Hyperphosphatemia aggravates cardiac fibrosis and microvascular disease in experimental uremia

Amann, Kerstin; Törnig, Johannes; Kugel, Birgit; Gross, Marie–Luise; Tyralla, Karin; El-Shakmak, A.; Szabó, András; Ritz, Eberhard

doi:10.1046/j.1523-1755.2003.00864.x

Cited by 151 publications

(135 citation statements)

References 20 publications

(12 reference statements)

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“…One explanation for this unexpected finding may be that in experimental studies, hyperphosphatemia is a permissive factor for the above structural abnormalities, specifically interstitial fibrosis and thickening of intramyocardial arteries (35). It is also conceivable that hyperphosphatemia affects intracellular handling of calcium and thus interferes with electrical stability.…”

Section: Role Of Hyperphosphatemiamentioning

confidence: 99%

The Challenge of Sudden Death in Dialysis Patients

Ritz¹,

Wanner²

2008

Clinical Journal of the American Society of Nephrology

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114

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A 60-yr-old patient with ESRD (82 kg/168 cm), hypertension for the previous 18 yr, and type 2 diabetes is found dead in bed by his wife at home on a Saturday morning. The patient's history is notable for having started dialysis 34 weeks previously. His last dialysis had been the previous day (on a Friday afternoon). Predialysis potassium had been 5.7 mmol/L, the dialysate K ϩ was 2.0 mmol/L, and Mg 2ϩ was 0.5 mmol/L. Autopsy was not performed.Before his morbid event, the patient had been doing well on dialysis. He had less than 6 episodes of hypotension (Ͻ100 mmHg) per month. His average predialytic weight gain was 4 kg, and, with fluctuations, his average predialysis BP was 155/65 mmHg. While continuing on gliquidone (an oral sulfonylurea hypoglycemic drug that does not accumulate in renal failure), he had no episodes of hypoglycemia, and his last glycosylated hemoglobin level was 7.2%. His medical history is of hypertension, type 2 diabetes, and left ventricular hypertrophy (LVH) with an ejection fraction of 55%. His electrocardiogram showed signs of LVH and flat T waves. He had no history of hypoglycemic episodes and no evidence of retinopathy. He reported no episodes of arrhythmia or precordial pain. A predialysis chest x-ray 2 wk before the terminal event had shown pulmonary congestion. His medications included 0.25 g/d calcitriol, calcium carbonate, 10 mg of folate, 80 mg of verapamil, and no ␤ blockers. In addition, he received varying doses of darbepoietin and iron gluconate as required. He did not receive a statin. Dr. Eberhard Ritz: This case, unfortunately, is the usual presentation of patients on dialysis who succumb to sudden death: There are few, if any, specific premonitory symptoms or signs, cardiac standstill is usually the presenting symptom, and autopsy is not performed, so more specific information on underlying cardiac pathology, if any, is not available. The lack of pathoanatomic confirmation of the underlying pathology or pathologies-as in this case-continues to remain a problem that in the future should come onto the radar screen of nephrologists.Nevertheless, this case presentation raises a number of unresolved issues and provides an occasion to discuss how the currently unsatisfactory results might be improved in the future. In this context, it is of interest to have a look at the recent 4D study.

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Section: Role Of Hyperphosphatemiamentioning

confidence: 99%

The Challenge of Sudden Death in Dialysis Patients

Ritz¹,

Wanner²

2008

Clinical Journal of the American Society of Nephrology

Self Cite

114

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“…Naujausios studijos nustatė -hiperfosfatemija yra svarbus intersticinės fibrozės veiksnys [23]. Taigi geresnė serumo fosfatų kontrolė gali sumažinti miokardo fibrozę ir staigios mirties riziką.…”

