Cardiovascular Risk Factors in Chronic Renal Failure and Hemodialysis Populations

Ma, King W.; Greene, Edward L.; Raij, Leopoldo

doi:10.1016/s0272-6386(12)80827-4

Cited by 248 publications

(114 citation statements)

References 77 publications

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“…Several interventional approaches to reduce cardiovascular risk factors with RAS blockers, calcium antagonists, or ␤-blockers can result in a reduction in progression or even net regression of CIMT (2,3). The most potent agents to date are the statins, which have consistently shown effects on CIMT in nondiabetic patients with hypercholesterolemia and/or atherosclerotic disease (27).…”

Section: Discussionmentioning

confidence: 99%

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A Randomized, Double-Blind, Placebo-Controlled Trial of Spironolactone on Carotid Intima-Media Thickness in Nondiabetic Hemodialysis Patients

Vukusich

Varela

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Hemodialysis patients (HD) display high rates of cardiac diseases and mortality. In chronic kidney disease, vascular injury leads to coronary artery disease, heart failure, and stroke. Carotid intima-media thickness (CIMT) measurements are currently widely used in randomized controlled trials (RCTs) to study the efficacy of interventions. An RCT was designed for the assessment of the safety and effectiveness of spironolactone to inhibit the progression of CIMT in HD patients as a primary outcome. Secondary outcomes included measurements of plasma potassium.Design, setting, participants, & measurements: HD patients were randomly assigned to receive 50 mg spironolactone or placebo thrice weekly after dialysis. In between dialysis sessions, plasma potassium concentrations were measured every month. Ultrasonographic measurements of CIMT were done at the beginning of the study and after 2 years.Results: Fifty-three age-and sex-adjusted patients (30 with drug and 23 with placebo) successfully completed the trial. There were no significant differences between the two groups in all profiles studied at baseline. Measurements of CIMT after 2 years showed a progression in the placebo group, whereas in the spironolactone group a significant decrease or even reversed CIMT was observed. Progression rates (mm/yr) were: common carotid, placebo: 0.06 ؎ 0.07, spironolactone: 0.01 ؎ 0.04; carotid bifurcation, placebo: 0.15 ؎ 0.27, spironolactone: 0.0001 ؎ 0.01; internal carotid, placebo: 0.10 ؎ 0.12, spironolactone: ؊0.10 ؎ 0.15. No episodes of hyperkalemia were observed, but a slight increase in plasma potassium was found in the spironolactone group.Conclusions: Fifty milligrams of spironolactone thrice weekly significantly reduced the progression of CIMT in HD patients.

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Section: Discussionmentioning

confidence: 99%

“…Dialyzed patients have a 10% to 20% higher risk of death compared with the general population (1)(2)(3). To date, the major effect in delaying the progression of CKD has been provided by the use of renin-angiotensin system (RAS) blockers.…”

mentioning

confidence: 99%

A Randomized, Double-Blind, Placebo-Controlled Trial of Spironolactone on Carotid Intima-Media Thickness in Nondiabetic Hemodialysis Patients

Vukusich

Varela

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Despite its increasing incidence and the accelerated worsening of atherosclerosis in patients on chronic hemodialysis, the proportion of individuals with chronic kidney disease (CKD) receiving appropriate cardiovascular (CV) risk modification treatment is lower than that in the general population [3]. In metabolic disorders associated with atherosclerosis (dyslipidemia, hypertension (HT) and diabetes mellitus), a reduced endothelium-mediated nitric oxide (NO)-dependent vasodilation has been observed, which may contribute to the initiation and progression of atherosclerosis associated with these disorders [4].…”

Section: Introductionmentioning

confidence: 99%

Dimethylarginine Dimethylaminohydrolase 2 Gene Polymorphism and Its Association with Asymmetrical Dimethyl Arginine in Hemodialyzed Patients

