scholarly journals When Heart Failure Collides with Diabetes and Chronic Kidney Disease: Challenges and Opportunities

2021 ◽  
Author(s):  
Kris Vijay ◽  
Brendon L. Neuen ◽  
Edgar V. Lerma
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Evidence ◽  
Metabolic Risk ◽  
Downstream Effects ◽  
Increased Risk ◽  
Challenges And Opportunities ◽  
Treatment Plans

Background: Heart failure (HF), diabetes mellitus (DM), and chronic kidney disease (CKD) are commonly occurring and interlinked conditions. Approximately 25% to 40% of patients with HF have DM, and approximately 40% to 50% of patients with HF have CKD. Both DM and CKD are associated with increased risk of incident HF. Further, 40% of people with DM develop CKD, making DM the leading cause of kidney failure globally. Importantly, 16% of patients with HF have both comorbid DM and CKD, and the combination of these 3 comorbidities is associated with substantially increased risk for hospitalization and mortality. Mechanisms that underlie the relationships between HF, DM, and CKD are complex but likely relate to shared cardiovascular and metabolic risk factors, as well as downstream effects on inflammation, oxidative stress, and neurohormonal pathways. Summary: This review outlines the epidemiology and links between HF, DM, and CKD, as well as current clinical evidence for the treatment of individuals with a combination of these comorbidities. A case study of a patient with concomitant HF, DM, and CKD is discussed to explore potential treatment approaches for patients in whom all 3 comorbidities exist. Key Messages: Treatment plans for patients with a combination of these 3 comorbidities should consider the available clinical evidence.

scholarly journals Increased risk of stroke with darbepoetin alfa in anaemic heart failure patients with diabetes and chronic kidney disease

2015 ◽  
Vol 17 (11) ◽  
pp. 1201-1207 ◽  
Author(s):  
Natalie A. Bello ◽  
Eldrin F. Lewis ◽  
Akshay S. Desai ◽  
Inder S. Anand ◽  
Henry Krum ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Darbepoetin Alfa ◽  
Heart Failure Patients ◽  
Increased Risk ◽  
Patients With Diabetes

Chronic Kidney Disease is a Marker of Increased Risk and Co-morbidity in Heart Failure

2013 ◽  
Vol 22 ◽  
pp. S71-S72
Author(s):  
J. Lau ◽  
M. Chang ◽  
B. Ordys ◽  
M. Jardine ◽  
A. Al-kahwa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Increased Risk ◽  
Co Morbidity

scholarly journals POS0487 ASSOCIATION OF RHEUMATOID ARTHRITIS WITH MORTALITY IN A COHORT OF CHRONIC KIDNEY DISEASE PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 476.1-476
Author(s):  
M. Ezeanuna ◽  
D. Prince ◽  
S. A. Alexander ◽  
J. S. Richards ◽  
G. Kerr ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Proportional Hazards ◽  
Current Smoker ◽  
Proportional Hazards Regression ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Race Ethnicity