Section: Staigi Kardialinė Mirtisunclassified

Damoklo kardas: širdies įvykiai dializės metu

Januškevičius

Grigutis

Rimševičius

et al. 2015

Medicinos Teorija Ir Praktika

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santraukaReikšminiai žodžiai: hemodializė, aritmija, prieširdžių virpėjimas, staigi kardialinė mirtis. Lėtinė inkstų liga, kai reikalinga pakaitinė inkstų terapija, -svarbi visuomenės sveikatos problema. Kiekvienos hemodializės (HD) metu atsiranda didelė apkrova širdies ir kraujagyslių sistemai, susijusi su skysčių ir elektrolitų pokyčiais. Šiame straipsnyje apžvelgiami dažniausiai pasitaikantys širdies ir kraujagyslių sistemos pokyčiai HD pacientams. Prieširdžių virpėjimas (PV) -viena dažniausių aritmijų klinikinėje praktikoje. Hipokalemija -svarbus rizikos veiksnys, susijęs su prieširdžių virpė-jimo atsiradimu. Staigi kardialinė mirtis -tai netikėta žmogaus mirtis dėl širdies priežasčių, atsirandančių per trumpą laiką, kuriam anksčiau buvo arba nebuvo nustatyta širdies patologija, o akivaizdi terminalinė būklė anksčiau nebuvo diagnozuota. HD metu dažnai pastebimi pokyčiai elektrokardiogramoje. QT intervalas (norma 0,24-0,45 s) yra žinomas kaip skilvelinės repoliarizacijos žymuo, o jo pailgėjimas susijęs su padidėjusia aritmijų rizika. Hipokalemijai būdinga T bangos pailgėjimas, ST segmento depresija, patologinis U dantelis, supraventrikulinės ir skilvelinės tachikardijos bei aritmijos. Šiuos rizikos veiksnius ir širdies sutrikimus būtina laiku nustatyti ir koreguoti, todėl svarbus pastovus širdies parametrų (širdies dažnio variabilumo, elektrokardiogramos) fiksavimas hemodializės metu. aBstract Key words: hemodialysis, arrhythmia, atrial fibrillation, sudden cardiac death. Chronic kidney disease requiring renal replacement therapy is an important social problem. A large strain appears for the heart and cardiovascular system during each hemodialysis (HD) session. It is associated with changes of fluids and electrolytes. Most common cardiovascular system abnormalities during hemodialysis are reviewed in this article. Atrial fibrillation is one of the most frequent arrhythmia in clinical practice. Hypokalemia is an important risk factor related to the developing of atrial fibrillation. Sudden cardiac death is unexpected death due to heart causes, which appears in a short time, when no cardiac pathology was identified earlier and no fatal condition was diagnosed. QT interval (0,24-0,45 s) is known as a ventricular repolarisation marker and its elongation is associated with increased risk of arrhythmias. T wave elongation, ST segment depression, pathological U peak, supraventricular, ventricular tachycardia, arrhythmias are specific to hypokalemia. These risk factor and cardiac events must be diagnosed and treated. This condition requires intradialytic monitoring of cardiac parameters, such as heart rate variability and ECG. ĮVADASInkstų ligos, kai reikalinga pakaitinė inkstų terapija, -svarbi visuomenės sveikatos problema. Standartinė hemodializė (HD) dažniausiai atliekama tris kartus per savaitę -kiekvieno gydymo metu atkuriamas skysčių ir elektrolitų disbalansas. Nepaisant tobulėjančių technologijų dializės srityje, tik vienas iš dviejų ligonių išgyvena trejus metus po dializės pradžios. Kasmetis mirtingumas yra...

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“…3 Hyperphosphataemia may also directly affect vascular health by increasing reactive oxygen species, thereby causing oxidative damage & endothelial dysfunction. 5,6,7 Serum Calcium levels are invariably associated with CKD-MBD with fall in calcium levels as disease progresses. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines advise maintaining serum levels of total calcium (tCa), corrected for albumin level, within the "normal" range for the laboratory.…”

Section: Introductionmentioning

confidence: 99%