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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In bone and teeth formation, coordinated calcification is a highly desirable biological process. However, heterotopic calcification at unwanted tissue sites leads to dysfunction, disease and, potentially, to death and therefore requires prevention and treatment. With the recent discovery of calcification inhibitors we now know that biological calcification is not passive but a complex, active and highly regulated process. Calcification at vascular sites is the most threatening localization and manifests as part of atherosclerosis or arteriosclerosis. Atherosclerosis is often accompanied by intimal plaque calcification, whereas arteriosclerosis is characterized by calcification of the media. The severity of calcification of cerebral or coronary atherosclerotic plaques is associated with an increased incidence of events such as stroke or myocardial infarction. Medial calcification is the major cause of arterial stiffness, which contributes to left ventricular dysfunction and heart failure. Patients with chronic kidney disease are at especially increased risk for both intimal and medial calcification. In this context, it is currently thought that calcium-regulatory factors including fetuin-A, matrix Gla protein, osteoprotegerin, and pyrophosphates act in a local or systemic manner to prevent calcifications of the vasculature, and that dys-regulations of such calcification inhibitors may contribute to progressive calcifications. Nephrolithiasis represents another process of unwanted calcification responsible for significant morbidity. More than 80% of renal stones contain calcium. Urinary factors inhibiting calcification are citrate, glycosaminoglycans, Tamm-Horsfall protein, and osteopontin. This review summarizes current experimental and clinical data underlining the biological importance of these calcification inhibitors.
Semin Dial
PMID:Inhibitors of calcification in blood and urine. 1737 84

This case report concerns a hemodialysis patient with arrhythmia. A 71-year-old man had undergone hemodiafiltration (HDF) for 17 years for the treatment of chronic glomerulonephritis. Because of repeated heart failure and chronic atrial fibrillation, he could not continue receiving standard hemodialysis, which is hemodialysis using bicarbonate dialysate including a small amount of acetate. Neither elevating the sodium concentration of the dialysate nor changing the HDF modality was effective. Acetate-free biofiltration (AFB) was initiated and this treatment dramatically ameliorated the patient's intradialytic acute hypotension and arrhythmia. The patient's quality of life subsequently improved and his scores on the Short-form 36 questionnaire (a measure of quality of life) increased. AFB is an HDF technique based on the continuous postdilution infusion of a sterile isotonic bicarbonate solution. Previous studies have reported that acetate induces chemical cytokines and vasodilator substances. AFB may be effective for preventing acute hypotension and arrhythmia during dialysis and may improve quality of life, including mental status.
Ther Apher Dial 2007 Apr
PMID:A case report of the effect of acetate-free biofiltration on arrhythmia in a hemodialysis patient. 1738 38

Heart failure is a major public health problem and a leading cause of hospitalization in adults in the United States. Renal dysfunction is emerging as a critical feature of patients hospitalized with heart failure and as a strong predictor of increased mortality. Despite the challenges and unique problems of patients with heart failure who have end-stage renal disease, evidence-based data regarding optimal management of these patients are limited. Here, we explore recent advances in the understanding of cardiorenal interactions and future directions in management strategies for patients with congestive heart failure on dialysis.
Adv Perit Dial 2007
PMID:Heart failure and dialysis: new thoughts and trends. 1788 7

Heart failure is a major and growing health problem. Major advances leading to newer therapies are being made in understanding the pathophysiology of heart failure as a chronic progressive disorder. Whatever the cause, all heart failure patients eventually progress to a refractory stage characterized by worsening renal function and resistance to diuretic therapy with attending severe edema. A logical treatment for this "cardiorenal syndrome" is the use of dialysis, which is efficient in treating both the hypervolemia and azotemia of refractory heart failure. Although all modalities of dialysis have been tried, peritoneal dialysis (PD) is the simplest choice and offers several advantages. It is an already-established long-term home-based therapy and does not require complex machinery or hospital resources. It is associated with preservation of residual renal function, gentle continuous ultrafiltration, hemodynamic stability, better middle-molecule clearance, sodium sieving with maintenance of normonatremia and perhaps less inflammation than hemodialysis is, especially with newer PD solutions. In the present paper, we discuss the potential advantages of PD in the treatment of heart failure, review the available literature, and lay some foundations for future research.
Adv Perit Dial 2007
PMID:Peritoneal dialysis in congestive heart failure. 1788 9

"Reverse epidemiology" refers to paradoxical and counterintuitive epidemiologic associations between survival outcomes and traditional cardiovascular risk factors such as obesity, high blood pressure, and high cholesterol. Reverse epidemiology has been well described in end stage renal disease, but also has been observed in chronic disease states, including chronic heart failure, rheumatoid arthritis, chronic obstructive pulmonary disease, and Acquired Immune Deficiency Syndrome, and in elderly populations. This review will highlight the recent medical literature on reverse epidemiology in these populations. Common pathophysiologic underpinnings in these chronic disease states may help explain the reversal of risk factors observed in these diverse populations. Furthermore, guidelines for the general population for optimal goals of weight, cholesterol levels, and blood pressure may not apply to special populations, including patients with chronic diseases or elderly persons.
Semin Dial
PMID:Reverse epidemiology beyond dialysis patients: chronic heart failure, geriatrics, rheumatoid arthritis, COPD, and AIDS. 1799 Dec 3

