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Last Updated 4/14/13
 

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The leading cause of death for end-stage renal disease patients is cardiovascular disease (CVD).  In the prevalent dialysis population, the percentage of deaths due to cardiac disease has fallen from 45 in 1997–1999 to 39 in 2007–2009; the percentage attributable to cardiovascular disease has declined from 50 to 42 according to the United States Renal Data System (USRDS).  This risk for CVD is about 30 times the risk in the general population.  Even after statistical adjustments to account for age, CVD-related deaths remain 10 to 20 times higher than in the general population.

The high risk of CVD in end-stage renal disease is partly due to the fact that the dialysis patient population has a higher prevalence of conditions that are known risk factors for CVD in the general population, such as older age, hypertension (high blood pressure), high cholesterol levels, diabetes, and physical inactivity. The high risk may also be partly caused by factors involved in renal failure, including proteinuria (protein in urine), fluid retention, irregular blood chemistries, anemia, blood clotting disorders, and chronic inflammation.

The two most common CVD conditions seen in patients with end-stage renal disease are coronary artery disease (CAD) and left ventricular hypertrophy (LVH).  The physical symptoms of these two conditions may often be the same, and include chest pain, heart attack, congestive heart failure, and arrhythmias.

Warning:  Changes should never be made in a patient's treatment or care based solely on the information found here.  Every patient has unique healthcare concerns and considerations and all these factors must all be taken into account before any changes can be safely made.  All medical and therapeutic decisions must come from a qualified health care provider.  Read RenalWEB's Legal Disclaimer before proceeding.


  NEWS & LATEST ARTICLES

Serum Phosphorus Reduction in Dialysis Patients Treated with Cinacalcet for Secondary Hyperparathyroidism Results Mainly from Parathyroid Hormone Reduction - Free, full-text, Advance Access Article from Clinical Kidney Journal. - April 11, 2013

Why Do People with Apple Shaped Bodies Have an Increased Risk of Kidney Disease? - April 20, 2013

Diuretics, ACEIs, ARBs, and NSAIDs: A Nephrotoxic Combination - April 11, 2013

Cardiopoietic 'Smart' Stem Cells Show Promise in Heart Failure Patients - Press release from The Mayo Clinic. - April 10, 2013

Enlarged Heart No Excuse for Inactivity - (Registration required, but free.) Article from MedPage Today. - April 10, 2013

Increased Night Heart Rate Is Associated with Worse Large Artery Elasticity in Chronic Kidney Disease Patients - Online First abstract from International Urology and Nephrology. - April 2013

Nighttime Blood Pressure, Systolic Blood Pressure Variability, and Left Ventricular Mass Index in Children with Hypertension - Online First abstract from Pediatric Nephrology. - April 2013

Increased Basal Nitric Oxide Amplifies the Association of Inflammation with All Cause and Cardiovascular Mortality in Prevalent Hemodialysis Patients - Online First abstract from International Urology and Nephrology. - April 2013

Predictors of Cardiovascular Events in Hemodialysis Patients after Stress Myocardial Perfusion Imaging - Early View abstract from Hemodialysis International. - April 9, 2013

Cinacalcet Upregulates Calcium-Sensing Receptors of Parathyroid Glands in Hemodialysis Patients - Issue-in-Progress Article from American Journal of Nephrology - April 9, 2013

Cardiac Treatment Improves after Taking Page from Toyota Playbook - Article from American Medical News. - April 8, 2013

Nearly 30 Percent of Americans Have High Blood Pressure: CDC - Articles from HealthDay and the CDC's MMWR. - April 4, 2013

Magnesium Prevents Phosphate Induced Calcification in Human Aortic Vascular Smooth Muscle Cells - Free, full-text article from NDT. - April 2013

Full-Text Articles from the British Medical Journal - April 4, 2013
Effect of Longer Term Modest Salt Reduction on Blood Pressure: Cochrane Systematic Review and Meta-Analysis of Randomized Trials
Effect of Lower Sodium Intake on Health: Systematic Review and Meta-Analyses
Effect of Increased Potassium Intake on Cardiovascular Risk Factors and Disease: Systematic Review and Meta-Analyses

Waist Circumference Is Associated with Carotid Intima Media Thickness in Peritoneal Dialysis Patients - Online First abstract from International Urology and Nephrology. - April 2013

Hemodialysis and Hemodiafiltration Differently Modulate Left Ventricular Diastolic Function - Provisional abstract and full-text article (16-page pdf) from BMC Nephrology. - April 2, 2013

Calciphylaxis and Sodium Thiosulfate: a Glimmer of Hope in Desperate Situation - Early View abstract from Journal of Renal Care. - April 2, 2013

Sevelamer: A Phosphate Binder Friend With Benefits? - (Registration required, but free.) Berns on Nephrology video from Medscape Nephrology. - April 1, 2013

