scholarly journals Statins for Renal Patients: A Fiddler on the Roof?

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Anabela Malho Guedes ◽  
Pedro Leão Neves
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Renal Disease ◽  
Cardiovascular Events ◽  
Morbidity And Mortality ◽  
Atherosclerotic Cardiovascular Disease ◽  
Increased Risk ◽  
Progression Of Renal Disease

Atherosclerotic cardiovascular disease is the main cause of morbidity and mortality in chronic kidney disease patients. There is a raft of evidence showing that in the general population dyslipidaemia is associated with an increased risk of cardiovascular events, as well as with a greater prevalence of chronic kidney disease. Consequently, the use of statins in the general population with dyslipidaemia is not controversial. Nevertheless, the benefits of statins in patients with chronic kidney disease are more elusive. The authors review the possible effects of statins on the progression of renal disease and cardiovascular events in chronic kidney disease patients.

scholarly journals Epicardial Adipose Tissue, Adiponectin and Leptin: A Potential Source of Cardiovascular Risk in Chronic Kidney Disease

2020 ◽  
Vol 21 (3) ◽  
pp. 978 ◽  
Author(s):  
Luis D’Marco ◽  
Maria Jesús Puchades ◽  
Jose Luis Gorriz ◽  
Maria Romero-Parra ◽  
Marcos Lima-Martínez ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Adipose Tissue ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
General Population ◽  
Epicardial Adipose Tissue ◽  
Atherosclerotic Cardiovascular Disease ◽  
Increased Risk ◽  
The Impact

The importance of cardiometabolic factors in the inception and progression of atherosclerotic cardiovascular disease is increasingly being recognized. Beyond diabetes mellitus and metabolic syndrome, other factors may be responsible in patients with chronic kidney disease (CKD) for the high prevalence of cardiovascular disease, which is estimated to be 5- to 20-fold higher than in the general population. Although undefined uremic toxins are often blamed for part of the increased risk, visceral adipose tissue, and in particular epicardial adipose tissue (EAT), have been the focus of intense research in the past two decades. In fact, several lines of evidence suggest their involvement in atherosclerosis development and its complications. EAT may promote atherosclerosis through paracrine and endocrine pathways exerted via the secretion of adipocytokines such as adiponectin and leptin. In this article we review the current knowledge of the impact of EAT on cardiovascular outcomes in the general population and in patients with CKD. Special reference will be made to adiponectin and leptin as possible mediators of the increased cardiovascular risk linked with EAT.

scholarly journals Low statin use in nondialysis-dependent chronic kidney disease in the absence of clinical atherosclerotic cardiovascular disease or diabetes

2019 ◽  
Vol 12 (4) ◽  
pp. 530-537
Author(s):  
Talar W Markossian ◽  
Holly J Kramer ◽  
Nicholas J Burge ◽  
Ivan V Pacold ◽  
David J Leehey ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Atherosclerotic Cardiovascular Disease ◽  
Risk Equation ◽  
Diabetes Status ◽  
Increased Risk ◽  
Ascvd Risk ◽  
Risk Equivalent ◽  
Statin Use

Abstract Background Both reduced glomerular filtration rate and increased urine albumin excretion, markers of chronic kidney disease (CKD), are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). However, CKD is not recognized as an ASCVD risk equivalent by most lipid guidelines. Statin medications, especially when combined with ezetimibe, significantly reduce ASCVD risk in patients with nondialysis-dependent CKD. Unless physicians recognize the heightened ASCVD risk in this population, statins may not be prescribed in the absence of clinical cardiovascular disease or diabetes, a recognized ASCVD risk equivalent. We examined statin use in adults with nondialysis-dependent CKD and examined whether the use differed in the presence of clinical ASCVD and diabetes. Methods This study ascertained statin use from pharmacy dispensing records during fiscal years 2012 and 2013 from the US Department of Veterans Affairs Healthcare System. The study included 581 344 veterans aged ≥50 years with nondialysis-dependent CKD Stages 3–5 with no history of kidney transplantation or dialysis. The 10-year predicted ASCVD risk was calculated with the pooled risk equation. Results Of veterans with CKD, 62.1% used statins in 2012 and 55.4% used statins continuously over 2 years (2012–13). Statin use in 2012 was 76.2 and 75.5% among veterans with CKD and ASCVD or diabetes, respectively, but in the absence of ASCVD, diabetes or a diagnosis of hyperlipidemia, statin use was 21.8% (P < 0.001). The 10-year predicted ASCVD risk was ≥7.5% in 95.1% of veterans with CKD, regardless of diabetes status. Conclusions Statin use is low in veterans with nondialysis-dependent CKD in the absence of ASCVD or diabetes despite high-predicted ASCVD risk. Future studies should examine other populations.

