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4. Renal outcomes and blood pressure patterns in diabetic and nondiabetic individuals at high cardiovascular risk

Author

Bohm, M, Schumacher, H, Teo, K, Lonn, E, Mahfoud, F, Emrich, I, Mancia, G, Redon, J, Schmieder, R, Sliwa, K, Lehrke, M, Marx, N, Weber, M, Williams, B, Yusuf, S, Mann, J, Bohm M., Schumacher H., Teo K. K., Lonn E. M., Mahfoud F., Emrich I., Mancia G., Redon J., Schmieder R. E., Sliwa K., Lehrke M., Marx N., Weber M. A., Williams B., Yusuf S., Mann J. F. E., Bohm, M, Schumacher, H, Teo, K, Lonn, E, Mahfoud, F, Emrich, I, Mancia, G, Redon, J, Schmieder, R, Sliwa, K, Lehrke, M, Marx, N, Weber, M, Williams, B, Yusuf, S, Mann, J, Bohm M., Schumacher H., Teo K. K., Lonn E. M., Mahfoud F., Emrich I., Mancia G., Redon J., Schmieder R. E., Sliwa K., Lehrke M., Marx N., Weber M. A., Williams B., Yusuf S., and Mann J. F. E.

Abstract

Background:Diabetes and hypertension are risk factors for renal and cardiovascular outcomes. Data on the association of achieved blood pressure (BP) with renal outcomes in patients with and without diabetes are sparse. We investigated the association of achieved SBP, DBP with renal outcomes and urinary albumin excretion (UAE) in people with vascular disease.Methods:In this pooled analysis, we assessed renal outcome data from high-risk patients aged 55 years or older with a history of cardiovascular disease, 70% of whom had hypertension, randomized to The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and to Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease trials investigating telmisartan, ramipril and their combination with a median follow-up of 56 months. Standardized office BP was measured every 6 months, estimated glomerular filtration rate (eGFR) and UAE at baseline, 2 years and study end. Associations of mean achieved BP on treatment were investigated on major renal outcomes including end-stage renal disease (ESRD), decline of eGFR by at least 40%, doubling of creatinine and the composites thereof and on UAE. Analyses were by Cox regression analysis, analysis of variance and Chi2-Test. Of 30 937 patients with complete data, 19 450 patients without and 11 487 with diabetes were enrolled between 1 December 2001 and 31 July 2003 and followed until 31 July 2008. Data were pooled as the outcomes for telmisartan 80 mg/day (n = 2903) or placebo (n = 2907) for Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease and ramipril 10 mg/day (n = 8407), telmisartan 80 mg/day (n = 8386) or the combination of both (n = 8334) were similar.Results:For both those with and without diabetes, the hazard ratios for the composites ESRD or doubling of serum creatinine (707 events overall) and ESRD or 40% eGFR loss (2371 events overall) reached a nadir at achieved SBP

Published
2021

5. Renal outcomes and blood pressure patterns in diabetic and nondiabetic individuals at high cardiovascular risk

Author

Bohm M, Schumacher H, Teo K, Lonn E, Mahfoud F, Emrich I, Mancia G, Redon J, Schmieder R, Sliwa K, Lehrke M, Marx N, Weber M, Williams B, Yusuf S, and Mann J