FGF-23, Vascular Calcification, and Cardiovascular Diseases in Chronic Hemodialysis Patients - Online First abstract from International Urology and Nephrology. - April 2013

Diuretics or Ultrafiltration for Acute Decompensated Heart Failure and Cardiorenal Syndrome? - Free, full-text, Article in Press editorial from American Journal of Kidney Diseases. - April 1, 2013

Blood Pressure Measurement in Peritoneal Dialysis: Which Method Is Best? - PDI in Press Abstract - April 1, 2013

Evaluation of Association between Atherogenic Index of Plasma and Intima Media Thickness of the Carotid Artery for Subclinic Atherosclerosis in Patients on Maintenance Hemodialysis - Early View Abstract from Hemodialysis International - April 1, 2013

Dietary Phosphorus Is Associated with Greater Left Ventricular Mass - Free, full-text article from Kidney International. - April 2013

Changes in Left Ventricular Diastolic Function During Hemodialysis Sessions - Article in Press abstract from American Journal of Kidney Diseases. - April 1, 2013

Magnesium Prevents Phosphate Induced Calcification in Human Aortic Vascular Smooth Muscle Cells - Free, full-text article from NDT. - April 2013

QT Interval in CKD and Hemodialysis Patients - Abstract from Clinical Kidney Journal - April 2013

Issue-in-Progress Open Access Articles from Kidney & Blood Pressure Research - April 2013
Calf Bioimpedance Spectroscopy for Determination of Dry Weight in Hemodialysis Patients: Effects on Hypertension and Left Ventricular Hypertrophy
Cardiovascular Risk and Mineral Bone Disorder in Patients with Chronic Kidney Disease

Effect of Nonsurgical Periodontal Treatment on C-Reactive Protein Levels in Maintenance Hemodialysis Patients - Early Online Abstract from Renal Failure - March 28, 2013

Blood Pressure Recordings During Hemodialysis Access Interventions: Implications for Acute Management - Early View abstract from Seminars in Dialysis. - March 28, 2013

Magnitude of End-Dialysis Overweight is Associated with All-Cause and Cardiovascular Mortality: A 3-Year Prospective Study - Issue-in-Progress article from American Journal of Nephrology. - March 28, 2013

Audit-based Education Lowers Systolic Blood Pressure in Chronic Kidney Disease: the Quality Improvement in CKD (QICKD) Trial Results - Free, full-text, Advance Access article from Kidney International. - March 27, 2013

Remote Ischemic Preconditioning in Hemodialysis: a Pilot Study - Online First abstract from Heart and Vessels. - March 2013

Chelation Little Help for Heart Disease: Study - March 26, 2013

Coronary Artery Calcium Score Prediction of All Cause Mortality and Cardiovascular Events in People with Type II Diabetes: Systematic Review and Meta-Analysis - Free, full-text article from BMJ. - March 25, 2013

Heart Repair Breakthroughs Replace Surgeon's Knife - Article from AP. - March 25, 2013

Ferric Citrate Hydrate, a New Phosphate Binder, Prevents the Complications of Secondary Hyperparathyroidism and Vascular Calcification - Free, Full-Text, Issue-In-Progress Article from American Journal Of Nephrology - March 23, 2013

Dynamic Cardiac Dyssynchrony Is Strongly Associated with 2-Year Dialysis Adequacy in Continuous Ambulatory Peritoneal Dialysis Patients - (15-page pdf) - Provisional Abstract and Full-Text Article (PDF) from BMC Nephrology - March 23, 2013

Atrial Fibrillation and Warfarin Use in Haemodialysis Patients: An Individualized Holistic Approach is Important in Stroke Prevention - Accepted Article abstract and full-text (19-page pdf) from Nephrology. - March 22, 2013

Nicotinic Acid and Nicotinamide: A Review of Their Use for Hyperphosphatemia in Dialysis Patients - Early View abstract from Pharmacotherapy. - March 21, 2013

Ultrafiltration in Heart Failure with Cardiorenal Syndrome - Correspondence from the New England Journal of Medicine - March 21, 2013

The Malnutrition-Inflammation-Depression-Arteriosclerosis Complex Is Associated with an Increased Risk of Cardiovascular Disease and All-Cause Death in Chronic Hemodialysis Patients - Issue in Progress abstract from Nephron Clinical Practice. - March 2013

Novel Filtration Markers as Predictors of All-Cause and Cardiovascular Mortality in US Adults - Articles in Press Abstract from American Journal Of Kidney Diseases - March 21, 2013

Disparities in Antihypertensive Medication Adherence in Adolescents - Online First abstract from Pediatric Nephrology. - March 2013

Arterial Disease in Chronic Kidney Disease - (Registration required, but free.) Article from Heart via Medscape Nephrology. - March 2013

Anxiety, Depression May Triple Risk of Death for Heart Patients: Study - Article from HealthDay. Online First article from the Journal of the American Heart Association. - March 19, 2013
"(An expert)... agreed anxiety and depression are most lethal when they co-exist."

