Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiovascular disease is the major casue of death in maintenance hemodialysis patients. We report two chronic hemodialysis patients with unstable, disabling angina in association with severe coronary artery disease involving all three major vessels. Both successfully underwent coronary artery bypass surgery and subsequently experienced dramatic clinical improvement. Principles of management are discussed and it is suggested that hemodialysis patients should not be arbitrarily denied consideration of coronary artery bypass surgery when it is otherwise indicated.
J Dial 1978
PMID:Successful coronary artery bypass in hemodialysis patients. 30 29

In our haemodialysis centre patients (n = 144), we compared 48 aspects of morbidity in patients with analgesic-associated nephropathy (AAN) and patients with other kidney diseases to determine the presence of characteristic diagnostic features of AAN in addition to a history of habitual analgesic intake. The comparison between 48 AAN patients and the control patients revealed statistically significant differences (p less than 0.05) with regard to myocardial infarction (25% vs 7%), angina pectoris (63% vs 32%), atrial fibrillation (21% vs 4%), arteriosclerosis obliterans of the lower extremity (52% vs 33%), anaemia (mean haemoglobin, 8.38 vs 9.16 g/dl), renal osteodystrophy (67% vs 41%), carpal tunnel syndrome (23% vs 7%), peptic ulcers and erosive gastritis (54% vs 23%), colonic diverticula (15% vs 4%), and haemorrhoids (67% vs 28%). AAN patients therefore have significantly higher morbidity with a characteristic pattern than do patients with other renal diseases.
Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985
PMID:Morbidity of patients with analgesic-associated nephropathy and end-stage renal failure. 399 17

Cardiovascular disease is the leading cause of death in patients undergoing maintenance dialysis. This study was undertaken to evaluate the lipid abnormalities and body composition by bioelectrical impedance in patients receiving continuous ambulatory peritoneal dialysis (CAPD). The patients were between the ages of 28 and 77 and had been on dialysis for periods ranging from 6-48 months. Body composition studies performed by electrical impedance showed that the CAPD patients generally had elevated levels of body fat. Most of these patients had waist-to-hip fat ratios of more than 1.0, and lean tissue was decreased. Serum chemistries showed that most of the patients had albumin levels less than 3.5 g/dL. The most frequent lipid abnormalities found were: hypertriglyceridemia; hypercholesterolemia; decreased HDL levels; elevated cholesterol/HDL and apoproteins (Apo B/A-1); and elevated lipoprotein [Lp(a)] levels. Cardiovascular disease was prevalent in the patients studied. Ten had a positive history of angina, with three documented myocardial infarction and two documented cardiovascular disease. In conclusion, standard CAPD treatment may increase the risk of cardiovascular disease.
Perit Dial Int 1993
PMID:Body composition and lipid abnormalities in hispanic and black patients on continuous ambulatory peritoneal dialysis. 839 30

Clinical data and outcomes of 18 patients, aged 80 or older, on continuous ambulatory peritoneal dialysis (CAPD) during the last five years were reviewed. There were 12 males and 6 females, with a mean age of 85 (range 82-91 years) and median duration on CAPD of 31.5 months (range 2-58 months). End-stage renal disease was caused by nephrosclerosis in 9, diabetes mellitus and light chain disease in 2 each, and chronic glomerulonephritis, membranous nephropathy, and IgA nephropathy in 1 each, with the cause unknown in yet another 2 patients. Hypertension and angina were the commonest comorbid conditions observed. Peritonitis episodes occurred one per 10.8 patient-months, and necessitated catheter removal in 7 patients and reinsertion in 6 of them. Fourteen episodes of exit-site infections were seen in 8 patients, 2 developed pericatheter leak, and 1 had tunnel infection. Nine patients are continuing CAPD successfully, with a median duration of 29 months (range 11-57 months). One patient was transferred to hemodialysis, and 8 died. The causes of death were peritonitis (3/8), cerebrovascular accident (2/8), pneumonia (1/8), and septicemia (1/8), with the cause not known in 1 patient. Our survival rate of 80% at three years is encouraging, and we advocate CAPD as a successful alternative treatment modality in octogenarians.
Adv Perit Dial 1996
PMID:Successful use of continuous ambulatory peritoneal dialysis in octogenarians. 886 86