Abstract

BACKGROUND: Diabetes and hypertension are risk factors for renal and cardiovascular outcomes. Data on the association of achieved blood pressure (BP) with renal outcomes in patients with and without diabetes are sparse. We investigated the association of achieved SBP, DBP with renal outcomes and urinary albumin excretion (UAE) in people with vascular disease. METHODS: In this pooled analysis, we assessed renal outcome data from high-risk patients aged 55 years or older with a history of cardiovascular disease, 70% of whom had hypertension, randomized to The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial and to Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease trials investigating telmisartan, ramipril and their combination with a median follow-up of 56 months. Standardized office BP was measured every 6 months, estimated glomerular filtration rate (eGFR) and UAE at baseline, 2 years and study end. Associations of mean achieved BP on treatment were investigated on major renal outcomes including end-stage renal disease (ESRD), decline of eGFR by at least 40%, doubling of creatinine and the composites thereof and on UAE. Analyses were by Cox regression analysis, analysis of variance and Chi2-test. Of 30 937 patients with complete data, 19 450 patients without and 11 487 with diabetes were enrolled between 1 December 2001 and 31 July 2003 and followed until 31 July 2008. Data were pooled as the outcomes for telmisartan 80 mg/day (n = 2903) or placebo (n = 2907) for Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease and ramipril 10 mg/day (n = 8407), telmisartan 80 mg/day (n = 8386) or the combination of both (n = 8334) were similar. RESULTS: For both those with and without diabetes, the hazard ratios for the composites ESRD or doubling of serum creatinine (707 events overall) and ESRD or 40% eGFR loss (2371 events overall) reached a nadir at achieved SBP of 120 to less than 140 mmHg, and increased with higher and lower SBP with similar relative risk with or without diabetes. For example, risk for the former composite reached a hazard ratios 3.06 (confidence interval 1.90-4.92) with a mean achieved SBP more than 160 mmHg compared with 120 to less than 130 mmHg with diabetes and hazard ratios 2.14 (1.09-4.26) without diabetes. In contrast, the development of new microalbuminuria and macroalbuminuria (3002 and 846 events overall) associated linearly over the whole range of achieved SBP (apart from a slight increase in risk at SBP less than 120 mmHg only in those without diabetes). Absolute risks for the composite and albuminuria outcomes were consistently greater in those with diabetes as compared with without diabetes with high event rates over the whole SBP spectrum. The increased renal risk at low SBP was not related to a meaningful reduction of mandated study drugs or open label renin-angiotensin-aldosterone system inhibition. CONCLUSION: In patients at high cardiovascular risk, SBP levels more than 140 mmHg and less than 120 are associated with increased risk for renal outcomes. Renal risk was greater in diabetes across the whole range of achieved SBP and DBP. These data suggest similar target BP range in patients with and without diabetes to prevent renal outcomes, a frequent complication in high-risk vascular patients. CLINICAL TRIAL REGISTRATION: Clinical Trial registration: http://clinicaltrials.gov.Unique identifier: NCT00153101.

Published
2021

6. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data

Author

Matsushita, K, Ballew, Sh, Coresh, J, Arima, H, Ärnlöv, J, Cirillo, Massimo, Ebert, N, Hiramoto, Js, Kimm, H, Shlipak, Mg, Visseren, Flj, Gansevoort, Rt, Kovesdy, Cp, Shalev, V, Woodward, M, Kronenberg, F, Chronic Kidney Disease Prognosis Consortium: Chalmers, J, Perkovic, V, Grams, Me, Sang, Y, Schaeffner, E, Martus, P, Levin, A, Djurdjev, O, Tang, M, Heine, G, Seiler, S, Zawada, A, Emrich, I, Sarnak, M, Katz, R, Brenner, H, Schöttker, B, Rothenbacher, D, Saum, Ku, Köttgen, A, Schneider, M, Eckardt, Ku, Green, J, Kirchner, Hl, Chang, Ar, Black, C, Marks, A, Prescott, G, Clark, L, Fluck, N, Jee, Sh, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, Van, Zuilen, Bots, M, Peralta, C, Hiromoto, J, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Kenealy, T, Elley, Cr, Collins, Jf, Drury, Pl, Bakker, Sj, Heerspink, Hjl, Jassal, Sk, Bergstrom, J, Jh, Ix, Barrett Connor, E, Kalantar Zadeh, K, Carrero, Jj, Gasparini, A, Qureshi, Ar, Barany, P, Algra, A, Van, Der, Graaf, Y, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Lannfelt, L, Larsson, A, Hallan, S, Levey, As, Chen, J, Kwak, L, Sang, Y., Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Matsushita, K, Ballew, Sh, Coresh, J, Arima, H, Ärnlöv, J, Cirillo, Massimo, Ebert, N, Hiramoto, J, Kimm, H, Shlipak, Mg, Visseren, Flj, Gansevoort, Rt, Kovesdy, Cp, Shalev, V, Woodward, M, Kronenberg, F, Chronic Kidney Disease Prognosis Consortium: Chalmers, J, Perkovic, V, Grams, Me, Sang, Y, Schaeffner, E, Martus, P, Levin, A, Djurdjev, O, Tang, M, Heine, G, Seiler, S, Zawada, A, Emrich, I, Sarnak, M, Katz, R, Brenner, H, Schöttker, B, Rothenbacher, D, Saum, Ku, Köttgen, A, Schneider, M, Eckardt, Ku, Green, J, Kirchner, Hl, Chang, Ar, Black, C, Marks, A, Prescott, G, Clark, L, Fluck, N, Jee, Sh, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, Van, Zuilen, Ad, Bots, M, Peralta, C, Hiromoto, J, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Kenealy, T, Elley, Cr, Collins, Jf, Drury, Pl, Bakker, Sj, Heerspink, Hjl, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett Connor, E, Kalantar Zadeh, K, Carrero, Jj, Gasparini, A, Qureshi, Ar, Barany, P, Algra, A, Van, Der, Graaf, Y, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Lannfelt, L, Larsson, A, Hallan, S, Levey, A, Chen, J, Kwak, L, and Sang, Y.

