Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We evaluated survival and risk factors in 86 elderly patients (pts) who underwent dialysis at one center throughout the last 10 years. Thirty-five pts received hemodialysis (HD), 32 intermittent peritoneal dialysis (IPD), and 19 continuous peritoneal dialysis (CAPD). Risk factors included: treatment, age, sex, underlying disease, heart failure (HF), peripheral vascular disease (PVD), diabetes mellitus (DM) and malignancy. Median age was 65 years for both HD and CAPD, and 69 for IPD (p less than 0.05). Survival evaluation demonstrated a longer life span for HD vs. IPD (p = 0.02) for CAPD vs. IPD (p = 0.03) and no difference between HD and CAPD pts. Cox analysis showed higher death odds ratio (OR = 2.4) for IPD vs. HD and lower ratio for CAPD vs. IPD (OR = 0.3). Other OR positive risk factors were: HF, PVD, DM and malignancy. The median value of risk factors for each group was higher for both IPD and CAPD vs. HD. Both life span and death OR for CAPD were equal to HD in spite of higher risk factors in CAPD group. The lower survival of the IPD group may be due to its older age. CAPD should represent the elective treatment for elderly uremics while HD or IPD should be reserved for selected patients.
Adv Perit Dial 1989
PMID:Dialysis for the elderly: survival and risk factors. 257 26

Recovery of renal function was observed in 10 out of 300 patients (3.3%) treated by CAPD. These 10 patients presented the following primary renal diseases: 4 nephroangiosclerosis, 4 interstitial nephropathies, 1 diabetic nephropathy, 1 unknown nephropathy, and were treated by CAPD for a mean period of 10.2 +/- 5.5 months. CAPD was discontinued when residual renal function reached 12 ml/min. After recovery 8 patients were still alive, including 1 patient who returned to dialysis. 2 patients died. When risk factors such as uncontrolled hypertension, cardiac failure, severe nephrotic syndrome, rapidly progressive renal failure, analgesics or non steroidal anti-inflammatory drug treatments or abuses, chronic urinary obstruction, cholesterol emboli were associated with end stage renal failure, CAPD should be the dialysis treatment of choice, expecting the preservation of the kidney capacities and further a recovery of renal function.
Adv Perit Dial 1989
PMID:Recovery of renal function in patients treated by CAPD. 257 29

In ten uremic patients, who were not yet undergoing periodic hemodialysis and in whom we were creating a 1 cm, distal, side-to-side arteriovenous fistula of Brescia-Cimino type for hemodialysis, the acute hemodynamic changes of the systemic and pulmonary circulations were studied immediately after the opening of the fistula. An increase in cardiac output (Q) was observed in one patient, the other patients showing either no change or a slight reduction. In the four patients in whom the Q decreased there was a significant reduction of total blood volume (TBV) and stroke volume (SV) and an increase in systemic vascular resistance (SVR) (p less than 0.05, p less than 0.05, p less than 0.01 respectively). At the level of pulmonary circulation, in these patients a decrease in pulmonary blood volume (PBV) (mean = 20%) and a significant increase in pulmonary vascular resistance (PVR) were also observed. In five patients who had been on chronic hemodialysis and who presented the clinical picture of cardiac failure, the acute hemodynamic changes following temporary closure of the fistula (by a sphygmomanometer) were studied: a significant decrease (p less than 0.05) in Q, TBV and SV was observed. The difference between the two values of Q (i.e. fistula open and closed) was considered to indicate the magnitude of the flow across the fistula.
Clin Exp Dial Apheresis 1982
PMID:Acute hemodynamic effects of Brescia-Cimino arteriovenous fistula for hemodialysis. 709 11

The response of heart function to angiotensin II (AT II) was studied in 18 patients on regular hemodialysis. The mean age was 33 years and they had been dialyzed for 55 months in the average. AT II was infused from a large vein and systolic blood pressure was raised by 40 mmHg. Before and after the change in blood pressure, M-mode echocardiogram of left ventricle was recorded. Left ventricular enddiastolic dimension, stroke index and cardiac index were found to be normal except for 9 patients who showed cardiac index above 4.0L/min/m2. No significant change was found in these parameters after the rise of blood pressure by AT II. Control ejection fraction (EF) was slightly but nonsignificantly lower in the patients than the healthy subjects; 0.73 +/- 0.13 vs. 0.80 +/- 0.05. Though significant falls in EF were found in the patient and in the healthy group, the former showed a profound depression of EF to 0.64 +/- 0.10. This value was significantly lower than the value of the latter group; 0.76 +/- 0.04 (p less than 0.01). Since none had overt heart failure, a depression of EF after AT II can be regarded as subclinical abnormality of heart function. AT II will be useful to detect this limited reserve of heart function in patients on regular hemodialysis who may show normal function at rest.
Clin Exp Dial Apheresis 1981
PMID:Depression of heart function after angiotensin II infusion in patients on chronic hemodialysis. 734 Oct 21