Background:Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease. RA is also associated with increased risk of chronic kidney disease (CKD) (1, 2), which is a known cardiovascular risk factor (3). We hypothesized that RA (compared with no RA) would be associated with increased risk of mortality among a cohort of patients with CKD.Objectives:To determine the risk of mortality in RA patients with CKD.Methods:This study was conducted using participants from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) prospective Chronic Renal Insufficiency Cohort (CRIC) study. Approximately 3600 participants were enrolled from seven US clinical centers. Patients aged 21 – 74 years with mild to moderate CKD were eligible for enrollment. The primary outcome of interest was all-cause mortality. Secondary outcomes of interest included: kidney event defined as end stage renal disease (ESRD) or 50% decline in estimated glomerular filtration rate (eGFR), myocardial infarction (MI), cerebrovascular accident (CVA), heart failure and a composite cardiovascular endpoint. The association of RA mortality over time was examined using Cox multivariate proportional hazards regression, adjusting for potential covariates (age, sex, race/ethnicity, BMI, current smoker, education).Results:The study cohort included 492 participants with self-reported RA with a mean follow up of 9.5 years. Compared to the non-RA group, RA patients tended to be older, female, Black. Hypertension, diabetes, use of prednisone was more prevalent among the RA cohort. The unadjusted hazards ratio (HR) for mortality based on RA status was 1.45 (1.26, 1.67) but this association was attenuated after adjusting for the confounding factors [aHR 1.09 (0.94, 1.27)] (Table 1). Participants with RA had a significantly higher risk for heart failure than those without RA [aHR 1.17 (1.02, 1.34)]. We did not observe a statistically significant association between RA status and other secondary outcomes.Conclusion:RA was not associated with higher mortality among participants with CKD. However, RA was associated with higher rates of heart failure. Further studies evaluating the mechanisms behind this association are needed.References:[1]Kochi M, Kohagura K, Shiohira Y, Iseki K, Ohya Y. Chronic kidney disease, inflammation, and cardiovascular disease risk in rheumatoid arthritis. J Cardiol. 2018;71(3):277-83.[2]Sumida K, Molnar MZ, Potukuchi PK, Hassan F, Thomas F, Yamagata K, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int. 2018;93(5):1207-16.[3]Chiu HY, Huang HL, Li CH, Chen HA, Yeh CL, Chiu SH, et al. Increased Risk of Chronic Kidney Disease in Rheumatoid Arthritis Associated with Cardiovascular Complications - A National Population-Based Cohort Study. PLoS One. 2015;10(9):e0136508.[4]Muthukumar P, Dhanapriya J, Gopalakrishnan N, Dineshkumar T, Sakthirajan R, Balasubramaniyan T. Evaluation of renal lesions and clinicopathologic correlation in rheumatoid arthritis. Saudi J Kidney Dis Transpl. 2017;28(1):44-50.Table 1.Estimated hazard ratios (HR) for various outcomes from Cox proportional hazards regression for RA statusUnadjustedModel 1Model 2HR (95% CI)HR (95% CI)HR (95% CI)Death1.45 (1.26, 1.67)1.09 (0.94, 1.27)1.13 (0.97, 1.32)MI or death1.43 (1.25, 1.63)1.09 (0.95, 1.26)1.15 (0.99, 1.33)CVA or death1.42 (1.24, 1.63)1.07 (0.92, 1.24)1.11 (0.95, 1.29)CHF or death1.54 (1.35, 1.75)1.17 (1.02, 1.34)1.22 (1.06, 1.40)Composite1.49 (1.31, 1.69)1.13 (0.99, 1.30)1.18 (1.03, 1.35)Kidney event1.09 (0.94, 1.27)0.91 (0.78, 1.07)1.01 (0.85, 1.20)Model 1 adjusted for: age, sex, race/ethnicity, BMI, current smoker, educationModel 2 adjusted for: model 1 + cardiovascular risk factors (urine albumin creatinine ratio, systolic blood pressure, estimated glomerular filtration rate)Disclosure of Interests:None declared

scholarly journals EVALUATION OF 2-D ECHO FINDINGS IN CHRONIC KIDNEY DISEASE :A CASE STUDY OF 50 END STAGE RENAL DISEASE PATIENTS

2020 ◽  
pp. 1-2
Author(s):  
Ruby Patel ◽  
Deepak Baldania ◽  
Babulal Bamboria
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Major Public Health Problem ◽  
Cardiac Abnormalities ◽  
Increased Risk ◽  
Esrd Patients

Chronic kidney disease (CKD) is a major public health problem worldwide with increase in incidence and prevalence. Diabetes and hypertension are the leading cause of CKD worldwide, whereas hypertension is a cause as well as effect of CKD. CKD is a risk factor for cardiovascular events and complications which increase as CKD progress to ESRD [3]. Cardiovascular mortality is 10-20 times more common in ESRD patients on renal replacement therapy as compared to general population. One of the major structural cardiac abnormalities in CKD patients is left ventricular hypertrophy (LVH) and is associated with increased risk for cardiac ischemia, congestive heart failure, as well as a very strong independent predictor for cardiovascular mortality [4]. Majority patients with CKD die due to cardiovascular events before reaching ESRD due to risk factors [5]. Anemia and hypertension are most consistent with heart failure that causes 2/3rd death of all dialysis patients. ESRD patients do have myriads of structural and functional cardiac abnormalities which include LVH, depressed LV function, regional wall motion abnormality, pericardial effusion and valvular calcification.

scholarly journals Role of comorbidities in heart failure prognosis Part 2: Chronic kidney disease, elevated serum uric acid

2020 ◽  
Vol 27 (2_suppl) ◽  
pp. 35-45
Author(s):  
Andrea Tedeschi ◽  
Piergiuseppe Agostoni ◽  
Beatrice Pezzuto ◽  
Ugo Corra’ ◽  
Domenico Scrutinio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Chronic Heart Failure ◽  
Kidney Disease ◽  
Serum Uric Acid ◽  
Elevated Serum ◽  
Morbidity And Mortality ◽  
Heart Failure Patients ◽  
Increased Risk

