Clinical and echocardiographic disease in patients starting end-stage renal disease therapy

Foley, Robert N.; Parfrey, Patrick S.; Harnett, John D.; Kent, Gloria M.; Martín, Christopher J.; Murray, David C.; Barré, Paul E.

doi:10.1038/ki.1995.22

Cited by 1,154 publications

(809 citation statements)

References 32 publications

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“…Reduced LVEF has been associated with adverse cardiovascular events in ESRD patients 42. In agreement with previous studies,12, 43 we also demonstrated that a reduced LVEF was an independent predictor for both all‐cause and cardiovascular mortalities in hemodialysis patients 12…”

Section: Discussionsupporting

confidence: 91%

Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients

Huang

Cheng

et al. 2017

JAHA

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BackgroundThe excess pressure integral (XSPI), derived from analysis of the arterial pressure curve, may be a significant predictor of cardiovascular events in high‐risk patients. We comprehensively investigated the prognostic value of XSPI for predicting long‐term mortality in end‐stage renal disease patients undergoing regular hemodialysis.Methods and ResultsA total of 267 uremic patients (50.2% female; mean age 54.2±14.9 years) receiving regular hemodialysis for more than 6 months were enrolled. Cardiovascular parameters were obtained by echocardiography and applanation tonometry. Calibrated carotid arterial pressure waveforms were analyzed according to the wave‐transmission and reservoir‐wave theories. Multivariable Cox proportional hazard models were constructed to account for age, sex, diabetes mellitus, albumin, body mass index, and hemodialysis treatment adequacy. Incremental utility of the parameters to risk stratification was assessed by net reclassification improvement. During a median follow‐up of 15.3 years, 124 deaths (46.4%) incurred. Baseline XSPI was significantly predictive of all‐cause (hazard ratio per 1 SD 1.4, 95% confidence interval 1.15‐1.70, P=0.0006) and cardiovascular mortalities (1.47, 1.18‐1.84, P=0.0006) after accounting for the covariates. The addition of XSPI to the base prognostic model significantly improved prediction of both all‐cause mortality (net reclassification improvement=0.1549, P=0.0012) and cardiovascular mortality (net reclassification improvement=0.1535, P=0.0033). XSPI was superior to carotid‐pulse wave velocity, forward and backward wave amplitudes, and left ventricular ejection fraction in consideration of overall independent and incremental prognostics values.ConclusionsIn end‐stage renal disease patients undergoing regular hemodialysis, XSPI was significantly predictive of long‐term mortality and demonstrated an incremental value to conventional prognostic factors.

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Section: Discussionsupporting

confidence: 91%

Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients

Huang

Cheng

et al. 2017

JAHA

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“…In the Canadian Prospective Cohort Study of 433 incident dialysis patients, 74% had LVH at baseline, 44% had concentric LVH, 30% had hypertrophy with left ventricular dilatation, and 15% had systolic dysfunction. 18 …”

Section: Cvd In Kidney Failurementioning

confidence: 99%

Kidney Disease as a Risk Factor for Development of Cardiovascular Disease

Sarnak¹,

Levey²,

Schoolwerth³

et al. 2003

Circulation

3,061

752

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“…From previous studies (24,25), a SD of 30 g/m 2 was assumed for the change in LVMi (26). A sample size of 75 patients per treatment arm was needed to detect a difference in LVMi of 15 g/m 2 at a two-sided significance level of 5%, with a power of 80% and an attrition rate of 20%.…”

Section: End Pointsmentioning

confidence: 99%

Effects of Early and Late Intervention with Epoetin α on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4)

Roger¹,

McMahon²,

Clarkson³

et al. 2004

Journal of the American Society of Nephrology

197

115

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Abstract. It is not known whether prevention of anemia among patients with chronic kidney disease would affect the development or progression of left ventricular (LV) hypertrophy. A randomized controlled trial was performed with 155 patients with chronic kidney disease (creatinine clearance, 15 to 50 ml/min), with entry hemoglobin concentrations ([Hb]) of 110 to 120 g/L (female patients) or 110 to 130 g/L (male patients). Patients were monitored for 2 yr or until they required dialysis; the patients were randomized to receive epoetin ␣ as necessary to maintain [Hb] between 120 and 130 g/L (group A) or between 90 and 100 g/L (group B). [Hb] increased for group A (from 112 Ϯ 9 to 121 Ϯ 14 g/L, mean Ϯ SD) and decreased for group B (from 112 Ϯ 8 to 108 Ϯ 13 g/L) (P Ͻ 0.001, group A versus group B). On an intent-to-treat analysis, the changes in LV mass index for the groups during the 2-yr period were not significantly different (2.5 Ϯ 20 g/m 2 for group A versus 4.5 Ϯ 20 g/m 2 for group B, P ϭ NS). There was no significant difference between the groups in 2-yr mean unadjusted systolic BP (141 Ϯ 14 versus 138 Ϯ 13 mmHg) or diastolic BP (80 Ϯ 6 versus 79 Ϯ 7 mmHg). The decline in renal function in 2 yr, as assessed with nuclear estimations of GFR, also did not differ significantly between the groups (8 Ϯ 9 versus 6 Ϯ 8 ml/min per 1.73 m 2 ). In conclusion, maintenance of [Hb] above 120 g/L, compared with 90 to 100 g/L, had similar effects on the LV mass index and did not clearly affect the development or progression of LV hypertrophy. The maintenance of [Hb] above 100 g/L for many patients in group B might have been attributable to the relative preservation of renal function.Chronic kidney disease (CKD) is widespread in the community, with a prevalence far exceeding previous estimates (1). Many studies examining mortality and morbidity rates among patients with CKD have identified high rates of cardiovascular events. When even mild renal insufficiency is associated with other risk factors for cardiovascular disease, the risk of subsequent cardiovascular events is significantly increased (2-10). The effect of mild renal insufficiency (serum creatinine levels of Ͼ124 M) on cardiovascular risk is possibly also independent of other known risk factors and treatment (11)(12)(13)(14)(15). For patients established on dialysis, cardiovascular disease is responsible for up to 50% of the all-cause mortality rate (16,17). It is therefore important to attempt to reduce the incidence of cardiovascular events with risk factor modification before the onset of dialysis.Left ventricular (LV) hypertrophy (LVH) is recognized as a powerful independent predictor of death and morbidity in the dialysis population, together with anemia, hypertension, malnutrition, hyperparathyroidism, and an elevated calcium-phos-

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Clinical and echocardiographic disease in patients starting end-stage renal disease therapy

Cited by 1,154 publications

References 32 publications

Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients

Value of Excess Pressure Integral for Predicting 15‐Year All‐Cause and Cardiovascular Mortalities in End‐Stage Renal Disease Patients

Kidney Disease as a Risk Factor for Development of Cardiovascular Disease

Effects of Early and Late Intervention with Epoetin α on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4)

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