Incidental findings on cardiac computed tomography in incident hemodialysis patients: the predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study

Jaar, Bernard G.; Zhang, Lili; Chembrovich, Svetlana; Sozio, Stephen M.; Shafi, Tariq; Scialla, Julia J.; Tomaselli, Gordon F.; Lima, João A.C.; Kao, W. H. Linda; Parekh, Rulan S.; Meoni, Lucy A.

doi:10.1186/1471-2369-15-68

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…This study (ancillary to the Predictors of Arrhythmic and Cardiovascular Risk in ESRD [PACE] trial; R01DK072367) (15,16) was an in-person assessment of frailty and other factors in patients who had initiated hemodialysis at 27 free-standing dialysis centers in Baltimore, Maryland, and six surrounding counties (17). Although all participants were hemodialysis initiates (within 6 months), participants were not necessarily enrolled on their first day of hemodialysis; 95% were enrolled within the first month of dialysis.…”

Section: Methodsmentioning

confidence: 99%

Frailty and Cognitive Function in Incident Hemodialysis Patients

McAdams‐DeMarco¹,

Tan²,

Salter³

et al. 2015

Clinical Journal of the American Society of Nephrology

164

136

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Background and objectives Patients of all ages undergoing hemodialysis (HD) have a high prevalence of cognitive impairment and worse cognitive function than healthy controls, and those with dementia are at high risk of death. Frailty has been associated with poor cognitive function in older adults without kidney disease. We hypothesized that frailty might also be associated with poor cognitive function in adults of all ages undergoing HD.Design, setting, participants, & measurements At HD initiation, 324 adults enrolled (November 2008 to July 2012) in a longitudinal cohort study (Predictors of Arrhythmic and Cardiovascular Risk in ESRD) were classified into three groups (frail, intermediately frail, and nonfrail) based on the Fried frailty phenotype. Global cognitive function (3MS) and speed/attention (Trail Making Tests A and B [TMTA and TMTB, respectively]) were assessed at cohort entry and 1-year follow-up. Associations between frailty and cognitive function (at cohort entry and 1-year follow-up) were evaluated in adjusted (for sex, age, race, body mass index, education, depression and comorbidity at baseline) linear (3MS, TMTA) and Tobit (TMTB) regression models.Results At cohort entry, the mean age was 54.8 years (SD 13.3), 56.5% were men, and 72.8% were black. The prevalence of frailty and intermediate frailty were 34.0% and 37.7%, respectively. The mean 3MS was 89.8 (SD 7.6), TMTA was 55.4 (SD 29), and TMTB was 161 (SD 83). Frailty was independently associated with lower cognitive function at cohort entry for all three measures (3MS: 22.4 points; 95% confidence interval [95% CI], 24.2 to 20.5; P=0.01; TMTA: 12.1 seconds; 95% CI, 4.7 to 19.4; P,0.001; and TMTB: 33.2 seconds; 95% CI, 9.9 to 56.4; P=0.01; all tests for trend, P,0.001) and with worse 3MS at 1-year follow-up (22.8 points; 95% CI, 25.4 to 20.2; P=0.03). ConclusionsIn adult incident HD patients, frailty is associated with worse cognitive function, particularly global cognitive function (3MS).

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Section: Methodsmentioning

confidence: 99%

Frailty and Cognitive Function in Incident Hemodialysis Patients

McAdams‐DeMarco¹,

Tan²,

Salter³

et al. 2015

Clinical Journal of the American Society of Nephrology

164

136

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“…Moreover, reporting of incidental findings to both participants and care providers adds significant responsibility to nephrologist and study team for reporting findings in a time sensitive manner, as well as potentially increasing the need for further imaging and work-up and increased worry to the participant. Requirements by ethics boards for vigilant reporting of incidentalomas does not take into account the lack of a actionable plans for most findings and the concerns of participants of unnecessary testing [ 76 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prior to the study, a beta-blocker, metoprolol, was given orally to bring the heart rate to less than 65 beats per minute. Based on protocol, trained cardiologists and radiologists independently read all CT images to assess for both cardiac and non-cardiac pathologies and submitted a separate report of these findings within a week [ 76 ].…”

Section: Methodsmentioning

confidence: 99%

“…The Committee reviewed events that occurred during the study visits or from the study’s cardiac imaging procedures. Clinical readings of the echocardiogram, CT angiography, and CT chest over-reads were required even though they were obtained for clinical research, as the discovery of incidental findings may have necessitated the timely reporting of critical results to the primary nephrologists, dialysis facilities, primary care physicians, and participants [ 76 ]. Depending on the findings, we had instituted a protocol to report urgent findings that required intervention to the nephrologist and participant.…”

Section: Methodsmentioning

confidence: 99%

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Rationale and design for the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study

et al. 2015

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BackgroundSudden cardiac death occurs commonly in the end-stage renal disease population receiving dialysis, with 25% dying of sudden cardiac death over 5 years. Despite this high risk, surprisingly few prospective studies have studied clinical- and dialysis-related risk factors for sudden cardiac death and arrhythmic precursors of sudden cardiac death in end-stage renal disease.Methods/DesignWe present a brief summary of the risk factors for arrhythmias and sudden cardiac death in persons with end-stage renal disease as the rationale for the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, a prospective cohort study of patients recently initiated on chronic hemodialysis, with the overall goal to understand arrhythmic and sudden cardiac death risk. Participants were screened for eligibility and excluded if they already had a pacemaker or an automatic implantable cardioverter defibrillator. We describe the study aims, design, and data collection of 574 incident hemodialysis participants from the Baltimore region in Maryland, U.S.A.. Participants were recruited from 27 hemodialysis units and underwent detailed clinical, dialysis and cardiovascular evaluation at baseline and follow-up. Cardiovascular phenotyping was conducted on nondialysis days with signal averaged electrocardiogram, echocardiogram, pulse wave velocity, ankle, brachial index, and cardiac computed tomography and angiography conducted at baseline. Participants were followed annually with study visits including electrocardiogram, pulse wave velocity, and ankle brachial index up to 4 years. A biorepository of serum, plasma, DNA, RNA, and nails were collected to study genetic and serologic factors associated with disease.DiscussionStudies of modifiable risk factors for sudden cardiac death will help set the stage for clinical trials to test therapies to prevent sudden cardiac death in this high-risk population.

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“…4 The prevalence of noncardiac IFs ranges from 8% to 69% depending on the type of CT protocol used and age of the participants with the most frequent IFs being pulmonary nodules. 5 IFs can be classified as benign, i.e., of no clinical importance and requiring no additional work-up or follow-up or a clinically significant finding, which is a potentially or definitely important lesion requiring additional investigation. This second category can be subdivided into indeterminate findings requiring clinical correlation or follow-up and major findings requiring immediate evaluation or management.…”

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confidence: 99%

The good, bad, and ugly of incidental findings on cardiovascular-computed tomography

Bhambhvani

2016

Journal of Nuclear Cardiology

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Incidental findings on cardiac computed tomography in incident hemodialysis patients: the predictors of arrhythmic and cardiovascular events in end-stage renal disease (PACE) study

Abstract: Background: This is the first study that has examined non-cardiac incidental findings in research cardiac computed tomography (CT) of hemodialysis patients and their relationship with patient characteristics.

Cited by 10 publications

References 20 publications

Frailty and Cognitive Function in Incident Hemodialysis Patients

Frailty and Cognitive Function in Incident Hemodialysis Patients

Rationale and design for the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study

The good, bad, and ugly of incidental findings on cardiovascular-computed tomography

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