Anemia as a Predictor of Cardiovascular Events in Patients with Elevated Serum Creatinine (original) (raw)
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Serum Creatinine and Occurrence and Severity of Coronary Artery Disease
Medical Archives, 2019
Introduction: The risk for cardiovascular disease is increased in all stages of the impairment of renal function. It is proposed that serum creatinine is a marker of diabetes and coronary artery disease (CAD) as well as the kidney function. Aim: to study the association of serum creatinine with the likelihood and severity of CAD. The study population consisted of 262 males and 266 females who were classified as CAD cases and controls according to the results of coronary angiography. Results: Patients with CAD compared with the controls had increased levels of serum urea and creatinine. Serum creatinine showed significant positive correlation with male sex, hypertension and negative correlation with total-and HDL-cholesterol and apoAI. Serum urea, uric acid and potassium were the major determinants of creatinine. All hematological parameters were strong negative correlates of creatinine. None of markers of inflammation had significant correlation with creatinine. Creatinine was associated significantly with the prevalence [odds ratio of 1.79 (1.47-2.20), p<0.001] and severity of CAD [F(3,528)= 3.0, p=0.03]. Serum creatinine was excluded from the regression equation after adjustment for major risk factors. Conclusion: Serum creatinine has significant association with CAD, but the correlation is not independent. Creatinine have significant association with markers of kidney function and body water status, but not with markers of inflammation and insulin function.
National Journal of Medical Research, 2019
Introduction: Chronic kidney disease and anemia, both independently have been shown to be a causative factor in the development of Cardiovascular diseases. The aim of the study is to establish that both CKD and Anemia are risk factors for adverse CVD outcomes in the general population. Methods: This cross-sectional, observational, single-centre, study comprising of 108 patients. A diagnosis of acute coronary syndrome was made in each patient after obtaining an ECG and cardiac biomarkers (Troponin-T/ Troponin-I) when indicated. Normality of data was tested by Kolmogorov-Smirnov test. If the normality was rejected, then a nonparametric test was used. A p value of <0.05 was considered statistically significant. Results: Out of 108 patients, 38(35%) were diagnosed with Chronic kidney disease, whose proportion was higher in patients with STEMI (55.81%) and NSTEMI (33.36%) than those with unstable angina (13.95%) (p=0.001). The mean hemoglobin level in non-CKD patients was 11.67 gm/dl while in CKD patients it was 9.72 gm/dl. In patients with acute coronary syndrome, 78 patients (72.22%) were anemic, a much higher proportion than general population. Conclusion: Overall, our study shows that both CKD and Anemia are risk factors for adverse CVD outcomes in the general population. There is a high prevalence of CVD in subjects with CKD. Therefore regular evaluation for renal disease, should be included as routine investigations for patients with, or at a higher risk for CVD. Anemia is associated with increased cardiovascular morbidity. It appears play a causative role in the progression of CVD, especially in patients with CKD. Microcytic type was the most common. Hence large scale iron supplementation programs may have a significant benefit in reducing the cardiovascular mortality too.
Journal of the American Society of Nephrology, 2005
Left ventricular hypertrophy (LVH) and anemia are highly prevalent in moderate chronic kidney disease (CKD). Because anemia may potentiate the adverse effects of LVH on cardiovascular outcomes, the effect of both anemia and LVH on outcomes in CKD was examined. Data from four community-based longitudinal studies were pooled: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Serum creatinine levels were calibrated indirectly across studies, and GFR was estimated using the Modification of Diet in Renal Disease equation. CKD was defined as GFR between 15 and 60 ml/min per 1.73 m(2). LVH was based on electrocardiogram criteria. Anemia was defined as hematocrit &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;36% in women and 39% in men. The primary outcome was a composite of myocardial infarction, stroke, and death; a secondary cardiac outcome included only myocardial infarction and fatal coronary heart disease. Among 2423 patients with CKD, 96% had electrocardiogram and anemia data. Median follow-up was 102 mo. In adjusted analysis, LVH was associated with increased risk for composite and cardiac outcomes (hazard ratio [HR], 1.67 [95% confidence interval (CI), 1.34 to 2.07] and 1.62 [95% CI, 1.18 to 2.24], respectively), whereas anemia was associated with increased risk for the only composite outcome (HR, 1.51 [95% CI, 1.27 to 1.81]). The combination of anemia and LVH was associated with an increased risk for both study outcomes compared with individuals with neither risk factor (HR, 4.15 [95% CI, 2.62 to 6.56] and 3.92 [95% CI, 2.05 to 7.48]; P = 0.02 and 0.01 for interaction term, respectively). The combination of anemia and LVH in CKD identifies a high-risk population.
