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AVFs May Cause Cardiac Problems
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www.renalandurologynews.com
CARDIAC CHANGES AFTER AV FISTULA CREATION A pilot study using cardiovascular magnetic resonance imaging to evaluate changes in heart and vascular structures showed increases in a number of cardiac parameters, as indicated here. Cardiac output +25%
MRI reveals ominous changes to the heart
Left ventricular end-systolic volume +21% Right ventricular end-systolic volume +18%
BY JODY A. CHARNOW ARTERIOVENOUS fistulas (AVFs) are considered the preferred form of vascular access for hemodialysis, but a new Australian pilot study using magnetic resonance imaging suggests these fistulas can result in adverse cardiovascular (CV) effects. The study found that elective AVF creation in patients with chronic kidney disease (CKD) not yet on hemodialysis is associated with significant increases in left and right atrial and ventricular chamber volumes and left ventricular mass, as well as deteriora-
IN THIS ISSUE 8 14
Cigarette smoking found to decrease the risk of gout Elevated sclerostin levels linked to lower cardiovascular mortality
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Increasing dietary fiber intake associated with higher GFR
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Serious technical adverse events rare with home hemodialysis
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Point/Counterpoint: Should metformin be used in CKD patients?
Higher dietary fiber intake is associated with better kidney function. PAGE 15
tion in systemic endothelial function. Such alterations in cardiovascular structure and function may contribute to the poor health outcomes seen in patients with end-stage renal disease, researchers concluded in a report in the International Journal of Nephrology and Renovascular Disease (2014;7:337–345). A team led by Matthew I. Worthley, MBBS, PhD, of the Royal Adelaide Hospital in Adelaide, South Australia, used cardiovascular magnetic resonance imaging (MRI), which they called a “gold standard imaging modality,” to evaluate the impact of
CKD Linked to Low Levels of Magnesium LOW SERUM magnesium levels are associated with an elevated the risk of developing kidney disease, according to a new study. Adrienne Tin, MD, of Johns Hopkins University in Baltimore, and colleagues studied 13,226 individuals aged 45–65 years participating in the Atherosclerosis Risk in Communities study. Subjects had baseline estimated glomerular filtration rates of 60 mL/min/1.73 m2 or higher in 1987–1989 and were followed through 2010. During a median follow-up of 21 years, chronic kidney disease (CKD) developed in 1,965 subjects and endstage renal disease (ESRD) developed continued on page 10
Left atrial area +11% Right atrial area +9% Left ventricular mass +12.7% 0
5
10
Percent 15
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Source: Dundon BK, et al. The deleterious effects of arteriovenous fistula-creation on the cardiovascular system: a longitudinal magnetic resonance imaging study. Int J Nephrol Renovas Dis (2014;7:337-345).
AVF creation on cardiac and vascular structure and function in 24 patients with stage 5 CKD undergoing AVF creation. Patients underwent imaging at baseline and prior to and 6 months after fistula creation.
At follow-up, left ventricular ejection fraction (LVEF) remained unchanged, whereas mean cardiac output increased significantly by 25%, Dr. Worthley’s group reported. Results also showed continued on page 10
Fracture Risk Tied to eGFR MANY PATIENTS with chronic kidney disease (CKD) will suffer fractures, with the risk of fracture increasing with decline kidney function, new study findings suggest. A Canadian team led by Amit X. Garg, MD, of the London Health Sciences Centre in London, Ontario, studied 679,114 individuals aged 40 years and older. The cohort had a mean age of 62 years. At study entry, the researchers stratified subjects according to estimated glomerular filtration rate (eGFR), gender, and age. The primary outcome was the 3-year cumulative incidence of fracture: the proportion of subjects who fractured
their hip, forearm, pelvis, or proximal humorus at least once within 3 years of follow-up. Results showed that the 3-year incidence of fracture among women older than 65 years was 4.3%, 5.8%, 6.5%, 7.8%, and 9.6% for those with an eGFR (in mL/min/1.73 m2) of 60 or higher, 45–59, 30–44, 15–29, and below 15, respectively, according to findings published in Kidney International (2014;86:810-818). Among men older than 65 years, the corresponding incidences were 1.6%, 2.0%, 2.7%, 3.8%, and 5.0%, respectively. According to the researchers’ estimates, 1 in 10 continued on page 10
MRA-BASED TREATMENTS FOR PATIENTS ON DIALYSIS
Murray Epstein, MD, discusses the role of mineralocorticoid receptor antagonists SEE STORY PAGE 21
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