Subjects
Male, Databases, Factual, Endocrinology, Diabetes and Metabolism, nefropatia, arteriopatia periferica, epidemiologia, 030204 cardiovascular system & hematology, GLOMERULAR-FILTRATION-RATE, arteriopatia periferica, 0302 clinical medicine, Endocrinology, Risk Factors, CRITICAL LIMB ISCHEMIA, 030212 general & internal medicine, epidemiologia, POPULATION, biology, CYSTATIN C, Incidence, Middle Aged, PREVALENCE, Diabetes and Metabolism, nefropatia, Creatinine, Female, medicine.symptom, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Renal function, ATHEROSCLEROSIS RISK, HEART-ASSOCIATION, CARDIOVASCULAR OUTCOMES, 03 medical and health sciences, Peripheral Arterial Disease, Internal medicine, Diabetes mellitus, medicine, Internal Medicine, Albuminuria, Humans, Risk factor, Renal Insufficiency, Chronic, Aged, business.industry, Critical limb ischemia, medicine.disease, Intermittent claudication, Surgery, Cystatin C, biology.protein, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Kidney disease
Abstract

BACKGROUND: Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease.METHODS: In this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics.FINDINGS: We analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m(2), adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m(2) and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m(2). Compared with an ACR of 5 mg/g, the adjusted HR for incident study-specific peripheral artery disease was 1·50 (1·41-1·59) at an ACR of 30 mg/g and 2·28 (2·12-2·44) at an ACR of 300 mg/g. The adjusted HR at an ACR of 300 mg/g versus 5 mg/g was 3·68 (95% CI 3·00-4·52) for leg amputation. eGFR and albuminuria contributed multiplicatively (eg, adjusted HR 5·76 [4·90-6·77] for incident peripheral artery disease and 10·61 [5·70-19·77] for amputation in eGFR INTERPRETATION: Even mild-to-moderate chronic kidney disease conferred increased risk of incident peripheral artery disease, with a strong association between albuminuria and amputation. Clinical attention should be paid to the development of peripheral artery disease symptoms and signs in people with any stage of chronic kidney disease.FUNDING: American Heart Association, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.

Published
2017

9. Adiposity and risk of decline in glomerular filtration rate : Meta-analysis of individual participant data in a global consortium

