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

Cholesterol embolic disease is a devastating complication of atherosclerosis. Universally recommended treatment is lacking thus far. Recent data suggest that a therapeutic protocol aimed at specifically combating three causes of mortality, recurrent bouts of cholesterol embolism, cardiac failure, and cahexia, were associated with a favorable clinical outcome. As for drug therapy, corticosteroid has been reported to be beneficial in reducing local and general inflammatory responses. Concerning apheresis, combined therapy consisting of plasma exchange and low to intermediate-dose corticosteroid therapy has been shown to be effective in multivisceral cholesterol embolism. Low density lipoprotein (LDL) apheresis has been reported to be beneficial for cholesterol embolism-induced damage to the skin and brain.
Ther Apher Dial 2003 Aug
PMID:Apheresis in the treatment of cholesterol embolic disease. 1288 28

Patients with end-stage renal disease (ESRD) have much higher rates of cardiovascular disease than the healthy population. Left ventricular hypertrophy (LVH), in particular, is common in this patient group. The impact of a decline in haemoglobin concentration on left ventricular mass index has been well documented. Partial correction of anaemia with recombinant human erythropoietin (epoetin) treatment has been recognized as a significant step forward in decreasing left ventricular mass and improving cardiovascular morbidity and mortality. However, LVH and cardiac failure in patients with ESRD comprise a complex condition, which is influenced by a number of factors in addition to anaemia. This article examines some of the pathophysiological aspects of LVH in patients with ESRD.
Nephrol Dial Transplant 2003 Nov
PMID:Left ventricular hypertrophy: why does it happen? 1460 92

The renal community has long recognized that anaemia can impair the quality of life of patients and lead to irreversible cardiac consequences. This review examines anaemia-related outcome studies published after 2001. The profusion of observational studies in non-renal populations in 2002 has made it a remarkable year. One important community cohort study showed that 1 in 10 'healthy' adults has anaemia, an antecedent of the development of cardiovascular disease. Several cross-sectional studies have confirmed that anaemia is common in patients with congestive heart failure (CHF), and its severity correlates positively with the severity of CHF. All recent outcome studies have shown that anaemia is associated with mortality rates beyond those explicable from heart failure severity. A placebo-controlled, randomized trial showed that the normalization of haemoglobin (Hb) levels in anaemic patients with CHF improved peak oxygen uptake and exercise performance. Large clinical trials are required to define the true potential of anaemia therapy in CHF. Most renal guidelines suggest the use of Hb targets that are independent of disease stage or treatment modality. Virtually all the supportive evidence to date has been from haemodialysis populations. Anaemia, which occurs frequently and is often neglected, appears to precede left ventricular hypertrophy and CHF in renal transplant patients. Anaemia may not be an 'innocent bystander' in chronic disease; both components of the term 'anaemia of chronic disease' deserve attention.
Nephrol Dial Transplant 2003 Nov
PMID:Anaemia and the heart: what's new in 2003? 1460 94

Questionnaire forms for an annual survey conducted at the end of 2001 were sent out to 3520 institutions, and 3485 replies were received (response rate, 99.00%). According to the survey, the dialysis population of Japan at year end was 219 183 patients, up 6.3% (13 049) over the year before. This equals 1721.9 dialysis patients per million population. The gross mortality rate was 9.3% for the year extending from the end of 2000 to the end of 2001. The mean age of patients beginning dialysis was 64.2 years (+/- 13.7 SD). The mean age of the overall dialysis population in the study year was 61.6 years (+/- 13.1 SD), which was also a higher age than the year before. Among dialysis patients, the primary disease was diabetic nephropathy in 38.1% of patients, slightly down from 39.1% the previous year. Chronic glomerulonephritis was the primary disease in 32.4% of cases, a decrease from 34.7% the previous year. This survey included for the first time the items of the lowest blood pressure during hemodialysis session, vasopressor therapy before dialysis and vasopressor therapy during dialysis session. An analysis of the relationship between the type of vascular access used at the initiation of dialysis and the survival prognosis revealed a significantly higher risk of death in patients undergoing dialysis with synthetic arterio-venous (AV) fistula, AV shunt, or catheter implantation into a central vein than in those receiving dialysis treatments with a native fistula. There was a significantly lower risk of death in the patient group in whom the vascular access was created at 3-6 months before initiation of dialysis than in those in whom such access was created at the time of initiation or within 3 months before the initiation of dialysis. An analysis of the risk factors affecting survival prognosis in maintenance hemodialysis patients showed that risk factors for death are post-dialysis systolic blood pressure over 180 mm Hg and lower than 120 mm Hg, blood pressure elevating progressively from the start to the end of dialysis, serum high density lipoprotein cholesterol concentration of less than 30 mg/dL, and a higher ultrafiltration rate. In comparisons of the death risk between the patient group with a history of intervention for ischemic heart disease and the patient group with a history of myocardial infarction or heart failure but without such intervention, among diabetes patients, those who underwent percutaneous transluminal coronary angioplasty had a significantly lower risk of death than those in whom no intervention was made.
Ther Apher Dial 2004 Feb
PMID:An overview of regular dialysis treatment in Japan (as of 31 December 2001). 1512 16