Despite improvements in pharmacotherapy, morbidity and mortality rates in community-based populations with chronic heart failure still remain high. The increase in medical complexity among patients with heart failure may be reflected by an increase in concomitant non-cardiovascular comorbidities, which are recognized as independent prognostic factors in this population. Heart failure and chronic kidney disease share many risk factors, and often coexist. The presence of kidney failure is associated with incremented risk of cardiovascular and non-cardiovascular mortality in heart failure patients. Chronic kidney disease is also linked with underutilization of evidence-based heart failure therapy that may reduce morbidity and mortality. More targeted therapies would be important to improve the prognosis of patients with these diseases. In recent years, serum uric acid as a determinant of cardiovascular risk has gained interest. Epidemiological, experimental and clinical data show that patients with hyperuricaemia are at increased risk of cardiac, renal and vascular damage and cardiovascular events. Moreover, elevated serum uric acid predicts worse outcome in both acute and chronic heart failure. While studies have raised the possibility of preventing heart failure through the use of uric acid lowering agents, the literature is still inconclusive on whether the reduction in uric acid will result in a measurable clinical benefit. Available evidences suggest that chronic kidney disease and elevated uric acid could worsen heart failure patients’ prognosis. The aim of this review is to analyse a possible utilization of these comorbidities in risk stratification and as a therapeutic target to get a prognostic improvement in heart failure patients.

scholarly journals Chronic kidney disease, heart failure and neprilysin inhibition

2019 ◽  
Vol 35 (4) ◽  
pp. 558-564 ◽  
Author(s):  
Richard Haynes ◽  
Doreen Zhu ◽  
Parminder K Judge ◽  
William G Herrington ◽  
Philip A Kalra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Cardiac Biomarkers ◽  
Function Allocation ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Neprilysin Inhibition ◽  
The Uk

Abstract Patients with chronic kidney disease are at increased risk of cardiovascular disease and this often manifests clinically like heart failure. Conversely, patients with heart failure frequently have reduced kidney function. The links between the kidneys and cardiovascular system are being elucidated, with blood pressure being a key risk factor. Patients with heart failure have benefitted from many trials which have now established a strong evidence based on which to base management. However, patients with advanced kidney disease have often been excluded from these trials. Nevertheless, there is little evidence that the benefits of such treatments are modified by the presence or absence of kidney disease, but more direct evidence among patients with advanced kidney disease is required. Neprilysin inhibition is the most recent treatment to be shown to improve outcomes among patients with heart failure. The UK HARP-III trial assessed whether neprilysin inhibition improved kidney function in the short- to medium-term and its effects on cardiovascular biomarkers. Although no effect (compared to irbesartan control) was found on kidney function, allocation to neprilysin inhibition (sacubitril/valsartan) did reduce cardiac biomarkers more than irbesartan, suggesting that this treatment might improve cardiovascular outcomes in this population. Larger clinical outcomes trials are needed to test this hypothesis.

Hospitalization and Critical Illness in Chronic Kidney Disease

2020 ◽  
Vol 10 (5) ◽  
pp. 302-312
Author(s):  
Jefferson Lorenzo Triozzi ◽  
Jingbo Niu ◽  
Carl P. Walther ◽  
Wolfgang C. Winkelmayer ◽  
Sankar D. Navaneethan
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Intensive Care ◽  
Critical Illness ◽  
Kidney Disease ◽  
Safety Net ◽  
Increased Risk ◽  
Ckd Stage

Background: Patients with chronic kidney disease (CKD) who are hospitalized with a critical illness are at increased risk for adverse outcomes. We studied the predictors of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 in a safety-net healthcare setting. Methods: A retrospective cohort study was conducted among patients ≥18 years of age with CKD stages 3 and 4 using a CKD registry from a safety-net healthcare system. Hospitalizations with critical illness were identified among patients requiring nonelective admission or transfer to the intermediate or intensive care unit during a 3-year period after the diagnosis of CKD. Poisson regression was used to determine associations between baseline characteristics and hospitalization requiring intermediate or intensive care among all CKD patients and in those with different stages of CKD. Outcomes of these hospitalizations were also tabulated. Results: Among 8,302 patients with CKD stages 3 and 4, 1,298 were hospitalized and 495 required intermediate or intensive care during a 3-year follow-up period. In the adjusted analysis, advanced CKD, Hispanics (incident rate ratio [IRR]: 1.88), non-Hispanic Blacks (IRR: 1.48), presence of congestive heart failure (IRR: 2.09), cardiovascular disease (IRR: 1.57), chronic pulmonary disease (IRR: 1.60), liver disease, malignancy, and anemia were associated with higher risk of hospitalization requiring intermediate or intensive care. The association of age, gender, race/ethnicity, congestive heart failure, anemia, and body mass index with hospitalization requiring intermediate or intensive care differed significantly by CKD stage (p value for interaction term <0.05). Congestive heart failure and severity of anemia were associated with a higher risk of hospitalization requiring intermediate or intensive care among patients with mild CKD, and the magnitude of association attenuated among patients with advanced CKD. Conclusions: The burden of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 remains high and was associated with demographic factors and comorbid medical conditions, especially among those with congestive heart failure and cardiovascular disease. Targeted, effective interventions to reduce the burden of hospitalization and critical illness in CKD patients within safety-net healthcare systems are needed.