Yusuf¹,

Thaha²,

Yogiarto³

et al. 2013

OJNeph

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Introduction: Patients with CKD have elevated plasma levels of Asymmetrical Dimethyl Arginine (ADMA), impaired EDRF/NO responses in isolated resistance vessels, and a marked increase in the frequency of cardiovascular events that are predicated by plasma levels of ADMA. ADMA is considered as a risk factor for endothelial dysfunction, progression of chronic kidney disease and a marked increase in the frequency of cardiovascular events that are predicated by plasma levels of ADMA. Elevated ADMA in CKD have been related to a combination of a reduced renal ADMA excretion and a reduced catabolism of ADMA by dimethylarginine dimethylaminohydrolase (DDAH). The current study was undertaken to determine whether there is a correlation between ADMA and SNPs at −449 DDAH 2. Subjects and Methods: It was a cross sectional analytic study, 56 hemodialysis patients and 30 healthy individuals were enrolled. Based on its etiology, HD patients group was further divided in to hypertension (HT) subgroup and non-HT subgroup. Genotyping of the polymorphisms was performed using PCR-based SNP detection methods based on 5'-exonuclease activity assays for rs805305. Results: Heterozygotes were observed as the most abundant genotypes in both groups, followed by GG genotype in the HD patients (30%) and CC (27%) healthy individuals. Among the HT subgroup, the mean plasma levels of ADMA were sequentially higher from genotypes CC, G/C and GG (p = 0.037). Further multiple comparisons between groups using post hoc test showed results that genotype GG and CC were different at 0.05 level of significance. These findings were not found among non HT subgroup. Conclusion: Genetic variation in the DDAH 2 genes is significantly associated with serum ADMA levels in hypertensive HD patients. We observed that carriage of a G at position −449 in the promoter region of the DDAH 2 gene is associated with higher ADMA levels.

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“…Furthermore, in CKD patients, cardiovascular disease is the major cause of death, which cannot be entirely explained by the clustering of the traditional cardiovascular risk factors (3). It has been hypothesized that this excessive risk can be attributed, at least in part, to endothelial dysfunction and reduced bioavailability of nitric oxide (NO), which might play a pivotal role in the initiation and progression of atherosclerosis and might be a potential link between cardiovascular disease and CKD (4).…”

Section: Introductionmentioning

confidence: 99%

Asymmetric Dimethylarginine and Clinical Outcomes in Chronic Kidney Disease

Chung²,

Lin

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Elevated plasma level of asymmetric dimethylarginine (ADMA) have been reported to be associated with endothelial dysfunction and atherosclerosis risk factors, and may predict cardiovascular events in patients with ESRD. In this study, we aimed to assess the association between plasma ADMA and long-term outcome in a cohort of patients with stage 3 to 4 chronic kidney disease (CKD).Design, setting, participants, & measurements From July 2006 to June 2009, 298 consecutive patients with stage 3 to 4 CKD scheduled to undergo coronary angiography were recruited. Plasma ADMA levels were determined using HPLC. ResultsThe mean age was 73 Ϯ 10 years. Approximately half of the patients had diabetes and 88 patients had proteinuria. The baseline estimated GFR (eGFR) was 44 Ϯ 13 ml/min per 1.73 m 2 . The plasma ADMA levels of the patients with proteinuria were significantly higher than those without. The plasma ADMA levels correlated significantly with eGFR. During the median follow-up period of 2.7 years, we observed 26 all-cause deaths, 12 nonfatal myocardial infarctions, and 2 strokes. Multivariate Cox analysis revealed that an increase of 0.1 mol/L in plasma ADMA level was associated with a 37% increased risk of the composite outcomes of all-cause deaths, nonfatal myocardial infarctions, and strokes. ConclusionsIn this elder and high-risk population with stage 3 to 4 CKD, high plasma ADMA level was associated with low eGFR and macroalbuminuria. Furthermore, high plasma ADMA level appeared to be an independent predictor of long-term outcome.

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Cardiovascular Risk Factors in Chronic Renal Failure and Hemodialysis Populations

Cited by 248 publications

References 77 publications

A Randomized, Double-Blind, Placebo-Controlled Trial of Spironolactone on Carotid Intima-Media Thickness in Nondiabetic Hemodialysis Patients

A Randomized, Double-Blind, Placebo-Controlled Trial of Spironolactone on Carotid Intima-Media Thickness in Nondiabetic Hemodialysis Patients

Dimethylarginine Dimethylaminohydrolase 2 Gene Polymorphism and Its Association with Asymmetrical Dimethyl Arginine in Hemodialyzed Patients

Asymmetric Dimethylarginine and Clinical Outcomes in Chronic Kidney Disease

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