scholarly journals Comparison of the Modification of Diet in Renal Disease Study and Chronic Kidney Disease Epidemiology Collaboration Equations for Detection of Cardiovascular Risk: Tehran Lipid and Glucose Study

2020 ◽  
Vol 18 (4) ◽  
Author(s):  
Pouria Mousapour ◽  
Maryam Barzin ◽  
Majid Valizadeh ◽  
Maryam Mahdavi ◽  
Fereidoun Azizi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Renal Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Atherosclerotic Cardiovascular Disease ◽  
Disease Study

Objectives: The study aimed to compare the Modification of Diet in Renal Disease Study (MDRD) and the Epidemiology Collaboration (CKD-EPI) equations for the detection of cardiovascular risk. Methods: Data of 9,970 Tehranian participants aged ≥ 20 years were analyzed. The prevalence of cardiovascular disease (CVD), its risk factors, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk were compared across the categories of glomerular filtration rate based on the MDRD and CKD-EPI equations. Chronic kidney disease (CKD) was defined as the estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73 m2 according to each equation. Results: The prevalence of CKD weighted to the 2016 Tehranian urban population was 11.0% (95% confidence interval: 10.3 - 11.6) and 9.7% (9.1 - 10.2) according to the MDRD and CKD-EPI equations, respectively. Besides, 8.3% and 1.5% of the participants with CKDMDRD and non-CKDMDRD were reclassified to non-CKDCKD-EPI and CKDCKD-EPI categories, respectively. Participants with CKDCKD-EPI but without CKDMDRD were more likely to be male and older, and more frequently had diabetes, hypertension, dyslipidemia, and CVD, when compared to those without CKD according to both equations; they were also more likely to be male, older, and smokers, and had less dyslipidemia and more CVD, when compared to those with CKD by using both equations. In multivariate logistic regression analysis, compared to CKDMDRD, the odds of CKDCKD-EPI were significantly higher for older age and lower for the female gender. Conclusions: Compared to MDRD, the CKD-EPI equation provides more appropriate detection of cardiovascular risk, which is caused by the reclassification of older individuals and fewer females into lower eGFR categories.

scholarly journals Detection of Atherosclerotic Cardiovascular Disease in Patients with Advanced Chronic Kidney Disease in the Cardiology and Nephrology Communities

2018 ◽  
Vol 8 (4) ◽  
pp. 285-295 ◽  
Author(s):  
Rafia I. Chaudhry ◽  
Roy O. Mathew ◽  
Mandeep S. Sidhu ◽  
Preety Sidhu-Adler ◽  
Radmila Lyubarova ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Transplant ◽  
Small Sample ◽  
Morbidity And Mortality ◽  
Atherosclerotic Cardiovascular Disease ◽  
Convenience Sample ◽  
Randomized Controlled ◽  
Transplant Evaluation

Background: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality among patients with chronic kidney disease (CKD) with a glomerular filtration rate of < 60 mL/min/1.73 m2 body surface area. The availability of high-quality randomized controlled trial data to guide management for the population with CKD and ASCVD is limited. Understanding current practice patterns among providers caring for individuals with CKD and CVD is important in guiding future trial questions. Methods: A qualitative survey study was performed. An electronic survey regarding the diagnosis and management of CVD in patients with CKD was conducted using a convenience sample of 450 practicing nephrology and cardiology providers. The survey was administered using Qualtrics® (https://www.qualtrics.com). Results: There were a total of 113 responses, 81 of which were complete responses. More than 90% of the respondents acknowledged the importance of CVD as a cause of morbidity and mortality in patients with CKD. Outside the kidney transplant evaluation setting, 5% of the respondents would screen an asymptomatic patient with advanced CKD for ASCVD. Outside the kidney transplant evaluation scenario, the respondents did not opt for invasive management strategies in advanced CKD. Conclusions: The survey results reveal a lack of consensus among providers caring for patients with advanced CKD about the management of ASCVD in this setting. Future randomized controlled trials will be needed to better inform the clinical management of ASCVD in these patients. The limitations of the study include its small sample size and the relatively low response rate among the respondents.