Hypertension is clearly an independent risk factor for cardiovascular (CV) events and death in the general population, but the relationship between blood pressure (BP) and survival in dialysis patients is less clear. In dialysis populations at lower risk of CV events, BP is directly related to survival, while in those with high risk, it has been difficult to show such an effect. The effects of cardiac disease complicate the relationship between BP and outcome. Retrospective studies of large cohorts, with high prevalence of CV disease, have shown a U-shaped relationship between both systolic and diastolic BP and outcome. These findings probably reflect a high prevalence of cardiac failure and thus high mortality associated with low BP (i.e., a so-called reverse causation). Pulse pressure (high systolic BP and low diastolic BP) predicts outcome in hypertensive dialysis patients. Whether this reflects advanced vessel wall disease or is an independent etiologically significant risk factor is unclear. However, the current uncertainties as to the exact relationship between BP and outcome in dialysis patients do not warrant complacency regarding the prevention and treatment of hypertension.
Semin Dial
PMID:Hypertension and survival in hemodialysis patients. 1525 Sep 16

Definitive randomized trials are rare in the dialysis literature. Treatment decisions are often based on extrapolation from trials in other populations and observational studies in dialysis patients. "Reverse epidemiology" is a term increasingly applied to classic cardiovascular risk factors in studies of dialysis patients. The term is used when outcome associations are the opposite of those seen in general population studies. Hypertension is an archetypal example, with several studies showing inverse associations with mortality. As a term, "reverse epidemiology" is intellectually unsatisfactory because validation of the real direction of an association is only possible with experimental designs. In contrast, blood pressure (BP) is associated with typical association patterns for outcomes other than death, including left ventricular hypertrophy and cardiac failure, which are dominant entities in dialysis populations. There is a strong suspicion that current analytical approaches may partly explain the paradox. For example, it is possible that unmeasured comorbidities are associated with lower BP levels. In addition, few studies use BP as a time-integrated parameter, which is problematic given the variability of this parameter. Several recent studies suggest that using pulse pressure as a BP parameter may normalize associations with mortality. BP, extracellular blood volume, residual renal function, and vasoactive medications are interlinked. Time-integrated analysis that examines all these parameters concurrently makes sense, but has rarely been attempted. A large burden of cardiac disease and insensitive analytical approaches may go a long way toward explaining the reverse epidemiology of hypertension and survival in dialysis patients.
Semin Dial
PMID:Cardiac disease in chronic uremia: can it explain the reverse epidemiology of hypertension and survival in dialysis patients? 1525 Sep 17