KYAMC Journal, 2022
Background: Chronic kidney disease (CKD) is a worldwide public health problem. It is usually associated with anemia and prevalence of anemia increases progressively with worsening CKD. Objective: To find out the association of anemia with different stages of CKD. Materials and Methods: This cross-sectional study was conducted in the department of physiology in Mymensingh medical college, Bangladesh over a period of one year from January to December 2016. A total number of 174 subjects were enrolled in this study among which 87 patients and 87 healthy participants. On the basis of inclusion and exclusion criteria study subjects were divided into case and control group. Hemoglobin concentrations in the blood were measured in all study subjects by using auto-analyzer. Result: Hemoglobin concentration in the blood was decreased in both male and female CKD patients which were 9.55±1.13 gm/dl and 9.11±0.95 gm/dl respectively and result was statistically significant (p<0.01).) 55% is an...
Prevalance of anemia and its association with cardio-renal syndrome
International Journal of Cardiology, 2007
Anemia is common in cardio-renal syndrome and may contribute to increase mortality.To examine the prevalence of anemia and its relationship with cardio-renal syndrome, and to evaluate the risk factors for death.Retrospective study with all patients admitted with congestive heart failure (CHF). The parameters as age, gender, hemoglobin (Hb), estimated glomerular filtration rate (eGFR), New York Heart Association (NYHA) functional class, ejection fraction (EF%), hospital stay, hypertension, diabetes, smoking and CHF etiology were analyzed. Anemia was defined as Hb < 12g/dL, systolic dysfunction EF < 55% and renal failure was stratified according to K-DOQI classification. Statistical analysis was done by the programs EpiInfo and SPSS for windows.A total of 174 patients were studied. The average age was 63 ± 16 years, 65.5% were males, and 18 of them (11%) were non-survivors. Anemia was observed in 45% of patients, and 82% presented some degree of renal failure. The majority of patients (87%) were classified as NYHA functional class III or IV. The average ejection fraction was 43.9 ± 16.6%, and there was no difference between survivors and non-survivors (p > 0.05). Mortality was not significantly higher among patients with anemia (12.4%) when comparing to those without anemia (8.3%, p = 0.31). There was a progressive decrease in the level of hemoglobin as renal function decreased (p < 0.05). Increased serum creatinine was a significant risk factor for death (OR = 1.59, 95% CI = 1.074–2.363, p = 0.021), and increased EF% was a protection factor against development of death (OR = 0.904, 95% CI = 0.845–0.973, p = 0.007).The prevalence of anemia is high among patients with cardio-renal syndrome but was not associated with increased mortality. Increased serum creatinine and low EF% were variables associated with death.
Is anemia a new cardiovascular risk factor?
International Journal of Cardiology, 2015
Anemia is frequent in patients with cardiovascular disease and is often characterized as the fifth cardiovascular risk factor. It is considered to develop due to a complex interaction of iron deficiency, cytokine production and impaired renal function, although other factors, such as blood loss, may also contribute. Unfortunately, treatment of anemia in cardiovascular disease lacks clear targets and specific therapy is not defined. Treatment with erythropoietin-stimulating agents in combination with iron is the basic strategy but clear guidelines are not currently available. This review aims to clarify poorly investigated and defined issues concerning the relation of anemia and cardiovascular riskin particular in patients with acute coronary syndromes and chronic heart failureas well as the current therapeutic strategies in these clinical conditions.