Author

Chang AR, Grams ME, Ballew SH, Bilo H, Correa A, Evans M, Gutierrez OM, Hosseinpanah F, Iseki K, Kenealy T, Klein B, Kronenberg F, Lee BJ, Li Y, Miura K, Navaneethan SD, Roderick PJ, Valdivielso JM, Visseren FLJ, Zhang L, Gansevoort RT, Hallan SI, Levey AS, Matsushita K, Shalev V, Woodward M, Astor B, Appel L, Greene T, Chen T, Chalmers J, Arima H, Perkovic V, Yatsuya H, Tamakoshi K, Hirakawa Y, Coresh J, Sang Y, Polkinghorne K, Chadban S, Atkins R, Levin A, Djurdjev O, Klein R, Lee K, Liu L, Zhao M, Wang F, Wang J, Tang M, Heine G, Emrich I, Zawada A, Bauer L, Nally J, Schold J, Shlipak M, Sarnak M, Katz R, Hiramoto J, Iso H, Yamagishi K, Umesawa M, Muraki I, Fukagawa M, Maruyama S, Hamano T, Hasegawa T, Fujii N, Jafar T, Hatcher J, Poulter N, Chaturvedi N, Wheeler D, Emberson J, Townend J, Landray M, Brenner H, Schöttker B, Saum KU, Rothenbacher D, Fox C, Hwang SJ, Köttgen A, Schneider MP, Eckardt KU, Green J, Kirchner HL, Ito S, Miyazaki M, Nakayama M, Yamada G, Cirillo M, Romundstad S, Øvrehus M, Langlo KA, Irie F, Sairenchi T, Rebholz CM, Young B, Boulware LE, Ishikawa S, Yano Y, Kotani K, Nakamura T, Jee SH, Kimm H, Mok Y, Chodick G, Wetzels JFM, Blankestijn PJ, van Zuilen AD, Bots M, Inker L, Peralta C, Kollerits B, Ritz E, Nitsch D, Fletcher A, Bottinger E, Nadkarni GN, Ellis SB, Nadukuru R, Fernandez E, Betriu A, Bermudez-Lopez M, Stengel B, Metzger M, Flamant M, Houillier P, Haymann JP, Froissart M, Ueshima H, Okayama A, Tanaka S, Okamura T, Elley CR, Collins JF, Drury PL, Ohkubo T, Asayama K, Metoki H, Kikuya M, Iseki C, Nelson RG, Knowler WC, Bakker SJL, Heerspink HJL, Brunskill N, Major R, Shepherd D, Medcalf J, Jassal SK, Bergstrom J, Ix JH, Barrett-Connor E, Kovesdy C, Kalantar-Zadeh K, Sumida K, Muntner P, Warnock D, Judd S, Panwar B, de Zeeuw D, Brenner B, Sedaghat S, Ikram MA, Hoorn EJ, Dehghan A, Wong TY, Sabanayagam C, Cheng CY, Banu R, Segelmark M, Stendahl M, Schön S, Tangri N, Sud M, Naimark D, Wen CP, Tsao CK, Tsai MK, Chen CH, Konta T, Hirayama A, Ichikawa K, Hadaegh F, Mirbolouk M, Azizi F, Solbu MD, Jenssen TG, Eriksen BO, Eggen AE, Lannfelt L, Larsson A, Ärnlöv J, Landman GWD, van Hateren KJJ, Kleefstra N, Chen J, Kwak L, Surapaneni A., Chang, Ar, Grams, Me, Ballew, Sh, Bilo, H, Correa, A, Evans, M, Gutierrez, Om, Hosseinpanah F, Iseki K, Kenealy, T, Klein, B, Kronenberg, F, Lee, Bj, Li, Y, Miura, K, Navaneethan, Sd, Roderick, Pj, Valdivielso, Jm, Visseren, Flj, Zhang, L, Gansevoort, Rt, Hallan, Si, Levey, A, Matsushita, K, Shalev, V, Woodward, M, Astor, B, Appel, L, Greene, T, Chen, T, Chalmers, J, Arima, H, Perkovic, V, Yatsuya, H, Tamakoshi, K, Hirakawa, Y, Coresh, J, Sang, Y, Polkinghorne, K, Chadban, S, Atkins, R, Levin, A, Djurdjev, O, Klein, R, Lee, K, Liu, L, Zhao, M, Wang, F, Wang, J, Tang, M, Heine, G, Emrich, I, Zawada, A, Bauer, L, Nally, J, Schold, J, Shlipak, M, Sarnak, M, Katz, R, Hiramoto, J, Iso, H, Yamagishi, K, Umesawa, M, Muraki, I, Fukagawa, M, Maruyama, S, Hamano, T, Hasegawa, T, Fujii, N, Jafar, T, Hatcher, J, Poulter, N, Chaturvedi, N, Wheeler, D, Emberson, J, Townend, J, Landray, M, Brenner, H, Schöttker, B, Saum, Ku, Rothenbacher, D, Fox, C, Hwang, Sj, Köttgen, A, Schneider, Mp, Eckardt, Ku, Green, J, Kirchner, Hl, Ito, S, Miyazaki, M, Nakayama, M, Yamada, G, Cirillo, M, Romundstad, S, Øvrehus, M, Langlo, Ka, Irie, F, Sairenchi, T, Rebholz, Cm, Young, B, Boulware, Le, Ishikawa, S, Yano, Y, Kotani, K, Nakamura, T, Jee, Sh, Kimm, H, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, van Zuilen, Ad, Bots, M, Inker, L, Peralta, C, Kollerits, B, Ritz, E, Nitsch, D, Fletcher, A, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Fernandez, E, Betriu, A, Bermudez-Lopez, M, Stengel, B, Metzger, M, Flamant, M, Houillier, P, Haymann, Jp, Froissart, M, Ueshima, H, Okayama, A, Tanaka, S, Okamura, T, Elley, Cr, Collins, Jf, Drury, Pl, Ohkubo, T, Asayama, K, Metoki, H, Kikuya, M, Iseki, C, Nelson, Rg, Knowler, Wc, Bakker, Sjl, Heerspink, Hjl, Brunskill, N, Major, R, Shepherd, D, Medcalf, J, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett-Connor, E, Kovesdy, C, Kalantar-Zadeh, K, Sumida, K, Muntner, P, Warnock, D, Judd, S, Panwar, B, de Zeeuw, D, Brenner, B, Sedaghat, S, Ikram, Ma, Hoorn, Ej, Dehghan, A, Wong, Ty, Sabanayagam, C, Cheng, Cy, Banu, R, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Wen, Cp, Tsao, Ck, Tsai, Mk, Chen, Ch, Konta, T, Hirayama, A, Ichikawa, K, Hadaegh, F, Mirbolouk, M, Azizi, F, Solbu, Md, Jenssen, Tg, Eriksen, Bo, Eggen, Ae, Lannfelt, L, Larsson, A, Ärnlöv, J, Landman, Gwd, van Hateren, Kjj, Kleefstra, N, Chen, J, Kwak, L, Surapaneni, A., Lifestyle Medicine (LM), Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Asayama, Kei, and Sedaghat, SeyyedMah