To determine whether the onset of coronary artery disease may precede the initiation of dialysis in patients with end-stage renal disease, we performed coronary angiography within 1 month of initiation of maintenance haemodialysis in 24 patients (age range 42-78 years; mean 63.7 +/- 11). Coronary angiography was performed regardless of the absence or presence of angina. Fifteen patients had diabetic nephropathy, and nine had non-diabetic nephropathy. Significant coronary stenosis was defined as at least 75% narrowing of the reference segment. Fifteen patients (62.5%) with a total of 49 lesions were classified as the coronary artery disease present group. Eleven of those 15 (73.3%) had multivessel disease. The average number of stenotic lesions was 3.3 per patient. The most common patterns of stenosis were complex (23 lesions; 47%), and diffuse lesions over 20 mm long (14 lesions; 29%). None of the clinical or haematological factors evaluated differed significantly between the groups with and without coronary artery disease. The prevalence of coronary artery disease was 72.7% in the symptomatic patients and 53.8% in the asymptomatic patients. The diagnosis of coronary artery disease at the start of maintenance haemodialysis based only on chest symptoms and clinical factors proved to be difficult. Coronary angiography is thus essential for evaluating coronary artery disease in uraemic patients. Many patients with end-stage renal disease had coronary artery disease prior to the start of haemodialysis.
Nephrol Dial Transplant 1997 Apr
PMID:Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease. 914 Oct

The data on 256 non-diabetic patients entering renal replacement therapy (RRT) in Manchester between 1 January 1983 and 31 December 1986 were compared with those on 84 non-diabetic patients entering RRT in Milan between 1 January 1983 and 31 December 1988. In each unit, patients had been studied prospectively and the findings were entered on the same database for this report. At the end of the study, 68% of patients were alive in each centre and in each 16% had died from cardiovascular disease. 11% of Manchester and 18% of the Milan patients developed angina. The data do not support the view that there is a differential risk for cardiovascular disease in the Northern and Southern parts of Europe and it may be advisable to study the matter prospectively in a larger patient cohort.
Nephrol Dial Transplant 1998 Feb
PMID:Comparison between two prospective studies of cardiovascular disease carried out amongst renal replacement patients in UK and Italy. 950 61

The amount of oxygen delivered to an organ depends on three factors: blood flow and its distribution; the oxygen-carrying capacity of the blood, i.e. haemoglobin concentration; and oxygen extraction. Non-haemodynamic and haemodynamic mechanisms operate to compensate for anaemia. Non-haemodynamic mechanisms include increased erythropoietin production to stimulate erythropoiesis, and increased oxygen extraction (displacement of the haemoglobin oxygen dissociation curve). This decreased affinity of oxygen for haemoglobin is mediated by increased 2,3-diphosphoglycerate concentrations. Increased cardiac output is the main haemodynamic factor, mediated by lower afterload, increased preload, and positive inotropic and chronotropic effects. Decreased afterload is due to vasodilatation and reduced vascular resistance as a consequence of lower blood viscosity, hypoxia-induced vasodilatation, and enhanced nitric oxide activity. Vasodilatation also involves recruitment of microvessels and, in the case of chronic anaemia, stimulation of angiogenesis. With decreased afterload, the venous return (preload) and left ventricular (LV) filling increase, leading to increased LV end-diastolic volume and maintenance of a high stroke volume and high stroke work. High stroke work is also due to enhanced LV contractility attributed to increased concentrations of catecholamines and non-catecholamine inotropic factors. In addition, heart rate is increased in anaemia, due to hypoxia-stimulated chemoreceptors and increased sympathetic activity. In the long term, these haemodynamic alterations lead to gradual development of cardiac enlargement and LV hypertrophy (LVH). The LVH is eccentric, characterized by increased LV internal dimensions and a normal ratio of wall thickness to cavity diameter, as occurs in other forms of volume overload. When anaemia-related LVH develops in an otherwise 'healthy' humoral environment, the lesions are reversible and the type of LVH is primarily physiological and is not associated with impaired diastolic function. In the absence of underlying cardiovascular disorders, severe anaemia (Haemoglobin concentration < 4-5 g/dl) leads to congestive heart failure. In the presence of heart disease, especially coronary artery disease, anaemia intensifies angina and contributes to a high incidence of cardiovascular complications. In end-stage renal disease (ESRD), LVH is influenced by many other factors, leading to intense interstitial fibrosis, to alterations in diastolic function, and usually to poor reversibility. The chronic increase in cardiac output contributes to arterial remodelling of central elastic arteries such as the aorta and common carotid artery. This remodelling consists principally of arterial enlargement and compensatory arterial intima--media thickening. In ESRD, these geometric changes are accompanied by arterial stiffening. The principal consequences of arterial alterations are increased systolic pressure and high inertia due to higher blood mass in the dilated arterial system. These alterations contribute to the development of LVH and abnormal coronary perfusion.
Nephrol Dial Transplant 2000
PMID:Pathophysiology of anaemia: focus on the heart and blood vessels. 1103 52