Anemia: The Point of Convergence or Divergence for Kidney Disease and Heart Failure?
Journal of the American College of Cardiology, 2009
Cardiorenal anemia syndrome refers to the simultaneous presence of anemia, heart failure (HF), and chronic kidney disease (CKD) that forms a pathologic triangle with an adverse impact on morbidity and mortality. The reciprocal relationships among these 3 components have been the subject of a number of trials with inconsistent and sometimes paradoxic results. In this paper, the pathophysiologic concepts underlying interactions among these 3 conditions are discussed. Then, the similarities and dissimilarities of the relationships between anemia and either HF or CKD are considered; explanations are provided for differences in the results of the currently available studies. Erythropoietin-stimulating agent protocols are usually based on the results of studies designed for the CKD population, and upper hemoglobin target levels are chosen to avoid cardiovascular complications. It is not yet clear whether those renal guidelines are optimal for patients with HF, especially because those patients may have reversible components of kidney dysfunction, both HF and renal parameters improving with anemia correction. We review these issues and suggest a pragmatic approach to the care of patients with HF until such time that controlled trials establish definitive anemia treatment goals that are dynamic and disease specific, rather than those that adopt a more simplistic hemoglobin-specific approach. (J Am Coll Cardiol 2009;53:639-47)
Renal Failure, 2000
Mildly elevated serum creatinine concentration was proposed to be a marker for increased risk of cardiovascular disease mortality. The aim of our prospective study was to evaluate a possible association between serum creatinine concentration and extent of coronary atherosclerosis together with conventional risk factors for atherosclerosis. Serum creatinine concentration was measured in 40 male patients without overt renal or ischemic renal disease (mean age 53 AE 7 years) with stable or unstable angina undergoing routine coronary arteriography. The extent of coronary atherosclerosis was assessed by Gensini score. In univariate linear regression analysis Gensini score signi®cantly correlated with serum concentrations of apolipoprotein AII (r À0.3242, P`0.05) and creatinine (r 0.3194, P`0.05), but not with serum concentrations of lipids (total, low-and high-density lipoprotein cholesterol, triglycerides), other apolipoproteins (apo B, apo AI),
Do acute elevations of serum creatinine in primary care engender an increased mortality risk?
BMC Nephrology, 2014
Background: The significant impact Acute Kidney Injury (AKI) has on patient morbidity and mortality emphasizes the need for early recognition and effective treatment. AKI presenting to or occurring during hospitalisation has been widely studied but little is known about the incidence and outcomes of patients experiencing acute elevations in serum creatinine in the primary care setting where people are not subsequently admitted to hospital. The aim of this study was to define this incidence and explore its impact on mortality. Methods: The study cohort was identified by using hospital data bases over a six month period. Inclusion criteria: People with a serum creatinine request during the study period, 18 or over and not on renal replacement therapy. The patients were stratified by a rise in serum creatinine corresponding to the Acute Kidney Injury Network (AKIN) criteria for comparison purposes. Descriptive and survival data were then analysed. Ethical approval was granted from National Research Ethics Service (NRES) Committee South East Coast and from the National Information Governance Board. Results: The total study population was 61,432. 57,300 subjects with 'no AKI', mean age 64.The number (mean age) of acute serum creatinine rises overall were, 'AKI 1' 3,798 (72), 'AKI 2' 232 (73), and 'AKI 3' 102 (68) which equates to an overall incidence of 14,192 pmp/year (adult). Unadjusted 30 day survival was 99.9% in subjects with 'no AKI', compared to 98.6%, 90.1% and 82.3% in those with 'AKI 1', 'AKI 2' and 'AKI 3' respectively. After multivariable analysis adjusting for age, gender, baseline kidney function and co-morbidity the odds ratio of 30 day mortality was 5.3 (95% CI 3.6, 7.7), 36.8 (95% CI 21.6, 62.7) and 123 (95% CI 64.8, 235) respectively, compared to those without acute serum creatinine rises as defined. Conclusions: People who develop acute elevations of serum creatinine in primary care without being admitted to hospital have significantly worse outcomes than those with stable kidney function.