Cardiac Disease in Chronic Uremia: Management

Venkatesan, J.; Henrich, William L.

doi:10.1016/s1073-4449(97)70033-5

Cited by 14 publications

(5 citation statements)

References 122 publications

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“…Although the term "uremic cardiomyopathy" has been used for many years, our concept of the clinical features has changed dramatically (27). Foley et al (28) have demonstrated that, although systolic dysfunction is demonstrable in the minority of chronic renal failure patients, hospitalization for fluid overload or congestive heart failure occurs very commonly (29).…”

Section: Discussionmentioning

confidence: 99%

Effect of Chronic Renal Failure on Cardiac Contractile Function, Calcium Cycling, and Gene Expression of Proteins Important for Calcium Homeostasis in the Rat

Kennedy

Omran

Periyasamy

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Patients with chronic renal failure frequently develop cardiac hypertrophy and diastolic dysfunction; however, the mechanisms by which this occurs are still unclear. Male Sprague-Dawley rats were subjected to 5/6 nephrectomy and studied for their isolated myocyte function, calcium cycling, and gene expression of proteins important in calcium homeostasis after 4 wk. Comparable rats subjected to suprarenal aortic banding for the same duration were used for comparison. Rats subjected to 5/6 nephrectomy and aortic banding developed comparable hypertension; however, rats subjected to 5/6 nephrectomy experienced a greater degree of cardiac hypertrophy and downregulation of cardiac sodium potassium ATPase (Na ϩ /K ϩ -ATPase) activity than rats subjected to aortic banding. Moreover, cells isolated from the 5/6 nephrectomy rat hearts displayed impaired contractile function and altered calcium cycling compared with cells isolated from control or aortic constriction rat hearts. The 5/6 nephrectomy rat heart cells displayed a prolonged time constant for calcium recovery following stimulation, which corresponded to decreases in homogenate sarcoplasmic reticulum calcium ATPase-2a (SERCA2a) activity, protein density, and mRNA for SERCA2a. In conclusion, chronic renal failure leads to alterations in cardiac gene expression, which produces alterations in cardiac calcium cycling and contractile function. These changes cannot be explained only by the observed increases in BP. jshapiro@mco.eduPatients with renal failure usually develop cardiac complications. In end-stage renal disease (ESRD) patients treated with hemodialysis in the United States, annual mortality rates exceed 20%, with more than 50% attributed to cardiac mortality (1). Although the term "uremic cardiomyopathy" had previously been used to refer to a dilated cardiomyopathy complicating renal failure, more recent studies suggest that the most common form of heart disease in renal failure patients is one characterized by diastolic dysfunction and left ventricular hypertrophy (2). Although a number of known factors have been implicated in the pathogenesis of the left ventricular hypertrophy and diastolic dysfunction, our understanding of these processes is still incomplete (3).For many years, it has been known that the sodium pump is abnormal in chronic renal failure and that circulating inhibitor(s) can be demonstrated in the serum of uremic patients (4 -6). We have observed that sodium pump inhibition initiates a signal cascade that can cause alterations in gene transcription and ultimately produce hypertrophy in cardiomyocytes grown in culture (7-9). We have also observed that sodium pump inhibitors, including those circulating in the serum of uremic patients, can acutely cause altered calcium cycling and cardiomyocyte relaxation through sodium pump inhibition (10). The following studies were performed to further examine how cardiac growth and function are chronically modified by the uremic milieu. Materials and Methods AnimalsMale Sprague-Dawley rats (200...