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD). Both in dialysis and in transplant patients, CVD remains the leading cause of death. There is accumulating evidence that the increase in CVD burden is present in patients prior to dialysis, due to both conventional risk factors as well as those specific to kidney disease. Of importance is that even in patients with mild kidney disease, the risk of cardiovascular events and death is increased relative to patients without evidence of kidney disease. The new classification system proposed by the National Kidney Foundation as part of the Dialysis Outcomes Quality Initiative (DOQI) process describes the five stages of kidney disease, as well as those complications associated with chronic kidney disease (CKD), in particular cardiovascular risk factors and disease. Patients with kidney disease are deemed to be at highest cardiovascular risk. CVD, defined as the presence of either congestive heart failure (CHF), ischemic heart disease (IHD), or left ventricular hypertrophy (LVH), is prevalent in cohorts with established CKD (8-40%). The prevalence of hypertension, a major risk factor for coronary artery disease (CAD) and LVH is high in patients with CKD (87-90%). At least 35% of patients with CKD have evidence of an ischemic event (myocardial infarction or angina) at the time of presentation to a nephrologist. The prevalence of LVH increases at each stage of CKD, reaching 75% at the time of dialysis initiation, and the modifiable risk factors for LVH include anemia and systolic blood pressure, which are also worse at each stage of kidney disease. Even under the care of nephrologists, a change in cardiac status (worsening of heart failure or anginal symptoms) occurs in 20% of patients. The presence of CVD predicts a faster decline of kidney function and the need for dialysis, after controlling for all other factors including glomerular filtration rate (GFR), age, and the presence of LVH. This article describes the new classification system for staging of CKD, defines and describes CVD in CKD, and reviews the evidence and its limitations with respect to the current understanding of CKD and CVD. Specifically, methodologic issues related to survival and referral bias limit our current understanding of the complex interaction of conventional and nonconventional kidney disease-specific risk factors. We identify the importance of well-conducted studies of patient groups with and without CVD, with and without CKD, in order to better understand the complex physiology so that treatment strategies can be appropriately applied.
Semin Dial
PMID:Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. 1264 72

Direct adsorption of lipoproteins (DALI) from whole blood is the first LDL hemoperfusion technique for extracorporeal LDL and Lp(a) elimination without initial plasma separation. Thus, this technique is characterized by high user-friendliness. In a long-term multicenter study, LDL and lipoprotein (a) (Lp(a)) reductions were 69% and 64%, respectively, per session. Adverse effects were rare, as 95% of the sessions were uneventful. Biocompatibility studies showed only minor blood-adsorber interactions for most parameters; however, there was a significant bradykinin generation. After a single session, significant reductions of plasma viscosity, erythrocyte aggregation and adhesion molecules were documented. A retrospective analysis of 18 chronic DALI patients revealed that in the majority of patients, symptoms like angina and dyspnea as well as their general status and subjective well-being improved significantly. Moreover, the objective cardiovascular event rate (MACE) decreased from a total of 26 in the 3-year period prior to DALI to 6 during a mean follow-up of 3.8 years during chronic DALI therapy. Thus, the average event rate of 0.48 per patient year at baseline could be significantly reduced to 0.09 (P < 0.004) by DALI. This impressive improvement of symptoms and coronary events can hypothetically be related to the improvement of hemorheology and the transformation of unstable into stable plaques by DALI LDL apheresis.
Ther Apher Dial 2003 Jun
PMID:Clinical effects of direct adsorption of lipoprotein apheresis: beyond cholesterol reduction. 1292 10

Low-density lipoprotein (LDL) apheresis is a last-resort treatment for hypercholesterolemic patients resistant to conservative lipid-lowering therapy. In the extracorporeal circuit, LDL, Lp(a) and coagulation factors are selectively eliminated, while the beneficial proteins like high-density lipoprotein, albumin and immunoglobulins are returned to the patient. Clinical effects of LDL apheresis comprise improvement of symptoms like angina and exercise tolerance, reduction of clinical coronary events like unstable angina, need for angioplasty or bypass operation, myocardial infarction and ultimately coronary mortality. The reduction of atherogenic lipoproteins and of coagulation factors by LDL apheresis (LA) positively influences hemorheology, endothelial function and coronary reserve. In the controlled LAARS, LA significantly improved the electrocardiographic signs of myocardial ischemia in the treadmill test. In angiographically controlled trials such as LARS and L-CAPS, a reduction of progression of coronary lesions was observed; in favorable cases, regression of the stenoses could be documented. In addition, in the LDL apheresis coronary morphology trial, LA decreased the coronary plaque area. The Hokuriku trial documented a 72% decrease of coronary events (MACE) in the LA group vs. controls treated only by statins. In longitudinal studies, the incidence of MACE after regular LA decreased compared with the preapheresis period in the same patients. Apart from coronary heart disease, recent studies indicate a positive effect of LA also on carotid artery stenoses and peripheral vascular disease. Prospective randomized studies showed the beneficial effects of cascade filtration on age-related macular degeneration and of heparin-induced LDL precipitation apheresis on acute inner ear deafness.
Ther Apher Dial 2004 Apr
PMID:State of the art of low-density lipoprotein apheresis in the year 2003. 1525 20


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