Further research in the form of a robust randomized controlled trial should be carried out to assess the true extent of the cardiovascular benefits these biocompatible solutions may hold.

Are traditional risk factors valid for assessing cardiovascular risk in end-stage renal failure patients?

Nephrology ◽  
2008 ◽  
Vol 13 (8) ◽  
pp. 667-671 ◽  
Author(s):  
DIBYA S SHAH ◽  
KEVAN R POLKINGHORNE ◽  
REBECCA PELLICANO ◽  
PETER G KERR
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Cardiovascular Risk ◽  
End Stage Renal Failure ◽  
Traditional Risk Factors ◽  
End Stage

scholarly journals Speckle-tracking echocardiography in comparison to ejection fraction for prediction of cardiovascular mortality in patients with end-stage renal disease

2021 ◽  
Author(s):  
Janna Terhuerne ◽  
Merel van Diepen ◽  
Rafael Kramann ◽  
Johanna Erpenbeck ◽  
Friedo Dekker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
End Stage Renal Disease ◽  
Speckle Tracking ◽  
Roc Analysis ◽  
Speckle Tracking Echocardiography ◽  
Area Under The Curve ◽  
Stage Renal Disease ◽  
End Stage ◽  
Conventional Echocardiography

Abstract Background Cardiovascular disease is the major cause of death in end-stage renal disease (ESRD). To develop better means to assess cardiovascular risk in these patients, we compared conventional echocardiography-derived left ventricular ejection fraction (EF) with the novel method of 2D speckle-tracking echocardiography to determine cardiac strain. Methods Predictive performances of conventional EF and speckle-tracking echocardiography-derived global longitudinal strain (GLS) were compared using receiver-operator curve (ROC) analyses and calibration by calibration plots. We also took into account other known cardiovascular risk factors through multivariable logistic regression analysis. Results The study comprised 171 ESRD patients (mean age 64 years, 64% male) on maintenance dialysis therapy (93% haemodialysis, 7% peritoneal dialysis) for an average period of 39 months. During 2.1 years of follow-up, 42 patients (25%) died from cardiovascular disease. ROC analysis of GLS resulted in an area under the curve of 0.700 [95% confidence interval (CI) 0.603–0.797] compared with an area under the curve of EF of 0.615 (95% CI 0.514–0.716) (P = 0.059 for difference). The total absolute deviation between predicted and observed outcome frequencies obtained by calibration plots were 13.8% for EF compared with only 6.4% for GLS. Best results of ROC analysis (area under the curve = 0.759; P = 0.06), calibration and goodness-of-fit (χ2 = 28.34, P ≤ 0.0001, R2 = 0.25) were achieved for GLS added to a baseline model consisting of known cardiovascular risk factors in a multivariate regression analysis. Conclusions In summary, in chronic dialysis patients, GLS is a more precise predictor of cardiovascular mortality than conventional echocardiography-derived EF.

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