The prevalence of hypotension in continuous ambulatory peritoneal dialysis (CAPD) patients varies between 10% and 16%. The main causes of hypotension in these patients include hypovolemia, antihypertensive medications, myocardial failure, and a variety of poorly understood causes, viz, severe autonomic neuropathy, amyloidosis, malignancies, adrenal insufficiency, removal of vasopressor substances by dialysis and steroid withdrawal. In addition, there are a large number of patients with hypotension due to unknown causes. Between 1989 and 1994 we had 65 of 525 CAPD patients suffering from persistent hypotension. Sixteen (25%) patients were hypovolemic, 14 improved after increasing the target weight, but 2 did not because of concurrent administration of coronary vasodilators. The various steps in the treatment of this group include fluid repletion after discontinuing anti-hypertensive medications and excluding myocardial failure, oral sodium supplementation and possibly increasing the dialysate sodium. Preventive measures include frequent assessment of the hydration status. Judicious use of diuretics is also important. Bioelectrical impedance and inferior vena caval ultrasound are two promising tools to assess the fluid status and supplement careful clinical examination.
Adv Perit Dial 1995
PMID:Hypotension in CAPD: role of volume and sodium depletion. 853 43

We evaluated 725 diabetic haemodialysis (HD) patients, inducted into HD from 1967 to 1993 in Niigata University Hospital and its affiliated hospitals, to clarify the relationships among the clinical course and features including diabetes mellitus treatment. The glucose metabolism was also studied during HD with dialysis fluids containing different glucose concentration. At the time of HD induction, diabetic patients showed lower serum creatinine and more frequent overhydration, compared with those with glomerulonephritis. Heart failure was the leading cause of (53%) among the symptoms as the direct cause of HD induction. The survival rate in Japan, particularly in our group, was more prolonged than that in USA and Europe. The rate was lower in patients with cardiac complications than in those with gastrointestinal problems, and also lower in older patients (more than 70 years old) than in younger patients. Among the patients less than 70 years old, the survival period was longer in patients with serum HbA1c values of less than 7.5%, compared to those with greater than 7.5% Cerebro- and cardio-vascular involvements and infectious diseases were three major causes of death, and cerebro- and cardio-vascular disorders and diabetic gangrene were three major complications. Serum HbA1c was not different among patients with or without these causes of death or complications. In 18.1% of non-insulin-treated NIDDM patients insulin was needed one year after HD induction, while 32.1% of insulin-treated NIDDM patients before HD induction became free from insulin, who showed body weight loss on average of 10 kg. In 33.6% of insulin-treated patients, insulin doses increased from 2 to 20 units/day on the non-dialysis day.(ABSTRACT TRUNCATED AT 250 WORDS)
Nephrol Dial Transplant 1995
PMID:The treatment of the uraemic diabetic. Are we doing enough? A view from Japan. Fumitake Gejyo and Collaborate Study Group. 857 79

Our objective was to evaluate if peritoneal dialysis (PD) could improve survival of patients with progressive severe congestive heart failure resistant to drug therapy. The patients were selected by the cardiologist in cooperation with a nephrologist, including patients not responding to conventional medication with an expected fatal outcome within the next months. The study included 16 consecutive patients with a chronic progressive severe refractory heart failure (sHF) of NYHA class III (n = 6) or IV (n = 10) who did not respond to diuretics and angiotension converting enzyme (ACE) inhibitors. They had a mean age of 60 years (+/- 14, range 30-75, median 62 years). Nine of the patients had sHF as the only reason for initiating PD (all NYHA IV), while 7 also needed dialysis due to uremia. Five of 7 had been on hemodialysis but switched to PD due to a progressive congestive sHF. In 2 patients, PD was decided already at start of dialysis therapy due to the severity of their heart failure. The reason for sHF was: valvular dysfunction (n = 5) with defect prosthesis (n = 3); in the course of a myocardial infarction (n = 4); and cardiomyopathy (n = 4). Tenckhoff catheters were inserted under local anesthesia and ultrafiltration was started and maintained until discharge. The survival time and change in heart size by x-ray was used for analyses. All patients improved their stage of congestive heart failure by NYHA classification already during the first month. Six patients died during the follow-up period due to cardiac reasons (sudden death, relapse of sHF) after a mean of 10.7 months (+/- 3.7, range 1-24 months). Ten were alive after a median observation period of 10 months (+/- 12.5, range 1-36 months). Heart size was reduced in 15 of the patients. Three of the patients with sHF but without uremia could stop the PD. The results showed that ultrafiltration by PD was easy to perform despite low initial blood pressure. The sHF was reduced and life span was prolonged with improved quality of life.
Perit Dial Int 1996
PMID:PD treatment for severe congestive heart failure. 872 98

