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

The arteriovenous fistula used for vascular access for hemodialysis may contribute to development of congestive heart failure. Theses patients can present with frequent episodes of congestive hear failure. Traditional management of high-inflow, a high-cardiac-output fistula generally involves either closure or banding. Although high-output state can be controlled, the lifeline of the patient is lost. We describe a series of 17 hemodialysis patients (10 men and 7 women) in whom a novel inflow reduction method was employed. All patients had symptoms of heart failure (15 brachiocephalic fistulas and two brachioaxillary bypass grafts) and a fistula inflow rate above 1600 ml/min. The inflow reduction procedure included ligation of the brachial anastomosis and reconstruction of the fistula by using an expanded polytetrafluoroethylene (Gore-Tex Intering) vascular graft in a bypass from the radial artery. The mean (+/- SD) time between fistula creation and the inflow reduction procedure was 30 +/- 17 months. The mean access inflow rate decreased significantly after the inflow reduction procedure, from 3135 +/- 692 to 1025 +/- 551 ml/min (p =0.0001). The mean cardiac output rate decreased from 8 +/- 3.1 to 5.6 +/- 1.7 l/min (p = 0.001) with resolution of symptoms. During the follow-up period thrombosis or stenosis developed in seven patients, three of whom underwent surgical revision. Thirteen of the seventeen accesses (77%) subjected to the inflow reduction procedure remained patent. Access loss was due to failed fistuloplasty or thrombosis. To our knowledge, this is the first report demonstrating that inflow reduction obtained by distalization of the anastomosis of the access fistula is feasible and safe for managing high-inflow, high-cardiac-output fistulas. Longer and larger studies of the inflow reduction procedure and its benefits are needed.
Semin Dial
PMID:Inflow reduction by distalization of anastomosis treats efficiently high-inflow high-cardiac output vascular access for hemodialysis. 1724 25

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 remains a growing public health problem, hospitalizations represent the main cost component of heart failure care and the poor quality of life of patients is often worsened by frequent admissions. A multidisciplinary approach and specific disease management programs are a potentially useful instrument to reducing hospitalizations in heart failure patients. These concepts have recently been discussed in a consensus document by all the Scientific Societies involved in the care of heart failure patients. The effectiveness of intervention programs delivering continuity of care by a multidisciplinary team achieved a promising reduction in admissions, but the results of the studies have not been univocal for category of strategies and about the effect on survival. Telephone intervention significantly decreased heart failure admissions but not all-cause admissions and mortality. The multicenter randomized DIAL study, comparing a centralized telephone intervention program delivering continuity of care by a multidisciplinary team with usual care in patients with heart failure, confirms these findings. After a mean 16-month follow-up, there was a benefit mostly due to a significant reduction in admissions for heart failure, but mortality was similar in both groups. Data on 9000 patients from the IN-CHF registry show that hospitalizations are a serious problem in Italy: 44% of the patients had at least one hospitalization for heart failure in the year prior to the entry visit and this is the most powerful independent predictor of rehospitalization during the follow-up. Nearly a quarter of the population with follow-up data availability (92%) has been rehospitalized in the year after enrollment; patients in advanced functional class (32.1% hospitalization rate) and with ischemic etiology (25.0%) are more likely to be hospitalized than those in NYHA class I-II and without ischemic etiology. In a survey carried out recently in Italy, in 1152 patients admitted for decompensated heart failure, readmission rate was even higher: more than 40% of patients have been readmitted once in the 6 months after discharge and 7.2% had two or more admissions.
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PMID:[Heart failure: the importance of a disease management program]. 1838 68

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

Despite significant advances in the treatment of heart failure, patients' quality of life and prognosis are still poor. Hospitalization for decompensated heart failure or due to other causes is frequent in these patients and places a heavy financial burden on the healthcare system. The shortcomings of ambulatory treatment have led to the implementation of disease management programs whose aim is to optimize quality of care and treatment adherence, thereby improving clinical outcome and prognosis, and reducing healthcare costs. The multicenter randomized DIAL study compared treatment administered by means of a centralized telephone intervention by trained nurses with usual care in 1518 ambulatory patients with stable chronic heart failure who were receiving appropriate medical treatment and were being followed up by a cardiologist. This intervention proved effective in increasing treatment adherence, in reducing hospitalization due to heart failure or any cause, in improving quality of life, and in reducing costs. The findings of the DIAL study add to existing evidence that disease management programs have clinical benefits in patients with chronic heart failure and support their use as part of the strategy for ambulatory care in this population.
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PMID:[Disease management programs in heart failure. Findings of the DIAL study]. 1809 90

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


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