Boosting the Limited Use of Mineralocorticoid Receptor Antagonists Through New Agents for Hyperkalemia

2019 ◽  
Vol 24 (46) ◽  
pp. 5542-5547 ◽  
Author(s):  
Vasilios G. Athyros ◽  
Alexandros G. Sachinidis ◽  
Ioanna Zografou ◽  
Elisavet Simoulidou ◽  
Alexia Piperidou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Treatment Options ◽  
Sodium Polystyrene Sulfonate ◽  
Drug Induced ◽  
New Agents ◽  
Increased Risk ◽  
Raas Inhibitors ◽  
The Impact

Background: Hyperkalemia is an important clinical problem that is associated with significant lifethreatening complications. Several conditions are associated with increased risk for hyperkalemia such as chronic kidney disease, diabetes mellitus, heart failure, and the use of renin-angiotensin-aldosterone system (RAAS) inhibitors. Objective: The purpose of this review is to present and critically discuss treatment options for the management of hyperkalemia. Method: A comprehensive review of the literature was performed to identify studies assessing the drug-induced management of hyperkalemia. Results: The management of chronic hyperkalemia seems to be challenging and includes a variety of traditional interventions, such as restriction in the intake of the dietary potassium, loop diuretics or sodium polystyrene sulfonate. In the last few years, several new agents have emerged as promising options to reduce potassium levels in hyperkalemic patients. Patiromer and sodium zirconium cyclosilicate 9 (ZS-9) have been examined in hyperkalemic patients and were found to be efficient and safe. Importantly, the efficacy of these novel drugs might allow the continuation of the use of RAAS inhibitors, morbidity- and mortality-wise beneficial class of drugs in the setting of chronic kidney disease and heart failure. Conclusion: Data support that the recently emerged patiromer and ZS-9 offer significant hyperkalemia-related benefits. Larger trials are needed to unveil the impact of these drugs in other patients’ subpopulations, as well.

Abstract MP36: Anemia, Chronic Kidney Disease, and Incident Heart Failure: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Junichi Ishigami ◽  
Morgan E Grams ◽  
Rakhi P Naik ◽  
Melissa C Caughey ◽  
Laura R Loehr ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cross Sectional ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Incident Heart Failure ◽  
Aric Study ◽  
Prevalence Of Anemia

Background: Both chronic kidney disease (CKD) measures, estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR), are associated with incident heart failure (HF). Anemia is thought to play an important role in this association, particularly when eGFR is reduced, but this concept has not been rigorously evaluated. Methods: Using data from 5,539 participants in the Atherosclerosis Risk in Communities (ARIC) study at the fourth visit (1996-98), we first assessed the prevalence ratio (PrR) of anemia for eGFR and ACR using cross-sectional Poisson models, and then prospectively quantified the associations of eGFR, ACR, and anemia with incident HF using Cox proportional hazard models. Results: Based on the WHO definition, 477 (8.6%) participants had anemia at baseline. Both CKD measures were associated with increased prevalence of anemia independently of each other and other potential confounders (PrR, 1.22 [95% confidence interval, 1.11-1.34] with every 1SD decrease in eGFR; and 1.12 [1.03-1.23] with every 1SD increase in log 10 ACR). There were 724 (13.1%) cases of incident HF over median follow-up of 14.8 years. Lower eGFR and higher ACR were independently associated with increased risk of HF regardless of anemia status (Figure A for eGFR, and B for ACR). The association between anemia and HF risk was generally consistent in the range of eGFR below 90 ml/min/1.73m 2 and ACR between 5 and 300 mg/g, without significant interaction between both CKD measures and anemic status (e.g., hazard ratio for anemia vs. no anemia: 1.40 [0.81-2.41] at eGFR 60 ml/min/1.73m 2 and 1.37 [0.67-2.80] at ACR 30 mg/g). Conclusions: Reduced eGFR and elevated ACR were independently associated with higher prevalence of anemia and HF risk. The contribution of anemia to HF risk was overall consistent across CKD ranges of eGFR and ACR. Our results suggest the need of clinical attention on anemia and related HF risk in persons with low eGFR as well as those with high ACR.

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