Subjects
CHRONIC KIDNEY-DISEASE, Male, 030232 urology & nephrology, 030204 cardiovascular system & hematology, OBESITY PARADOX, Body Mass Index, BMI, eGFR, CKD-PC, Cohort Studies, 0302 clinical medicine, Risk Factors, Urologi och njurmedicin, Medicine, ALL-CAUSE MORTALITY, Adiposity, 2. Zero hunger, Aged, 80 and over, Medicine(all), education.field_of_study, Hazard ratio, ASSOCIATION, General Medicine, Middle Aged, 3. Good health, Cohort, Female, Waist Circumference, Life Sciences & Biomedicine, WAIST CIRCUMFERENCE, Obesity paradox, Glomerular Filtration Rate, Adult, Waist, Population, Renal function, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, CKD, Urology and Nephrology, Humans, Mortality, education, Aged, Science & Technology, business.industry, Research, medicine.disease, Body Height, BODY-MASS INDEX, Kidney Failure, Chronic, WEIGHT, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Body mass index, Demography, Kidney disease
Abstract

ObjectiveTo evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.DesignIndividual participant data meta-analysis.SettingCohorts from 40 countries with data collected between 1970 and 2017.ParticipantsAdults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).Main outcome measuresGFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR 2) and all cause mortality.ResultsOver a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.ConclusionsElevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

Published
2019

10. Additional file 3 of Hypophosphatemia after high-dose iron repletion with ferric carboxymaltose and ferric derisomaltose—the randomized controlled HOMe aFers study

Author

Emrich, I. E., F. Lizzi, J. D. Siegel, S. Seiler-Mussler, C. Ukena, D. Kaddu-Mulindwa, R. D’Amelio, S. Wagenpfeil, V. M. Brandenburg, M. Böhm, D. Fliser, and G. H. Heine

Subjects
Data_FILES, ComputingMilieux_COMPUTERSANDEDUCATION
Abstract

Additional file 3: Table S2. Study’s curriculum.

