Physicians' Academy for Cardiovascular Education

Chronic Kidney Disease & Cardiovascular Disease

Slides (presentation) - Mar. 20, 2012

Chronic Kidney Disease & Cardiovascular Disease: A clinical update from KDIGO
 

Presentation prepared by
Eberhard Ritz
University of Heidelberg
Germany

Presented at PACE Renal Master Class in Madrid, February 17-18, 2012


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Current & future management of chronic kidney disease
Rationale
Cardiorenal syndrome
first heart, then kidney
Type 1 acute heart - kidney
Type 1: acute worsening of heart dysfunction -acute kidney injury (AKI)
Type 1: acute worsening of heart dysfunction-acute kidney injury (AKI)
Cumulative all cause mortality in patients with a rise in Cystatin C within 48h after hospitalisation for acute heart failure
Worsening kidney function in decompensated heart failure:“treat the heart, don‘t mind the kidney“
Renal impairment in patients with cardiac dysfunction -decreased cardiac output or venous congestion ?
Comparison of the prognostic usefulness of N-terminal pro-brain natriuretic peptide in patients with heart failure with versus without chronic kidney disease
GFR from admission to discharge (% change GFR) - absence or presence of hemoconcentration
Type 2: chronic heart - kidney
Type 2: chronic heart dysfunction - progressive chronic kidney disease (CKD)
Renal function (eGFR) –a predictor of CV death or readmission for CV complications
In contrast to renal function outcome of heart failure (survival)virtually independent of ejection fraction
Type 2: chronic heart dysfunction -progressive chronic kidney disease (CKD)
Cras(Cardiorenal Anemia Syndrome)
Hospitalised patients with heart failure (OPTIMIZE-HF registry)
Causes of anemia in heart failure [Cardio-renal anemia syndrome]
Efficacy and safety of erythropoiesis stimulating agents (ESA) in heart failure
Prevalence of iron deficiency in patients with heart failure
Prevalence of iron deficiency in patients with heart failure impact on survival
Iron deficiency: an ominous sign in patients with systolic chronic heart failure (prospective observational study)
Ferric carboxymaltose in patients with heart failure and iron deficiency
Ferric carboxymaltose in patients with heart failure and iron deficiency
Type 3: acute kidney - heart
Type 3: acute kidney dysfunction - acute cardiac dysfunction
Type 4: chronic kidney - heart
Frequency of chronic kidney disease in the Netherlands
Mild reduction of glomerular filtration rate (GFR) associated with increased CV mortality (Hoorn study)
Mild renal dysfunction associated with incident coronary disease in young males
Both urinary albumin excretionand eGFR at baseline independently predict CV and renal events
Risk of CKD (< 60 ml/min/1.73m2) in 281 hypertensive patients after 13 years follow-up according to baseline s-creatinine quartiles within normal range
Inflammation – # main driving force for adverse outcomes of CV damage indicated by biomarkers e.g. CRP, pentraxin3, IL-6 …
Baseline S-P predicts 15 years later coronary calcium (EB scan) in 3015 healthy young men (CARDIA study)
Serum phosphorous and incidence of cardiovascular disease in the community (Framingham offspring study)
Increasing CV mortality with progressively higher serum phosphate within the normal range –patients with coronary heart disease
FGF23 (fibroblast growth factor) predicts future cardiovascular events before HD treatment
FGF23 (but not klotho) increased # LV mass index and # ejection fraction in CKD patients
Sham
Diastolic BP on treatment and risk of MI – type 2 diabetic patients with nephropathy (IDNT study)
Antihypertensive treatment with triple medication
Consequently when aiming for low blood pressures two caveats
Asymptomatic or symptomatic coronary artery disease in CKD or ESRD: To treat or not to treat ?
Prospective data collection non-dialysis dependent kidney disease and in dialysis dependent CKD CABG – survival advantage for all categories of kidney function PCI – lower risk of death in dialysis and reference patients compared with no revascularisation
ENDSTAGE KIDNEY DISEASE
Survival on hemodialysis- CV events the major cause of death on dialysis
Stunning – ischemia induced global or regional LV wall contraction abnormalities and impaired systolic LV function
Correlation between aortic calcification (AAC) and overall as well as cardiovascular mortality
Relation between renal function and presentation, use of therapies and in-hospital complications in acute coronary syndrome
In hospital mortality according to eGFR and admission ECG
Relation between renal function, presentation and use of therapies in acute coronary syndrome
Cardiac sequelae of primary kidney disease e.g. glomerulonephritis, polycystic kidney disease…
Cardiomyocyte hypertrophy and myocardial interstitial fibrosis in uremia –implications for cardiac compliance
Intramyocardial postcoronary arteries in renal failure

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