Influence of Chronic Kidney Disease on Cardiac Structure and Function

Dziedzic

Current Issues in Pharmacy and Medical Sciences

et al. 2016

events, hospitalisation, and more cardiovascular complications following a myocardial infarct [4,5]. Even microalbuminuria, in the absence of an apparent decrease in renal function or diabetes, predicts more cardiovascular disease (CVD) and death [6]. The impact of CVD in CKD is illustrated by reports on the natural history of patients with early CKD. These indicate that the risk of premature CVD death is much higher than the risk of dialysis/transplantation progress [7,8]. Such observations are significant not only because of a high incidence and prevalence of end stage CKD, but because the number of patients with early CKD far exceeds those with end stage CKD. This trend is continuing to rise [9].Patients with CKD, have the highest risk for atherosclerotic CVD. Current interventions have been insufficiently Accelerated atherosclerosis and increased cardiovascular events have been extensively documented in patients with end stage chronic kidney disease. The aim of our work was to find evidence supporting the theory that chronic heart failure (CHF) induces renal function damage. In our work, lipids, apolipoprotein (apo)AI, NTproBNP, hsCRP, lipid hydroperoxide (LPO) and creatinine levels were determined in patients with CHF. A total of 37 patients who were diagnosed with CHF, as well as 15 healthy persons, were recruited for the study. The patients were placed into 2 groups: patients with NYHA class 2 and NYHA class 3. Using routine laboratory methods, NTproBNP level, and lipids were measured by way of employing a Cobas Integra analyser, while the concentration of hs-CRP was measured by immunonephelometric methods. Moreover, serum LPO concentration was measured using Cayman's Assay Kit (LPO). The statistical analysis of the obtained results was performed using the nonparametric Kruskal-Wallis test and Spearman's correlation analysis. Our work demonstrated that the CHF patients had significantly decrease concentration of HDL cholesterol and apoAI, but increased NT-pro-BNP, hsCRP and LPO levels. In all CHF patients, a significant positive correlation between NTproBNP concentration and creatinine levels, and a significant negative correlation between NTproBNP concentration and apoAI levels, as well as between concentration of creatinine and apoAI levels, was shown. The study results suggest that variation in the concentration of NTproBNP, LPO, hsCRP, apoAI, creatinine, in addition to chronic heart failure progression, gradually accompany the progress of chronic renal failure. What is more, the disorders may lead to the occurrence of cardiovascular events, consequently, to patient death.

Section: Discussionsupporting

confidence: 88%

Can chronic heart failure induce kidney function damage?

Dziedzic

Current Issues in Pharmacy and Medical Sciences

et al. 2016

The American Journal of Cardiology

“…There are conflicting findings in the literature with respect to the association between UACR and LV systolic function, 8 likely in part due to the lack of sensitivity of LVEF for mild systolic dysfunction. Our inclusion of strain allowed us to better characterize systolic dysfunction as compared with most existing studies, and we found that microalbuminuria was significantly associated with impaired strain.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 In non-Hispanic populations, the urine albumin-to-creatinine ratio (UACR), a measure of proteinuria and marker of kidney damage, has been associated with cardiovascular disease (CVD) mortality and heart failure, 6,7 as well as subclinical measures of cardiac structure and function. 8 To our knowledge, no studies have examined the association between albuminuria and cardiac dysfunction in U.S. Hispanics/Latinos, despite a disproportionate burden of risk factors leading to chronic kidney disease in some Hispanic groups. 9,10 Using data from the Echocardiographic Study of Latinos (Echo-SOL), we examined the association between UACR and measures of cardiac structure and function among 1,815 Hispanic/Latino individuals who underwent a standardized 2-D echocardiography protocol, including speckle-tracking analysis for measurement of longitudinal strain.…”