Hypertension in end-stage renal disease (ESRD) is an important risk factor for left ventricular hypertrophy (LVH), cardiac failure, coronary artery disease (CAD), and arrhythmia. LVH is generally considered an integrator of the long-term effects of hypertension and other cardiovascular (CV) risk factors and represents the strongest predictor of adverse CV outcomes in ESRD patients. The risk of heart failure is higher in patients with a history of hypertensive renal disease than in those with other diagnoses. Both coronary heart disease (CHD) and LVH predict congestive heart failure, which is often the ultimate cause of death in patients with cardiac ischemia or LVH. A history of long-standing hypertension is associated with ischemic heart disease both in cross-sectional and prospective studies in ESRD. Atrial fibrillation and ventricular arrhythmias are highly prevalent in dialysis patients and are implicated in mortality and sudden death in this population. Despite the lack of evidence from randomized controlled trials, it appears reasonable that interventions aimed at curbing the high CV mortality of ESRD should be targeted to both hypertension and LVH.
Semin Dial
PMID:Cardiac consequences of hypertension in hemodialysis patients. 1525 Sep 22

Microinflammation in renal failure has been the subject of numerous studies, but the causes of the inflammatory response in these patients are not clear. There are several potential causes and possible therapies for microinflammation, and they are discussed in this review with regard to uraemia and acidosis, heart failure and volume overload, oxidative stress and iron therapy, and bioincompatibility, especially regarding dialysis membranes. In addition, issues regarding dialysate contamination and access site infection are examined, followed by a discussion of possible drug therapy for microinflammation with angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, statins, aspirin, and antioxidants, such as vitamin E.
Nephrol Dial Transplant 2004 Aug
PMID:Causes and therapy of microinflammation in renal failure. 1528 58

Cardiovascular disease (CVD) is a significant complication in chronic kidney disease (CKD) and a major cause of death in dialysis patients. Clinical studies have shown that anaemia is associated with reduced survival in patients with renal disease, heart failure or both. There is also evidence that, even in otherwise healthy individuals, anaemia is independently associated with an increased risk of CVD. The body adapts to anaemia by increasing cardiac output, which may result in cardiac remodelling and progression of left ventricular (LV) growth. Indeed, low haemoglobin (Hb) has been identified as an independent risk factor for LV growth in CKD patients, suggesting that there is a direct link between anaemia and adverse cardiac outcomes. This suggests that correction of anaemia with recombinant human erythropoietin (rhEPO; epoetin) may improve prognosis. Partial correction of anaemia produces partial regression of LV hypertrophy, while complete correction of anaemia can help to prevent LV dilatation in haemodialysis patients with normal LV volumes. Moreover, in non-dialysis patients with advanced CVD, pilot studies showed that a moderate increase in Hb improved cardiac function and reduced hospitalization rates. In addition, consistent epoetin treatment before the start of dialysis was associated with a reduced risk of developing cardiac disease in CKD patients. In contrast, in dialysis patients with advanced cardiac disease, Hb normalization increased mortality risk. Therefore, early correction of anaemia appears important. The Cardiovascular risk Reduction by Early Anaemia Treatment with Epoetin beta (CREATE) study is investigating whether this approach is associated with a measurable reduction in cardiovascular risk.
Nephrol Dial Transplant 2005 Jun
PMID:Managing a fateful alliance: anaemia and cardiovascular outcomes. 1595 21

The anaemia of chronic kidney disease (CKD) is efficiently corrected with a combination of recombinant erythropoietin (rhEPO) and intravenous iron supplementation. Recently, patients with severe cardiac failure and anaemia have also been shown to benefit from this treatment. However, iron excess may lead to the production of free radicals and has been incriminated in the pathogenesis of atherosclerosis and increased risk of infection, the two major causes of death in end-stage renal disease. The exact risk of excess iron supplementation has not been defined and, in the absence of sensitive and specific indicators of iron overload, the risk remains difficult to quantify. There is increasing epidemiological evidence incriminating iron overload as a risk factor in CKD, but direct evidence is still hard to obtain. The precise role of iron is complicated further by the complex inter-relationships between iron metabolism and the inflammatory process characteristic of CKD. The recent discovery of the antimicrobial peptide, hepcidin, may shed light on these inter-relationships. New methods for quantifying non-transferrin-bound (or labile plasma) iron may help in the future to identify patients at risk for toxicity from excess iron supplementation.
Nephrol Dial Transplant 2005 Jul
PMID:Intravenous iron supplementation in the anaemia of renal and cardiac failure--a double-edged sword? 1602 27


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