Patients Receiving Dialysis Are at a Heightened Risk for Sudden Cardiac Death 

Northwestern Memorial Hospital, 

Nov 14, 2010 - 12:09:54 PM

HealthNewsDigest.com

Understanding sudden cardiac death in dialysis patients will aid in developing better standards for prevention

(HealthNewsDigest.com) - CHICAGO, Nov. 14, 2010 -- Approximately 500,000 Americans require dialysis to treat kidney disease; of that population nearly half of the deaths that occur are caused by cardiovascular disease. Dialysis patients are at elevated risk for sudden cardiac death, but physicians are unclear why these deaths occur because little research has been done to examine how to best manage heart disease in this high-risk population.

Northwestern Medicine cardiologist Rod Passman, MD, medical director for the Center for Atrial Fibrillation at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital will present a paper at the American Heart Association's Scientific Sessions being held November 13 through 17 in Chicago about sudden cardiac death in dialysis patients. Passman is working to increase understanding within the medical community about this heightened mortality risk and how to prevent sudden cardiac death among this rapidly growing patient population.

"Dialysis patients have extraordinarily high mortality rates with cardiac disease accounting for 43 percent of deaths in this population; data indicates that approximately 27 percent of the mortalities are due to sudden cardiac death," said Passman, who is also an associate professor of cardiology at Northwestern University's Feinberg School of Medicine. "Patients on dialysis are excluded from clinical trials examining sudden cardiac death because of their kidney disease. The lack of research complicates clinicians' ability to understand the connection between renal disease and cardiovascular disease. The medical community needs to stop neglecting this community of patients because it is a rapidly growing group.

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Why Assistive Technology Is Needed for Probing of Dry Weight
Arjun D. Sinha
Division of Nephrology, Indiana University School of Medicine, Indianapolis, Ind., 


13th International Conference on Dialysis: Advances in Chronic Kidney Disease 2011
Blood Purification, S. Karger AG, Basel

Abstract

Despite advancements in dialysis therapy, the subjective clinical examination still remains the standard of care in managing volume removal in chronic dialysis. While there is no definitive trial establishing that dry weight management guided by an assistive technology is superior to the clinical method, there is ample evidence that there is a need for these technologies to be developed. Mortality, cardiovascular morbidity, and sequelae of volume overload remain far too common under the current paradigm. Recent studies indicate that the mortality associated with volume overload is independent of hypertension, suggesting that if mortality is to be improved, then a measure of volume independent of blood pressure must be developed. Even when considered as an integrated whole, the clinical method is inaccurate at setting dry weight when compared to the use of assistive technologies. 

A recent secondary analysis of a randomized trial showed that relative plasma volume (RPV) slope is responsive to change in volume status and may be useful in guiding therapy for hypertension. The only large randomized trial to investigate the ability of an assistive technology to manage volume removal in hemodialysis patients is the Crit-Line Intradialytic Monitoring Benefit Study, which found harm associated with RPV monitoring. However, the design of this trial did not require the RPV group to actually receive this intervention. Assistive technologies offer an opportunity to improve on the subjective clinical exam for the setting of dry weight, but well designed and adequately powered clinical trials are needed.

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Drug Dosing by the Numbers for Patients with Chronic Kidney Disease

By Oregon State University
Feb 8, 2011 - 3:00:03 PM
HealthNewsDigest.com


CORVALLIS, Ore. – Pharmacists at Oregon State University have developed a new approach to developing drug dosages for patients with chronic kidney disease that shows promise for improving the therapeutic value of drugs while minimizing adverse effects.

The process, which provides a systematic analysis of the complex interplay among biological, chemical and pharmaceutical processes in the patient’s body, was created by Ali Olyaei, a professor in the OSU College of Pharmacy, who also has an appointment at Oregon Health and Science University.

“Chronic kidney disease (CKD) can affect nearly every organ system in the body,” said Olyaei, who specializes in renal and transplant medicine at the OSU/OHSU Division of Nephrology and Hypertension in Portland. “Patients with CKD require a careful and thorough evaluation when medications are being prescribed.”

Patients with chronic kidney disease face significantly greater risks from medications than patients with normal kidney function – as much as three times higher, according to researchers at OSU. Kidney disease compromises the body’s ability to absorb, metabolize and eliminate drugs. Compounding the dangers are the multiple health problems that often accompany kidney disease.

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To good to be true.....

Researchers Unlock the Potential for Exploring Kidney Regeneration

ScienceDaily (Feb. 1, 2011) — Researchers  have identified a cell in zebrafish that can be transplanted from one fish to another to regenerate nephrons, providing the potential to improve kidney function.

It is estimated that up to 10 percent of the U.S. population may have some form of renal disease, with 450,000 patients with end stage renal disease (ESRD) requiring hemodialysis. Researchers at Brigham and Women's Hospital, Massachusetts General Hospital and the University of Pittsburgh have identified a cell in zebrafish that can be transplanted from one fish to another to regenerate nephrons, providing the potential to improve kidney function. These findings are published in the February 3 edition of Nature.

Currently, the five-year survival rate for patients on dialysis is 33 percent, worse than the survival rate for many forms of cancer. This epidemic of renal failure is projected to grow as obesity, poor nutrition and lack of exercise increase the incidence of diabetes and hypertension. There is also evidence that intra-uterine growth retardation and low birth weight/prematurity reduce the number of nephrons in each kidney thereby increasing the risk of  hypertension and renal failure when these premature infants become adults. The cost of treating end stage renal disease is currently 32 billion dollars annually and is likely to double in the next decade.

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