Published
2020
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13. Additional file 5 of Hypophosphatemia after high-dose iron repletion with ferric carboxymaltose and ferric derisomaltose—the randomized controlled HOMe aFers study

Author

Emrich, I. E., F. Lizzi, J. D. Siegel, S. Seiler-Mussler, C. Ukena, D. Kaddu-Mulindwa, R. D’Amelio, S. Wagenpfeil, V. M. Brandenburg, M. Böhm, D. Fliser, and G. H. Heine

Subjects
stomatognathic diseases, nutritional and metabolic diseases, urologic and male genital diseases
Abstract

Additional file 5: Table S4. Incidence of hypophosphatemia at different study timepoints in both treatment arms.

Published
2020
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14. Kardiovaskuläre Pharmakotherapie und koronare Revaskularisation bei terminaler Niereninsuffizienz

Author

Massachusetts Institute of Technology. Institute for Medical Engineering & Science, Lauder, L., Ewen, S., Emrich, I. E., Böhm, M., Mahfoud, Felix, Massachusetts Institute of Technology. Institute for Medical Engineering & Science, Lauder, L., Ewen, S., Emrich, I. E., Böhm, M., and Mahfoud, Felix

Abstract

Herz und Nieren sind in ihrer physiologischen Interaktion eng miteinander verbunden. Kardiovaskuläre Erkrankungen sind die häufigste Todesursache bei Patienten mit chronischer Nierenerkrankung, wobei diese wiederum das Auftreten und das Fortschreiten kardiovaskulärer Erkrankungen begünstigen kann. Die Therapie der koronaren Herzkrankheit (KHK) und der chronischen Herzinsuffizienz unterscheidet sich bei Patienten mit einer milden Nierenfunktionseinschränkung (geschätzte glomeruläre Filtrationsrate [eGFR]: >60 ml/min/1,73 m2) nicht wesentlich von der Therapie nierengesunder Patienten. Da Patienten mit einer fortgeschrittenen Niereninsuffizienz aus den Zulassungsstudien meist ausgeschlossen wurden, basieren viele Therapieempfehlungen in dieser Patientengruppe auf Beobachtungsstudien, Subgruppen- und Metaanalysen oder pathophysiologischen Erwägungen, die nicht durch kontrollierte Studien gestützt sind. Daher werden prospektive, randomisierte Studien zur Therapie von KHK und Herzinsuffizienz benötigt, die Patienten mit fortgeschrittener Nierenfunktionseinschränkung gezielt untersuchen. There is a close physiological relationship between the kidneys and the heart. Cardiovascular diseases are the most prevalent cause of death in patients with chronic kidney disease (CKD), whereas CKD may directly accelerate the progression of cardiovascular diseases and is considered to be a cardiovascular risk factor. In patients with mild CKD, i.e. an estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2, treatment of coronary artery disease and chronic heart failure is not essentially different from patients with preserved renal function; however, as most pivotal trials have systematically excluded patients with advanced renal failure, many treatment recommendations in this patient group are based on observational studies, post hoc subgroup analyses and meta-analyses or pathophysiological considerations, which are not supported by controlled studies. Therefore, prospective rand