Effects of Increasing Diffusive Sodium Removal on Blood Pressure Control in Hemodialysis Patients with Optimal Dry Weight - Free, full-text, Issue in Progress article from Blood Purification. - March 19, 2013

Clinical Audit Improves Hypertension Control in Hemodialysis Patients - Articles in Press Abstract from International Journal of Artificial Organs - March 18, 2013

Obese Heart Patients 'Do Better' - Article from the BBC. - March 16, 2013

Arterial Stiffness Depends on Serum Ionized Calcium Levels During Dialysis With Regional Citrate Anticoagulation - Early View abstract from Artificial Organs. - March 15, 2013

Importance of High-Density Lipoprotein Quality: Evidence from Chronic Kidney Disease - Published Ahead-of-Print abstract From Current Opinion in Nephrology and Hypertension - March 10, 2013

News Releases from the American Heart Association  Continually Updated!
Latest Cardiovascular Disease News Stories - Yahoo! News Continually Updated!
Latest Hypertension News Stories - Yahoo! News Continually Updated!
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  WEB RESOURCES
Latest Scientific Journal Articles on Cardiovascular Disease
Acute and Chronic Management of Atrial Fibrillation in Patients With Late-Stage CKD - Full-text article from the American Journal of Kidney Diseases. - April 2009
Cardiovascular disease calculators - subject page from RenalWEB
Cardiovascular complications of pediatric chronic kidney disease - educational feature from Pediatric Nephrology - February 2008
Cause or Casualty? The Impact and Role of the Kidney on Inflammation, Metabolic Syndrome and Atherogenesis (pdf) free CE program from the National Kidney Foundation (NKF) web site
Diseases & Conditions from the American Heart Association web site
Evaluation of cardiac function in the dialysis patient—a primer for the non-expert - editorial from Nephrology Dialysis Transplantation - June 2006
The Guide to Medicare Preventive Services (pdf) from the Medlearn/Centers for Medicare & Medicaid Services web site
Division for Heart Disease and Stroke Prevention: Interactive Atlas from the Centers for Disease Control and Prevention (CDC) web site
High Blood Pressure and Kidney Disease: How Are They Connected? from the Kidney & Urology Foundation of America (KUFA) web site
National Cholesterol Education Program (NCEP) web site. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
Understanding Cardiac Biomarkers in ESRD: Frequently Asked Questions and the Promise of Clinical Application - free, full-text review (43-page pdf) from Nephrology. - October 15, 2010
The Well-Controlled Patient: Looking Beyond the Lab Tests from the National Kidney Foundation (NKF) web site
American Heart Association web site
American College of Cardiology web site
American Society of Hypertension web site
The Drug Monitor web site - synopsis of the essential clinical pharmacology / pharmacy information
HeartPoint - multimedia site for patient information and education
National Heart, Lung and Blood Institute web site
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  ESSENTIALS AND CLASSICS
Heart Failure Treatment from WebMD
High Blood Pressure and Kidney Disease from the NIDDK web site (in layman's terms)
Ten Facts About High Blood Pressure and Chronic Kidney Disease from the NKF web site.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure - 1997
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  PUBMED SEARCHES (National Library of Medicine's MEDLINE Database)
MEDLINE PLUS for Heart Diseases Continually Updated!
heart AND dialysis Continually Updated!
hypertension AND dialysis Continually Updated!
cardiovascular disease AND end-stage renal disease AND dialysis Continually Updated!
MEDLINE / Pubmed Information from the National Library of Medicine
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  CLINICAL GUIDELINES
AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update
1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension
The National Cholesterol Education Program (NCEP) issues major new clinical practice guidelines on the prevention and management of high cholesterol in adults. The guidelines are the first major update from NCEP in nearly a decade. Press release from the NCEP. - May 15, 2001
Clinical Practice Guidelines for cardiovascular disease (search result) from the  National Guideline Clearinghouse web site
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  K/DOQI™ -  Kidney Disease Outcomes Quality Initiative
Clinical Practice Guidelines For Chronic Kidney Disease: Table of Contents
Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients
Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease
Managing Dyslipidemias in Chronic Kidney Disease


  DISCUSSION FORUM
General Dialysis Nursing Issues and Questions (No dedicated RenalWEB forum)
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  WEB SEARCH ENGINES
Cardiovascular Disease web sites by Yahoo! Continually Updated!
Cardiovascular Disease web sites by AOL Continually Updated!
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  INPUT / SUGGESTIONS
E-mail to RenalWEB on the Cardiovascular Disease Topic
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