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Section: Discussionmentioning

confidence: 99%

Effect of Chronic Renal Failure on Cardiac Contractile Function, Calcium Cycling, and Gene Expression of Proteins Important for Calcium Homeostasis in the Rat

Kennedy

Omran

Periyasamy

et al. 2003

Journal of the American Society of Nephrology

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“…However, if there is indeed accelerated atherogenesis it does not seem to be secondary to the dialysis itself. Half of all dialysis patients have evidence of coronary artery disease before the initiation of haemodialysis,26 and no correlation has been found between cardiac events and the duration of dialysis 12. The high prevalence of coronary artery disease in these patients seems to be related to numerous risk factors for atherosclerosis, including hypertension, diabetes, hypercoagulation, lipid abnormalities with hypertriglyceridaemia and decreased high density lipoprotein, and hyperhomocysteinaemia 27.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome following coronary angioplasty in dialysis patients: a case-control study in the era of coronary stenting

Feuvre

Dambrin

Helft

et al. 2001

Heart

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Background-Balloon coronary angioplasty has been reported to be ineVective in patients treated for end stage renal disease because of a high restenosis rate. Objective-To compare the clinical outcome following coronary angioplasty with provisional stenting in dialysis versus non-dialysis patients. Design-A case-control study. Patients-Of 1428 consecutive patients who underwent coronary angioplasty, 100 (7%) were being treated for end stage renal disease. These were compared with 100 control patients matched for age, sex, coronary lesions, presence of diabetes mellitus, and rate of coronary stenting (40%). Main outcome measures-In-hospital and one year clinical outcome. Results-The rates of procedural success (90% v 93%), in-hospital mortality (1% v 0%), stent thrombosis (0% v 0%), and Q wave myocardial infarction (0% v 1%) were similar in dialysis and non-dialysis patients. One year clinical outcome after coronary angioplasty was similar in the two groups in terms of clinical restenosis (31% v 28%) and myocardial infarction (6% v 2%), but cardiac death was more common in dialysed patients (11% v 2%, p < 0.03). Conclusions-Dialysis does not increase the risk of clinical restenosis after coronary angioplasty with provisional stenting. Coronary angioplasty is a safe and eVective therapeutic procedure in selected dialysis patients with culprit lesions accessible to stenting. However, the one year survival is reduced in this high risk population. (Heart 2001;85:556-560)

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“…However, at two years, the rate of cardiac death was 15%, compared with 5% in the control group 21) . Furthermore, there was no significant difference in the mortality rate between PCI and CABG groups if they had the same left ventricular function 22) . Our study group was unique with regard to including patients with diabetes and nephropathy.…”

Section: Discussionmentioning

confidence: 90%

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease and Diabetic Nephropathy: A Single Center Experience

Bae

Park

Kang

et al. 2007

Korean J Intern Med

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Background : Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD.Methods : The clinical and angiographic records of DN patients with CAD who underwent either CABG (n=52) or PCI (n=48) were retrospectively analyzed.Results : The baseline characteristics were similar in the two groups except for the severity of the CAD. At 30 days, the death rate (PCI: 2.1% vs. CABG: 9.6%, p=0.21) and major adverse cardiac events (MACE) rate (PCI: 2.1 % vs. CABG: 9.6%, p=0.21) were similar in comparisons between the PCI and CABG groups. At three years, the death rate (PCI: 18.8% vs. CABG: 19.2%, p=0.94) was similar between the PCI and CABG groups but the MACE rate (PCI: 47.9% vs. CABG: 21.2%, p=0.006) was higher in the PCI group compared to the CABG group. In addition, the repeat revascularization rate was higher in the PCI group compared to the CABG group (PCI: 12.5% vs. CABG: 1.9%, p=0.046).Conclusions : The CABG procedure was associated with a lower incidence of MACE and repeat revascularization for up to three years of follow-up in DN patients with CAD. However, the overall survival rate was similar in the CABG and PCI groups. Therefore, CABG may be superior to PCI with regard to MACE and repeat revascularization.

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Cardiac Disease in Chronic Uremia: Management

Cited by 14 publications

References 122 publications

Effect of Chronic Renal Failure on Cardiac Contractile Function, Calcium Cycling, and Gene Expression of Proteins Important for Calcium Homeostasis in the Rat

Effect of Chronic Renal Failure on Cardiac Contractile Function, Calcium Cycling, and Gene Expression of Proteins Important for Calcium Homeostasis in the Rat

Clinical outcome following coronary angioplasty in dialysis patients: a case-control study in the era of coronary stenting

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease and Diabetic Nephropathy: A Single Center Experience

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