Published
2020

17. CKD LAB METHODS, PROGRESSION & RISK FACTORS 2

Author

Onuigbo, M., primary, Agbasi, N., additional, Wu, M. J., additional, Shu, K. H., additional, Kugler, E., additional, Cohen, E., additional, Krause, I., additional, Goldberg, E., additional, Garty, M., additional, Jansen, J., additional, De Napoli, I. E., additional, Schophuizen, C. M., additional, Wilmer, M. J., additional, Mutsaers, H. A., additional, Heuvel, L. P., additional, Grijpma, D. W., additional, Stamatialis, D., additional, Hoenderop, J. G., additional, Masereeuw, R., additional, Van Craenenbroeck, A. H., additional, Van Craenenbroeck, E. M., additional, Van Ackeren, K., additional, Vrints, C. J., additional, Hoymans, V. Y., additional, Couttenye, M. M., additional, Erkmen Uyar, M., additional, Tutal, E., additional, Bal, Z., additional, Guliyev, O., additional, Sezer, S., additional, Liu, L., additional, Wang, C., additional, Tanaka, K., additional, Kushiyama, A., additional, Sakai, K., additional, Hara, S., additional, Ubara, Y., additional, Ohashi, Y., additional, Kunugi, Y., additional, Kawazu, S., additional, Untersteller, K., additional, Seiler, S., additional, Rogacev, K. S., additional, Emrich, I. E., additional, Lennartz, C. S., additional, Fliser, D., additional, Heine, G. H., additional, Hoshino, T., additional, Ookawara, S., additional, Miyazawa, H., additional, Ueda, Y., additional, Ito, K., additional, Kaku, Y., additional, Hirai, K., additional, Mori, H., additional, Yoshida, I., additional, Kakuta, S., additional, Hayama, N., additional, Amemiya, M., additional, Okamoto, H., additional, Inoue, S., additional, Tabei, K., additional, Campos, P., additional, Dias, C., additional, Baptista, J., additional, Papoila, A. L., additional, Ortiz, A., additional, Inchaustegui, L., additional, Soto, K., additional, Moon, K. H., additional, Yang, S., additional, Lee, D.-Y., additional, Kim, H. W., additional, Kim, B., additional, Isnard Bagnis, C., additional, Guerraoui, A., additional, Zenasni, F., additional, Idier, L., additional, Chauveau, P., additional, Cerqueira, A., additional, Quelhas-Santos, J., additional, Pestana, M., additional, Choi, J.-Y., additional, Jin, D.-C., additional, Choi, Y.-J., additional, Kim, W.-Y., additional, Nam, S.-A., additional, Cha, J.-H., additional, Cernaro, V., additional, Loddo, S., additional, Lacquaniti, A., additional, Romeo, A., additional, Costantino, G., additional, Montalto, G., additional, Santoro, D., additional, Trimboli, D., additional, Ricciardi, C. A., additional, Lacava, V., additional, Buemi, M., additional, Zawada, A. M., additional, Obeid, R., additional, Geisel, J., additional, Meneses, G. C., additional, Silva Junior, G., additional, Costa, M. F. B., additional, Goncalves, H. S., additional, Daher, E. F., additional, Liborio, A. B., additional, Martins, A. M. C., additional, Ekart, R., additional, Hojs, N., additional, Bevc, S., additional, Hojs, R., additional, Lim, C. S., additional, Hwang, J. H., additional, Chin, H. J., additional, Kim, S., additional, Kim, D. K., additional, Park, J. H., additional, Shin, S. J., additional, Lee, S. H., additional, Choi, B. S., additional, Lemoine, S., additional, Panaye, M., additional, Juillard, L., additional, Dubourg, L., additional, Hadj-Aissa, A., additional, Guebre-Egziabher, F., additional, Vieira, A. P. F., additional, Couto Bem, A. X., additional, Alves, M. P., additional, Stefan, G., additional, Capusa, C., additional, Stancu, S., additional, Margarit, D., additional, Petrescu, L., additional, Nedelcu, E. D., additional, Mircescu, G., additional, Szarejko-Paradowska, A., additional, Rysz, J., additional, Hung, C.-C., additional, Chen, H.-C., additional, Ristovska, V., additional, Grcevska, L., additional, Podesta, M. A., additional, Reggiani, F., additional, Cucchiari, D., additional, Badalamenti, S., additional, Ponticelli, C., additional, Graziani, G., additional, Nouri-Majalan, N., additional, Moghadasimousavi, S., additional, Eshaghyeh, Z., additional, Greenwood, S., additional, Koufaki, P., additional, Maclaughlin, H., additional, Rush, R., additional, Hendry, B. M., additional, Macdougall, I. C., additional, Mercer, T., additional, and Cairns, H., additional

