Tag Archives: chronic kidney disease

ACEi/ARB use Despite overwhelming evidence and innumerable local, regional, national and international guidelines, the prescription of ACEi/ARB therapies for patients with CKD have remained (to use Dr Hostetter’s word) ‘woeful’. North American data showed that between 1999 and 2014 the use of ACEi/ARB therapy in patients with CKD rose from 25.5% between 1999 and 2002 to 40.1% between 2011 and 2014, with their use being the exception unless patients had additional diseases, such as diabetes mellitus or cardiac disease.6 These findings are consistent with National Health and Nutrition Examination Survey data, which suggested that only 39

Vaduganathan et al. aggregated results from five heart failure trials,3 and the Nuffield Department of Population Health Renal Studies Group with the SGLT2 inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium combined standardised data from 13 large placebo-controlled SGLT2 inhibitor trials from three different patient populations. It included results from trials studying 42,568 patients with type 2 diabetes at high risk of atherosclerotic cardiovascular disease, 21,974 patients in heart failure trials, and 25,898 patients in CKD trials.4 Across the 13 trials, the risk of the composite of hospitalisation for heart failure or cardiovas

What’s new in transplantation Are kidney donors worse off? The meeting was opened by Dr Anna Price (Queen Elizabeth University Hospital, Birmingham) who addressed the long-term cardiovascular effects of unilateral nephrectomy in living kidney donors.1 Previous studies have shown a significant prevalence of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD),2,3 but the effects of reduced renal function in living kidney donors has been unexplored until now. A recent study by Price et al. demonstrated that living kidney donors had a reduction in estimated glomerular filtration rate (eGFR) from 95 to 67 ml/min

Chair of the writing group Professor Christian Sticherling (Universitätsspital Basel, Switzerland) said: “Traditionally we interrupted anticoagulation during device implantation and restarted it afterwards. And we bridged with heparin around the time of the operation. The new recommendation is to continue to give the VKA and perform the operation without any bridging. That shows the lowest rate of perioperative bleeding.” He added: “Also new is the recommendation not to interrupt VKAs during ablation and particularly during pulmonary vein isolation which is the most common type of ablation nowadays.” The paper, produced by the EHRA,

ESC guidelines and differences between NOACs Following the roll-out of the novel oral anticoagulants (NOACs), the European Society of Cardiology (ESC) published in 2012 a focused update of its guidelines for the management of atrial fibrillation (AF). Since the NOACs tested in clinical trials all showed at least non-inferiority when compared with vitamin K antagonists (VKAs), with a better safety profile, particularly with reduction in intracranial haemorrhage (ICH), the ESC 2012 guideline recommended NOACs as broadly preferable to VKAs in the vast majority of patients with non-valvular AF (NVAF).1 In 2013, the European Heart Rhythm Associati

Advances in imaging and diagnosis Dr Nik Abidin (Consultant Cardiologist, Salford Royal NHS Foundation Trust) kicked off the theme of ‘Advances in diagnosis’ with a tantalising taster of the future of echocardiography, and a demonstration of what is already possible. Patients with chronic kidney disease (CKD) have a high incidence of cardiac dysfunction, with 75% of patients with significant CKD demonstrating left ventricular hypertrophy. In such patients, left ventricular dilatation occurs late with advanced disease, and left ventricular mass is an earlier predictor of cardiac mortality. An increase in left atrium size is the downstream

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Introduction Myocardial infarction with persistent ST-elevation (STEMI) continues to be a major public health problem. In a recent report, the incidence of hospital admissions for STEMI in Europe varied between 44 and 142 per 100,000 inhabitants per year, and in-hospital mortality reached 13.5%.1 More than 30% of STEMI patients have chronic kidney disease (CKD).2 On the other hand, half of deaths in advanced CKD patients are of cardiovascular causes with myocardial infarction (MI) being the most frequent event.3 Patients with CKD are routinely excluded from cardiovascular clinical trials, and certain medications and treatment modalities are l

Multipolar left ventricular pacing to optimise acute haemodynamic response to cardiac resynchronisation therapy SY Ahsan (presenting author), B Sabberwal, C Hayward, P Lambiase, M Thomas, GG Babu, S Aggarwal, MD Lowe, AWC Chow The Heart Hospital, Institute of Cardiovascular Science, University College Hospitals NHS Foundation Trust, London Purpose: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in a sub-group of patients with heart failure, though up to 30% of patients have no benefit. CRT patients are heterogeneous and an individualised approach to CRT may be needed to increase response rate. We evaluated the impact

Introduction As doctors and scientists we are accustomed to breaking down problems and simplifying complex pathology in order to focus our management and identify possible targets for future therapies. The pathophysiology of cardiorenal disease is no different but, as yet, attempts to elucidate the complex interaction between heart and kidneys has failed. Although cardiac and renal disease are often diagnosed together, it is clear that a straightforward causal relationship does not exist. Disease in either serves as a risk factor for disease in the other and perpetuates the progression of that disease, but why this is so is unclear. Whilst th