Section: Introductionmentioning

confidence: 99%

Association of Albuminuria With Cardiac Dysfunction in US Hispanics/Latinos

Hanna

Melamed

et al. 2017

Higher urine albumin-to-creatinine ratio (UACR) has been associated with cardiac dysfunction in the general population. We assessed the association of UACR with cardiac structure and function in the Echocardiographic Study of Latinos (Echo-SOL), an ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) across 4 U.S. sites. Echo-SOL participants underwent standard 2-dimensional echocardiography, including speckle-tracking strain analysis. UACR was categorized as normal and high-normal (based on the midpoint of values below microalbuminuria), microalbuminuria (≥17 mg/g for men; ≥25 mg/g for women), and macroalbuminuria (≥250 mg/g; ≥355 mg/g). Simultaneous assessments were made of left ventricular (LV) mass index and hypertrophy, and measures of LV systolic and diastolic dysfunction. We assessed the association of UACR with subclinical cardiac measures, adjusting for sociodemographic and cardiometabolic factors. Among 1,815 participants (median age 54, female 65%), 42% had normal UACR, 43% high-normal UACR, 13% microalbuminuria, and 2% macroalbuminuria. Prevalence of LV hypertrophy was 13%, LV systolic dysfunction (ejection fraction <50%) 3%, and diastolic dysfunction 53%. After covariate adjustment, both micro- and macroalbuminuria were significantly associated with a two-fold increase in LV hypertrophy. Microalbuminuria but not macroalbuminuria was associated with worse global longitudinal strain. Elevated UACR, even at high-normal levels, was significantly associated with greater diastolic dysfunction. In conclusion, elevated UACR was associated with LV hypertrophy and diastolic dysfunction in the largest known population sample of U.S. Hispanic/Latinos. Screening and detection of even high-normal UACR could be of value to guide CVD prevention efforts among Hispanic/Latino Americans.

“…Indeed, CKD patients frequently develop left ventricular hypertrophy, hypertension, valvular heart disease, left ventricular systolic failure, diastolic failure, arrhythmias, accelerated atherosclerosis progression, ischemic artery disease, and sudden cardiac death. [9][10][11][12][13] Some therapeutic strategies, such as the blockage of reninangiotensin-aldosterone system, allow to slow down but not to fully halt CKD progression. For this reason, other potential treatments are currently under investigation but conclusive results are still lacking.…”

Section: Introduction To the Epidemiology And Management Issues In Ckdmentioning

confidence: 99%

Phosphate binders for the treatment of chronic kidney disease: role of iron oxyhydroxide

Cernaro

Santoro

Lacquaniti

et al. 2016

IJNRD

Chronic kidney disease-mineral bone disorder is frequent in patients with renal failure. It is characterized by abnormalities in mineral and bone metabolism with resulting hyperphosphatemia, low serum vitamin D, secondary hyperparathyroidism, altered bone morphology and strength, higher risk of bone fractures, and development of vascular or other soft tissue calcifications. Besides the recommendation to reduce phosphorus dietary intake, many drugs are currently available for the treatment of calcium/phosphate imbalance. Among them, phosphate binders represent a milestone. Calcium-based binders (calcium carbonate, calcium acetate) are effective in lowering serum phosphate, but their use has been associated with an increased risk of hypercalcemia and calcifications. Calcium-free binders (sevelamer hydrochloride, sevelamer carbonate, and lanthanum carbonate) are equally or slightly less effective than calcium-containing compounds. They would not induce an increase in calcium levels but may have relevant side effects, including gastrointestinal symptoms for sevelamer and risk of tissue accumulation for lanthanum. Accordingly, new phosphate binders are under investigation and some of them have already been approved. A promising option is sucroferric oxyhydroxide (Velphoro ® , PA21), an iron-based phosphate binder consisting of a mixture of polynuclear iron(III)-oxyhydroxide, sucrose, and starches. The present review is focused on pharmacology, mode of action, and pharmacokinetics of sucroferric oxyhydroxide, with a discussion on comparative efficacy, safety, and tolerability studies of this drug in chronic kidney disease and patient perspectives such as quality of life, satisfaction, and acceptability. Sucroferric oxyhydroxide has proven to be as effective as sevelamer in reducing phosphatemia with a similar safety profile and lower pill burden. Experimental and clinical studies have documented a minimal percentage of iron absorption without inducing toxicity. In conclusion, the overall benefit-risk balance of sucroferric oxyhydroxide is deemed to be positive, and this new drug may therefore represent a good alternative to traditional phosphate binders for the treatment of hyperphosphatemia in dialysis patients.