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How to reduce sudden cardiac death in patients with renal failure

[...]this raises the question whether ICD implantation in these patients is appropriate for prevention of SCD or whether other more conservative treatment strategies are preferred with regard to safety and cost effectiveness. Ischaemic heart disease Present in 80% of patients dying suddenly in the g... Full description

Journal Title: Heart 2012, Vol.98 (4), p.335-341
Main Author: de Bie, Mihály K
Other Authors: Buiten, Maurits S , Rabelink, Ton J , Jukema, J Wouter
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: London: BMJ Publishing Group Ltd and British Cardiovascular Society
ID: ISSN: 1355-6037
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recordid: cdi_proquest_miscellaneous_917577688
title: How to reduce sudden cardiac death in patients with renal failure
format: Article
creator:
  • de Bie, Mihály K
  • Buiten, Maurits S
  • Rabelink, Ton J
  • Jukema, J Wouter
subjects:
  • Abridged Index Medicus
  • Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
  • Biological and medical sciences
  • Cardiac arrhythmia
  • Cardiology. Vascular system
  • Cardiovascular disease
  • chronic kidney disease
  • Death, Sudden, Cardiac - epidemiology
  • Death, Sudden, Cardiac - etiology
  • Death, Sudden, Cardiac - prevention & control
  • Emergency and intensive care: neonates and children. Prematurity. Sudden death
  • Global Health
  • Heart attacks
  • Humans
  • implantable cardioverter-defibrillator
  • Intensive care medicine
  • Kidney Failure, Chronic - complications
  • Kidney Failure, Chronic - mortality
  • Medical sciences
  • Mortality
  • Nephrology. Urinary tract diseases
  • Nephropathies. Renovascular diseases. Renal failure
  • Practice Guidelines as Topic
  • Renal failure
  • Sudden cardiac death
  • Survival Rate - trends
ispartof: Heart, 2012, Vol.98 (4), p.335-341
description: [...]this raises the question whether ICD implantation in these patients is appropriate for prevention of SCD or whether other more conservative treatment strategies are preferred with regard to safety and cost effectiveness. Ischaemic heart disease Present in 80% of patients dying suddenly in the general population Highly prevalent and more severe in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) Most important predictor of sudden cardiac death (SCD) in patients with ESRD In patients with coronary artery disease, severity of CKD is associated with the occurrence of SCD Left ventricular hypertrophy (LVH) and myocardial fibrosis Develops in the early stages of CKD and prevalence increases with severity of CKD Results in phenomena which predispose to electric excitability and ventricular arrhythmias (ie, decreased myocardial capillary density, diastolic and systolic dysfunction) Development of LVH-especially worsening of LVH-are associated with increased risk for SCD Vascular calcification Intima calcification leads to luminal narrowing resulting in ischaemia Media calcification leads to a reduced vascular compliance resulting in vascular stiffening Coronary calcification has been associated with higher spatial QRS-T angles, an important marker for SCD Sympathetic over activation Important mechanism for cardiovascular complications In dialysis patients norepinephrine predicts survival and cardiovascular events Damaged kidneys trigger sympathetic overactivation Dialysis treatment Timely relation between occurrence of SCD and dialysis treatment Significant decline in incidence of SCD after renal transplantation Probably rapid fluid and electrolyte shifts play an important role Other risk factors These include age, diabetes mellitus, malnutrition, inflammation, electrolyte abnormalities and the use of vascular access catheters Ischaemic heart disease CAD is highly prevalent among patients with CKD and is more severe compared to patients without CKD.w1 In patients starting dialysis the prevalence of significant CAD is believed to be around 40%.w2 However, recent studies evaluating the presence of significant CAD in dialysis patients indicate that this is probably an underestimation of the actual incidence of CAD.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1355-6037
fulltext: fulltext
issn:
  • 1355-6037
  • 1468-201X
url: Link