Abstract P120: Relationship of Lipoproteins With Cardiovascular Disease in Persons With Chronic Kidney Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Archna Bajaj ◽  
Dawei Xie ◽  
Esteban Cedillo-Couvert ◽  
Jeanne Charleston ◽  
Jing Chen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Hdl Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cvd Risk ◽  
Increased Risk ◽  
Low Hdl ◽  
Secondary Analyses

Introduction: Chronic kidney disease (CKD) is associated with dyslipidemia (particularly elevated triglycerides [TG] and reduced HDL-cholesterol [HDL-C]) and increased risk of atherosclerotic cardiovascular disease (CVD). However, the association between lipoprotein measures and CVD events in CKD is not well defined. Hypothesis: We hypothesize that high TG and low HDL-C are associated with increased risk for CVD (myocardial infarction [MI] and ischemic stroke) in CKD. Methods: The Chronic Renal Insufficiency Cohort (CRIC) is a prospective study of adults with CKD. We compared tertiles of TG, total cholesterol (TC), VLDL-cholesterol (VLDL-C), LDL-cholesterol (LDL-C), HDL-C, apolipoprotein B (apoB), and apolipoprotein A-I (apoA-I) with risk for MI and ischemic stroke using Fine and Gray methods with death as a competing risk. The lowest tertile was used as the reference category except for HDL-C and apoA-I, in which the highest tertile was used. In secondary analyses, we excluded participants with previous MI or stroke. Results: Among 3811 participants (55% men, 42% Caucasian) with mean age 57.7±11.0 years, 351 had an MI, 132 had an ischemic stroke, and 963 died over a median follow-up of 7.9 years. After adjusting for potential confounders, the hazard ratio (HR, 95% CI) for CVD was 1.04 (0.80-1.34) for high LDL-C, 1.31 (1.01-1.69) for high TG, 1.33 (1.04-1.70) for high VLDL-C, 1.30 (1.01-1.68) for high apoB, 1.65 (1.25-2.17) for low HDL-C, and 1.31 (1.01-1.70) for low apoA-I. In secondary analyses of 2751 participants with no CVD history, high TG (HR 1.46, 1.02-2.10), high VLDL-C (HR 1.56, 1.08-2.25), low HDL-C (HR 2.11, 1.40-3.16) and low apoA-I (HR 2.28, 1.54-3.37) were significantly associated with incident CVD. Conclusions: While high LDL-C is associated with increased CVD risk in the general population, we found no such association in CKD. Instead, high TG, high VLDL-C, low HDL-C and low apoA-I levels show strong associations with increased CVD risk and incident CVD events in CKD.

scholarly journals Effect of Strict Volume Control on Renal Progression and Mortality in Non-Dialysis-Dependent Chronic Kidney Disease Patients: A Prospective Interventional Study

2018 ◽  
Vol 27 (5) ◽  
pp. 420-427 ◽  
Author(s):  
Kubra Esmeray ◽  
Oguzhan Sıtkı Dizdar ◽  
Selahattin Erdem ◽  
Ali İhsan Gunal
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Diuretic Therapy ◽  
Volume Overload ◽  
Volume Control ◽  
Interventional Study ◽  
Increased Risk ◽  
Renal Progression ◽  
Progression Of Renal Disease

Objective: The aim of this study was to examine the effect of volume status on the progressions of renal disease in normovolemic and hypervolemic patients with advanced non-dialysis-dependent chronic kidney disease (CKD) who were apparently normovolemic in conventional physical exam­ination. Materials and Methods: This was a prospective interventional study performed in a group of stage 3–5 CKD patients followed up for 1 year. Three measurements were made for volume and renal status for every patient. The fluid status was assessed by a bioimpedance spectroscopy method. A blood pressure (BP) value > 130/80 mm Hg prompted the initiation or dose increment of diuretic treatment in normovolemic patients. Result: Forty-eight patients (48%) were hypervolemic. At the end of the 1-year follow-up, hypervolemic patients were found to have a significantly lower estimated glomerular filtration rate and higher systolic BP compared to baseline. Hypervolemia was associated with an increased incidence of death. Conclusion: We have shown that maintenance of normovolemia with diuretic therapy in normovolemic patients was able to slow down and even improve the progression of renal disease. Volume overload leads to an increased risk for dialysis initiation and a decrease in renal function in advanced CKD. Volume overload exhibits a stronger association with mortality in CKD patients.

Stroke in chronic renal failure

2008 ◽  
Vol 149 (15) ◽  
pp. 691-696
Author(s):  
Dániel Bereczki
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Kidney Diseases ◽  
Cerebrovascular Diseases ◽  
Lipid Lowering ◽  
Increased Risk ◽  
Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

scholarly journals Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Demetria Hubbard ◽  
Lisandro D. Colantonio ◽  
Robert S. Rosenson ◽  
Todd M. Brown ◽  
Elizabeth A. Jackson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Health Insurance ◽  
High Risk ◽  
Kidney Disease ◽  
Peripheral Artery ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Very High

Abstract Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD.

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