Outcome of Congestive Heart Failure, Dilated Cardiomyopathy, Hypertrophic Hyperkinetic Disease, and Ischemic Heart Disease in Dialysis Patients

Parfrey, Patrick S.; Griffiths, Sheila M.; Harnett, John D.; Taylor, Rhoda; King, Anthony; Hand, John R. M.; Barré, Paul E.

doi:10.1159/000168084

Cited by 70 publications

(20 citation statements)

References 28 publications

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“…LVH is present in >70% of patients with ESRD [13]and is an important factor for the development of cardiovascular events. Furthermore, LVH is an adverse prognostic factor in patients with ESRD [13, 14, 15]. Therefore, improving LVH and preventing the development of LVH is very important in the management of ESRD patients.…”

Section: Discussionmentioning

confidence: 99%

Angiotensin II Type 1 Receptor Antagonist, Losartan, Causes Regression of Left Ventricular Hypertrophy in End-Stage Renal Disease

Shibasaki

Masaki

Nishiue

et al. 2002

Nephron

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Left ventricular hypertrophy (LVH) commonly occurs in patients with end-stage renal disease (ESRD) and is an independent risk factor for cardiovascular events. Angiotensin II type 1 receptor (AT1-R) antagonists may be able to reverse LVH independent to the hypotensive effect in the ESRD setting. Thirty chronically hemodialyzed uremic patients with hypertension were randomly assigned to receive the AT1-R antagonist losartan (n = 10), the angiotensin-converting enzyme (ACD) inhibitor enalapril (n = 10), or calcium antagonist amlodipine (n = 10). Left ventricular mass (LVM) index was measured by echocardiography before and 6 months after treatment. The baseline demographic and clinical characteristics did not differ between the three groups. The mean baseline LVM index also did not differ in the three groups. After 6 months of treatment, losartan treatment significantly reduced the LVM index (–24.7 ± 3.2%) than amlodipine (–10.5 ± 5.2%) or enalapril (–11.2 ± 4.1%) therapy. All three groups had a similar decrease in the mean blood pressure with treatment. The plasma angiotensin II concentration increased 5-fold with losartan treatment. In contrast, the plasma angiotension II concentration did not change with enalapril and only increased 2-fold with amlodipine. Thus, the present study indicates that losartan more effectively regresses LVH in patients with ESRD than do enalapril and amlodipine despite a comparable depressor effect between the three drugs.

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Section: Discussionmentioning

confidence: 99%

Angiotensin II Type 1 Receptor Antagonist, Losartan, Causes Regression of Left Ventricular Hypertrophy in End-Stage Renal Disease

Shibasaki

Masaki

Nishiue

et al. 2002

Nephron

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“…It is well recognized that patients on HD have a higher cardiovascular morbidity and mortality [20], The contri bution of the HD process itself to the development of myocardial ischemia is less well known. We had previous ly shown that STD, a possible marker for myocardial isch emia developed in association with dialysis in nearly half the patients studied [10], While STD usually signals myocardial ischemia, we and others have raised the concern that, being an 'elec trical phenomenon', it may result from the electrolyte shifts which occur during dialysis [10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Myocardial Alterations during Hemodialysis: Insights from New Noninvasive Technology

Singh¹,

Langer²,

Freeman³

et al. 1994

Am J Nephrol

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Eighteen patients with chronic renal failure had their cardiac status monitored during hemodialysis (HD). Ten studies were carried out using an ambulatory nuclear vest to assess ejection fraction (EF), heart rate (HR), relative end-systolic (ESV) and end-diastolic (EDV) volumes every 60 s. A total of 36 episodes of EF falls occurred in 9 patients, all asymptomatic. These EF falls were associated with a rise in ESV, while HR, BP, and EDV remained unchanged. The EF falls correlated best with the volume of ultrafiltrate removed. Ten patients had on-line ST-segment monitoring with sestamibi injection either at the time of ST depression (STD) or at the end of dialysis, if no STD occurred, in order to detect the presence of transient ischemia. Seven often patients had perfusion defects after dialysis, with STD occurring in 3 of 10 patients. Pre-dialysis imaging was available in only 8 of 10 patients, and 6 of these patients had perfusion defects. Changes in perfusion defects were not significantly different in the 3 patients with STD compared with those without STD. EF falls and perfusion defects are common in HD patients even in the absence of known coronary artery disease; however, ST segment monitoring is not a sensitive tool for its detection. These changes in function and perfusion may represent myocardial ischemia and contribute to the high incidence of cardiovascular morbidity and mortality in this patient population.

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“…Cardiovascular diseases are the main cause of death in chronic renal failure [1] . Many risk factors can predict the mortality of these patients, and most of them are related to cardiovascular status [5][6][7] .…”

mentioning

confidence: 99%

Is 44-Hour Better than 24-Hour Ambulatory Blood Pressure Monitoring in Hemodialysis?

Martin¹,

Franco²,

Gavras

et al. 2006

Kidney Blood Press Res

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The aim of this study is to evaluate if hemodialysis (HD) patients with similar blood pressure (BP) in the whole inter-HD period could have different target organ lesions and survival if the behavior of BP differs from the first to the second day of the inter-HD period. The present study compares 44-hour ambulatory BP monitoring (ABPM) patterns in 45 HD patients. Three BP patterns emerged: group A (n = 15) had similar BPs throughout (138 ± 11/88 ± 12 in the first 22 h vs. 140 ± 11/87 ± 12 mm Hg in the second 22-hour period); group B (n = 15) had a significant systolic BP rise from the first to the second period (132 ± 15/80 ± 12 vs. 147 ± 12/86 ± 13 mm Hg, p < 0.05); group C (n = 15) had significantly higher BPs (p < 0.05) than the other 2 groups throughout the whole inter-HD period, with no significant change between the 2 halves (172 ± 14/108 ± 12 vs. 173 ± 18/109 ± 14 mm Hg). Ventricular mass and survival during the 30-month follow-up period were statistically significantly better in group A, intermediate in group B and worse in group C. The data suggest that a 44-hour ABPM is more accurate than a 24-hour one in evaluating organ lesion and prognosis in HD patients.

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Outcome of Congestive Heart Failure, Dilated Cardiomyopathy, Hypertrophic Hyperkinetic Disease, and Ischemic Heart Disease in Dialysis Patients

Cited by 70 publications

References 28 publications

Angiotensin II Type 1 Receptor Antagonist, Losartan, Causes Regression of Left Ventricular Hypertrophy in End-Stage Renal Disease

Angiotensin II Type 1 Receptor Antagonist, Losartan, Causes Regression of Left Ventricular Hypertrophy in End-Stage Renal Disease

Myocardial Alterations during Hemodialysis: Insights from New Noninvasive Technology

Is 44-Hour Better than 24-Hour Ambulatory Blood Pressure Monitoring in Hemodialysis?

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