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description[...]this raises the question whether ICD implantation in these patients is appropriate for prevention of SCD or whether other more conservative treatment strategies are preferred with regard to safety and cost effectiveness. Ischaemic heart disease Present in 80% of patients dying suddenly in the general population Highly prevalent and more severe in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) Most important predictor of sudden cardiac death (SCD) in patients with ESRD In patients with coronary artery disease, severity of CKD is associated with the occurrence of SCD Left ventricular hypertrophy (LVH) and myocardial fibrosis Develops in the early stages of CKD and prevalence increases with severity of CKD Results in phenomena which predispose to electric excitability and ventricular arrhythmias (ie, decreased myocardial capillary density, diastolic and systolic dysfunction) Development of LVH-especially worsening of LVH-are associated with increased risk for SCD Vascular calcification Intima calcification leads to luminal narrowing resulting in ischaemia Media calcification leads to a reduced vascular compliance resulting in vascular stiffening Coronary calcification has been associated with higher spatial QRS-T angles, an important marker for SCD Sympathetic over activation Important mechanism for cardiovascular complications In dialysis patients norepinephrine predicts survival and cardiovascular events Damaged kidneys trigger sympathetic overactivation Dialysis treatment Timely relation between occurrence of SCD and dialysis treatment Significant decline in incidence of SCD after renal transplantation Probably rapid fluid and electrolyte shifts play an important role Other risk factors These include age, diabetes mellitus, malnutrition, inflammation, electrolyte abnormalities and the use of vascular access catheters Ischaemic heart disease CAD is highly prevalent among patients with CKD and is more severe compared to patients without CKD.w1 In patients starting dialysis the prevalence of significant CAD is believed to be around 40%.w2 However, recent studies evaluating the presence of significant CAD in dialysis patients indicate that this is probably an underestimation of the actual incidence of CAD.
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subjectAbridged Index Medicus ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiac arrhythmia ; Cardiology. Vascular system ; Cardiovascular disease ; chronic kidney disease ; Death, Sudden, Cardiac - epidemiology ; Death, Sudden, Cardiac - etiology ; Death, Sudden, Cardiac - prevention & control ; Emergency and intensive care: neonates and children. Prematurity. Sudden death ; Global Health ; Heart attacks ; Humans ; implantable cardioverter-defibrillator ; Intensive care medicine ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - mortality ; Medical sciences ; Mortality ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Practice Guidelines as Topic ; Renal failure ; Sudden cardiac death ; Survival Rate - trends
ispartofHeart, 2012, Vol.98 (4), p.335-341
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description[...]this raises the question whether ICD implantation in these patients is appropriate for prevention of SCD or whether other more conservative treatment strategies are preferred with regard to safety and cost effectiveness. Ischaemic heart disease Present in 80% of patients dying suddenly in the general population Highly prevalent and more severe in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) Most important predictor of sudden cardiac death (SCD) in patients with ESRD In patients with coronary artery disease, severity of CKD is associated with the occurrence of SCD Left ventricular hypertrophy (LVH) and myocardial fibrosis Develops in the early stages of CKD and prevalence increases with severity of CKD Results in phenomena which predispose to electric excitability and ventricular arrhythmias (ie, decreased myocardial capillary density, diastolic and systolic dysfunction) Development of LVH-especially worsening of LVH-are associated with increased risk for SCD Vascular calcification Intima calcification leads to luminal narrowing resulting in ischaemia Media calcification leads to a reduced vascular compliance resulting in vascular stiffening Coronary calcification has been associated with higher spatial QRS-T angles, an important marker for SCD Sympathetic over activation Important mechanism for cardiovascular complications In dialysis patients norepinephrine predicts survival and cardiovascular events Damaged kidneys trigger sympathetic overactivation Dialysis treatment Timely relation between occurrence of SCD and dialysis treatment Significant decline in incidence of SCD after renal transplantation Probably rapid fluid and electrolyte shifts play an important role Other risk factors These include age, diabetes mellitus, malnutrition, inflammation, electrolyte abnormalities and the use of vascular access catheters Ischaemic heart disease CAD is highly prevalent among patients with CKD and is more severe compared to patients without CKD.w1 In patients starting dialysis the prevalence of significant CAD is believed to be around 40%.w2 However, recent studies evaluating the presence of significant CAD in dialysis patients indicate that this is probably an underestimation of the actual incidence of CAD.
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1Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
2Biological and medical sciences
3Cardiac arrhythmia
4Cardiology. Vascular system
5Cardiovascular disease
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7Death, Sudden, Cardiac - epidemiology
8Death, Sudden, Cardiac - etiology
9Death, Sudden, Cardiac - prevention & control
10Emergency and intensive care: neonates and children. Prematurity. Sudden death
11Global Health
12Heart attacks
13Humans
14implantable cardioverter-defibrillator
15Intensive care medicine
16Kidney Failure, Chronic - complications
17Kidney Failure, Chronic - mortality
18Medical sciences
19Mortality
20Nephrology. Urinary tract diseases
21Nephropathies. Renovascular diseases. Renal failure
22Practice Guidelines as Topic
23Renal failure
24Sudden cardiac death
25Survival Rate - trends
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abstract[...]this raises the question whether ICD implantation in these patients is appropriate for prevention of SCD or whether other more conservative treatment strategies are preferred with regard to safety and cost effectiveness. Ischaemic heart disease Present in 80% of patients dying suddenly in the general population Highly prevalent and more severe in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) Most important predictor of sudden cardiac death (SCD) in patients with ESRD In patients with coronary artery disease, severity of CKD is associated with the occurrence of SCD Left ventricular hypertrophy (LVH) and myocardial fibrosis Develops in the early stages of CKD and prevalence increases with severity of CKD Results in phenomena which predispose to electric excitability and ventricular arrhythmias (ie, decreased myocardial capillary density, diastolic and systolic dysfunction) Development of LVH-especially worsening of LVH-are associated with increased risk for SCD Vascular calcification Intima calcification leads to luminal narrowing resulting in ischaemia Media calcification leads to a reduced vascular compliance resulting in vascular stiffening Coronary calcification has been associated with higher spatial QRS-T angles, an important marker for SCD Sympathetic over activation Important mechanism for cardiovascular complications In dialysis patients norepinephrine predicts survival and cardiovascular events Damaged kidneys trigger sympathetic overactivation Dialysis treatment Timely relation between occurrence of SCD and dialysis treatment Significant decline in incidence of SCD after renal transplantation Probably rapid fluid and electrolyte shifts play an important role Other risk factors These include age, diabetes mellitus, malnutrition, inflammation, electrolyte abnormalities and the use of vascular access catheters Ischaemic heart disease CAD is highly prevalent among patients with CKD and is more severe compared to patients without CKD.w1 In patients starting dialysis the prevalence of significant CAD is believed to be around 40%.w2 However, recent studies evaluating the presence of significant CAD in dialysis patients indicate that this is probably an underestimation of the actual incidence of CAD.
copLondon
pubBMJ Publishing Group Ltd and British Cardiovascular Society
pmid22267816
doi10.1136/heartjnl-2011-300693