The ascites in the chronic renal failure patient is often difficult to treat and becomes intractable. Continuous ambulatory peritoneal dialysis (CAPD), as a maintenance therapy, is effective in the removal of ascites and may become a good alternative in dialysis therapy. The aim of this study was to evaluate the peritoneal membrane transport characteristics and ultrafiltration rate in CAPD patients who had preexisting ascites. Seven CAPD patients (6 male, 1 female; mean age 43 +/- 11 years) were included. The causes of ascites were liver cirrhosis (n = 4), hemodialysis-associated process (n = 2), and heart failure (n = 1). A peritoneal equilibration test (PET) using 2.5% dialysate was performed by the standard method at ten days after starting CAPD. The solute transport rate [dialysate glucose ratio (D/D6) and dialysate-to-plasma creatinine concentration ratio] showed high (n = 5) or high average (n = 2) transport. In 5 patients with high transport, PET showed a discrepancy between solute transport rate and drain volume. In spite of the high transport rate, the drain volume was greater than expected and corresponded to the area of low average or high average solute transport rate. Considering adequate solute clearance and good ultrafiltration, CAPD is an effective treatment in end-stage renal disease patients with intractable ascites.
Adv Perit Dial 1996
PMID:Discrepancy between solute transport rate and drain volume in CAPD patients with ascites. 886 69

At the present time we cannot assume that the proven benefits of ACEI on renal disease will be reproduced by using AT1-ra. With potentially differing modes of activity of these drugs, they cannot be seen as interchangeable and ACEI should remain the drug of choice in patients with progressive renal disease unless they are not tolerated. It is possible that AT1-ra may offer additional advantages in some patients or that synergy exists between the two agents, but this view will remain entirely speculative unless proper trials are conducted. Despite the results of the ELITE study [22], the uncertainty regarding the use AT1-ra in cardiovascular disease mirrors that of renal disease. This issue is obviously of relevance to the nephrologist in view of the spectrum of cardiac disease that accompanies chronic renal failure, such as left ventricular hypertrophy and cardiac failure, which provide multiple indications for manipulation of RAS. Despite their renoprotective effect, previous studies on ACEI [3,4] have not shown an overall reduction in mortality and this issue needs to be addressed in addition to renoprotection in studies comparing AT1-ra and ACEI.
Nephrol Dial Transplant 1999 Jan
PMID:Angiotensin converting enzyme inhibitors and angiotensin receptor (AT1) antagonists: either or both for primary renal disease? 1005 68

There is a clear relationship between anaemia and cardiovascular risk in chronic renal failure (CRF) patients. Left ventricular hypertrophy (LVH) is present in about three-quarters of patients starting dialysis, and is a strong predictor of mortality. Anaemia contributes to the development of LVH, mainly via increased cardiac output. In some patients, anaemia results in an increase in LV mass, while in others it also results in LV end-diastolic volume dilatation. These changes increase the risk of arrhythmias, myocardial infarction and myocardial fibrosis. The lower the haemoglobin, the more likely it is that LVH and heart failure will develop. Furthermore, a haemoglobin of < 11 g/dl is associated with increased morbidity and mortality. Partial correction of anaemia with epoetin leads to a partial, but not complete, reversal of LVH. One large prospective study (Lombardy Registry) found that epoetin treatment was accompanied by a 30% reduction in crude relative risk of mortality. A progressive reduction in the relative risk of general and cardiovascular mortality was found with increasing haematocrit, with and without adjustment for co-morbid conditions. Mean hospitalizations also decreased with increasing haematocrit. The long-term effects of normalized haematocrit/haemoglobin values in uraemic patients have not yet been evaluated exhaustively in prospective, randomized, multicentre studies. Epoetin treatment has been shown to induce lasting improvements in patients' sense of well-being, reduce fatigue, increase appetite and work capacity, and improve exercise tolerance, libido and work performance. Further studies are needed to demonstrate whether greater haemoglobin concentrations are associated with greater improvements in quality of life during epoetin treatment.
Nephrol Dial Transplant 1999
PMID:What are the short-term and long-term consequences of anaemia in CRF patients? 1033 65


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