Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0242339 (dyslipidemia)
 13,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We conducted a cost-effectiveness analysis to compare costs and clinical outcomes of sevelamer versus calcium carbonate plus atorvastatin for treatment of dyslipidemia in patients with chronic renal insufficiency. The model was from the third-party payer perspective. Efficacy and adverse event rates for each regimen were obtained from published clinical trials. Drug costs were based on average wholesale prices; monitoring costs were based on Medicare reimbursement rates. Our model suggests that the combination of calcium carbonate plus atorvastatin is substantially more cost-effective than sevelamer in reducing low-density lipoprotein (LDL) in these patients. One-way sensitivity analyses were performed to assess if 25% and 50% price reductions in sevelamer affected overall cost-effectiveness results. A 50% sevelamer price reduction was less expensive than combination therapy but remained less cost-effective. A two-way sensitivity analysis on the probability that a patient achieves the goal of a 35% LDL reduction resulted in calcium carbonate plus atorvastatin remaining more cost-effective. Further cost-effectiveness studies are necessary to corroborate our data.
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PMID:Cost-effectiveness of sevelamer versus calcium carbonate plus atorvastatin to reduce LDL in patients with chronic renal insufficiency with dyslipidemia and hyperphosphatemia. 1093 56

This is the report of an 11-year-old boy with chronic renal disease and secondary hyperparathyroidism. The child had been on dialysis, calcitriol, calcium carbonate, and presented dyslipidemia and calcified thrombi in various vessels and organs in the course of his condition. Pathological examination showed ischemic cerebral necrosis, calcification in coronary arteries, and myocardial infarction.
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PMID:Cardiovascular complications in a child with chronic renal failure. 1738 23

The biological effects in vitro and in vivo of acetate as the main dialysate buffer have been well documented since the introduction of bicarbonate dialysis in the late 1970s. Bicarbonate dialysis solutions have become the standard but still contain 3-5 mmol/L of acetate for chemical stability. This is an important controversy given the recent introduction in numerous hemodialysis techniques of totally acetate-free solutions in an attempt to improve the hemodynamic efficiency and prevent inflammatory and cardiovascular damage. The issue is particularly relevant with the use of on-line techniques, in which, by summing the quota diffused from the dialysate and the quota infused directly into the blood, elevated quantities of acetate can be transferred to the patient's blood. In spite of the relatively small concentration of acetate in the bicarbonate dialysate, the acetate mass transfer is underestimated, leading to various and serious side effects especially in malnourished patients and/ or patients with a low muscle mass or with hepatocellular dysfunction. These patients do not have the capacity to effectively and rapidly metabolize the acetate, leading inevitably to acetate intoxication and accumulation. As the acetate cannot be transformed, it will follow alternative metabolic pathways, with worsening of the acidosis, and will induce the production of nitric oxide with negative hemodynamic effects such as vasodilation. The hemodynamic consequences are myocardial disease with contractile dysfunction and hemodynamic instability. Other problems triggered by acetate include cytokine production with higher microinflammation, dyslipidemia, arterial hypotension, and myocardial dysfunction with a rise in troponin. The use of acetate is hard to defend. Bicarbonate dialysate with a low acetate concentration can be used in patients with a good acetate tolerance. In such patients acidosis adjustment can be continued in the post-dialysis period. Some broad scientific documentation on the benefits of convective-diffusive treatments, almost all of which performed with non-acetate-free techniques, seems to contradict the negative effects of acetate but several studies have shown better hemodynamic stability during dialysis sessions with totally acetate- free dialysate. In conclusion, the future of hemodialysis is likely to be without acetate because acetate-free solutions are easy to produce and their cost will diminish.
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PMID:[Will there be acetate in dialysis solutions for the foreseeable future?]. 2180 5

Dietary intervention is an important approach in the prevention of cardiovascular disease. Over the last decade, some studies have suggested that a calcium-rich diet could help to control body weight, with anti-obesity effects. The potential mechanism underlying the impact of calcium on body fat has been investigated, but it is not fully understood. Recent evidence has also suggested that a calcium-rich diet could have beneficial effects on other cardiovascular risk factors, such as insulin resistance, dyslipidemia, hypertension and inflammatory states. In a series of studies, it was observed that a high intake of milk and/or dairy products (the main sources of dietary calcium) is associated with a reduction in the relative risk of cardiovascular disease. However, a few studies suggest that supplemental calcium (mainly calcium carbonate or citrate) may be associated with an increased risk of cardiovascular events. This review will discuss the available evidence regarding the relationship between calcium intake (dietary and supplemental) and different cardiovascular risk factors and/or events.
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PMID:Does calcium intake affect cardiovascular risk factors and/or events? 2289 32

Chronic kidney disease (CKD) is an increasing problem worldwide. The number of end-stage renal disease patients requiring treatment by dialysis is estimated to be increasing by 10,000 patients per year in Japan. Furthermore, an estimated 13 million people are living with CKD in Japan. Various complications are associated with CKD, including cardiovascular disease (CVD). More than one-third of CKD patients die from CVD. Thus, prevention of CVD is a primary concern for the treatment of CKD patients. CKD-mineral and bone disorder (CKD-MBD) is a serious complication that typically leads to CVD. Hyperphosphatemia is thought to be a central-risk factor for CKD-MBD. Therefore, managing hyperphosphatemia is crucial to prevent CKD-MBD and CVD. It is difficult to achieve the target serum phosphate level through dietary modifications alone in patients with hyperphosphatemia, because most foods contain phosphate. Thus, phosphate binders such as calcium carbonate are commonly prescribed to CKD patients with hyperphosphatemia, but these have undesirable side effects. Inhibition of intestinal phosphate transport activity has also been investigated as an alternative approach for controlling serum phosphate levels in CKD patients. Nicotinamide, which is the amide of niacin, can inhibit intestinal phosphate transport. Niacin and related compounds have also been developed as drugs for hyperlipidemia conditions, especially hypertriglyceridemia with low high-density lipoprotein. This type of dyslipidemia is frequently observed in CKD patients and is a modifiable risk factor for CVD. Thus, niacin and related compounds may have utility for the treatment of both hyperphosphatemia and dyslipidemia in CKD patients to prevent CVD.
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PMID:Niacin and Chronic Kidney Disease. 2659 45