Approximately 50% of the mortality in chronic dialysis patients is due to cardiovascular diseases (CVD). Cardiomyopathy, coronary artery disease, and arrhythmia are all common conditions and predispose to sudden death, which accounts for 60% of all cardiac deaths in this population. Despite advances in dialysis therapy, the mortality from CVD remains substantially unchanged, partly due to the lack of evidence-based strategies for improving the outcome of cardiac diseases in this population. Activation of the sympathetic adrenergic system is well documented in chronic dialysis patients and is likely involved in the pathogenesis of myocardial hypertrophy, coronary artery disease, heart failure, and arrhythmia. Given the proven benefit of beta-blockers in patients with normal kidney function with similar cardiac comorbidities, beta-blockers would seem to be attractive agents to reduce cardiovascular morbidity and mortality in the patient population with advanced chronic kidney disease. However, the value of beta-blockade in patients on chronic dialysis remains unclear. This uncertainty surrounding the efficacy is compounded by the risk of side effects to these patients, such as hypotension, bradycardia, and hyperkalemia. In addition, numerous studies have suggested suboptimal usage of beta-blockers in the dialysis population; this is seen even in high risk patients, such as those with established coronary artery disease. In this review, we will focus on sympathetic nervous system activation in kidney disease and highlight the benefit and risks of beta-blockers usage in the chronic dialysis patient population.
Semin Dial
PMID:Beta-blockade in chronic dialysis patients. 1825 57

Kawasaki disease is a generalized vasculitis of unknown etiology that occurs predominantly in infants and young children. It is very important to prevent its cardiovascular manifestations, especially coronary artery lesions. Early treatment with intravenous immunoglobulin reduces cardiovascular sequelae, but some patients do not respond to this treatment, and they have a high incidence of coronary artery lesions. On the other hand, acute heart failure is rare in Kawasaki disease. We report on the cases of two patients with persistent fever and shock even after intravenous immunoglobulin therapy. In both cases, plasma exchange may have reduced the risk of coronary artery lesions and proved effective against acute heart failure with catecholamine-refractory shock; yet the mechanism of this improvement remains unclear.
Ther Apher Dial 2008 Apr
PMID:A report of two cases of Kawasaki disease treated with plasma exchange. 1838 69

In end-stage renal disease (ESRD) both an inappropriately high sympathetic drive and the activation of tissue-based renin-angiotensin systems lead to a complex pattern of comorbidity appearing early on in renal disease. In this context, uremic cardiomyopathy, diabetes, and renal failure display an intimate interaction that critically defines the prognosis in dialysis patients. Importantly, patients with moderate to severe loss of renal function not only carry a high burden of traditional cardiovascular risk factors, but also are exposed to uremia-specific risk factors that in concert induce an excessively increased cardiovascular mortality. Although cardiovascular guidelines may not simply be applicable to ESRD patients--these have invariably been excluded from larger cardiovascular trials--an early cardiological workup appears rational as the prevailing mode of death is characterized by sudden cardiac death and heart failure. This short review will therefore go beyond coronary heart disease, focus on the specific cardiac pathology in renal failure, and summarize the contemporary therapeutic strategies in ESRD.
Semin Dial
PMID:Cardiac problems in the dialysis patient: beyond coronary disease. 1862 66

Cardiac disease is the leading cause of death in uremic patients. In contrast to previous opinion, coronary events account for a relatively small proportion of cardiac deaths, the most common causes being sudden death and heart failure. Against this background the current text will discuss noncoronary cardiac pathology, specifically the pathogenesis and the morphological findings caused by (pathological) cardiac hypertrophy, cardiac interstitial fibrosis and microvascular disease.
Semin Dial
PMID:Hypertrophy and fibrosis in the cardiomyopathy of uremia--beyond coronary heart disease. 1862 69

An 11-year-old male patient suffering mixed connective tissue disease with life-threatening pulmonary arterial hypertension, progressive heart failure (New York Heart Association class III-IV), skin ulcers, Raynaud's phenomenon and arthritis, showing no improvement after intensive immunosuppressive therapy or high dose steroids, was treated with immunoadsorption onto protein A. With a combined therapy of low-dose cortisone and bosentan and 22 sessions of immunoadsorption, his condition improved significantly and he continues in clinical remission. At the time of writing no further immunosuppressive therapy or immunoadsorption had been necessary. The patient is now 15 years old and healthy with an age-based constitution comparable to the normal population.
Ther Apher Dial 2008 Aug
PMID:A case report of successful treatment with immunoadsorption onto protein A in mixed connective tissue disease in childhood. 1878 23


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