Published
2014
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19. Lab methods / biomarkers

Author

Borras, M., primary, Roig, J., additional, Betriu, A., additional, Vilar, A., additional, Hernandez, M., additional, Martin, M., additional, Fernandez, E. D., additional, Dounousi, E., additional, Kiatou, V., additional, Papagianni, A., additional, Zikou, X., additional, Pappas, K., additional, Pappas, E., additional, Tatsioni, A., additional, Tsakiris, D., additional, Siamopoulos, K. C., additional, Kim, J.-K., additional, Kim, Y., additional, Kim, S. G., additional, Kim, H. J., additional, Ahn, S. Y., additional, Chin, H. J., additional, Oh, K.-H., additional, Ahn, C., additional, Chae, D.-W., additional, Yazici, R., additional, Altintepe, L., additional, Bakdik, S., additional, Guney, I., additional, Arslan, S., additional, Topal, M., additional, Karagoz, A., additional, Stefan, G., additional, Mircescu, G., additional, Capusa, C., additional, Stancu, S., additional, Petrescu, L., additional, Alecu, S., additional, Nedelcu, D., additional, Bennett, A. H. L., additional, Pham, H., additional, Garrity, M., additional, Magdeleyns, E., additional, Vermeer, C., additional, Zhang, M., additional, Ni, Z., additional, Zhu, M., additional, Yan, J., additional, Mou, S., additional, Wang, Q., additional, Qian, J., additional, Saade, A., additional, Karavetian, M., additional, ElZein, H., additional, de Vries, N., additional, de Haseth, D. E., additional, Lay Penne, E., additional, van Dam, B., additional, Bax, W. A., additional, Bots, M. L., additional, Grooteman, M. P. C., additional, van den Dorpel, R. A., additional, Blankenstijn, P. J., additional, Nube, M. J., additional, Wee, P. M., additional, Park, J. H., additional, Jo, Y.-I., additional, Lee, J. H., additional, Cianfrone, P., additional, Comi, N., additional, Lucisano, G., additional, Piraina, V., additional, Talarico, R., additional, Fuiano, G., additional, Toyonaga, M., additional, Fukami, K., additional, Yamagishi, S.-i., additional, Kaida, Y., additional, Nakayama, Y., additional, Ando, R., additional, Obara, N., additional, Ueda, S., additional, Okuda, S., additional, Granatova, J., additional, Havrda, M., additional, Hruskova, Z., additional, Tesar, V., additional, Viklicky, O., additional, Rysava, R., additional, Rychlik, I., additional, Kratka, K., additional, Honsova, E., additional, Vernerova, Z., additional, Maluskova, J., additional, Vranova, J., additional, Bolkova, M., additional, Borecka, K., additional, Benakova, H., additional, Zima, T., additional, Lu, K.-C., additional, Yang, H.-Y., additional, Su, S.-L., additional, Cao, Y.-H., additional, Lv, L.-L., additional, Liu, B.-C., additional, Zeng, R., additional, Gao, X.-F., additional, Deng, Y.-Y., additional, Boelaert, J., additional, t' Kindt, R., additional, Glorieux, G., additional, Schepers, E., additional, Jorge, L., additional, Neirynck, N., additional, Lynen, F., additional, Sandra, P., additional, Sandra, K., additional, Vanholder, R., additional, Yamamoto, T., additional, Nameta, M., additional, Yoshida, Y., additional, Uhlen, M., additional, Shi, Y., additional, Tang, J., additional, Zhang, J., additional, An, Y., additional, Liao, Y., additional, Li, Y., additional, Tao, Y., additional, Wang, L., additional, Koibuchi, K., additional, Tanaka, K., additional, Aoki, T., additional, Miyagi, M., additional, Sakai, K., additional, Aikawa, A., additional, Martins, A. R., additional, Branco, P. Q., additional, Serra, F. M., additional, Matias, P. J., additional, Lucas, C. P., additional, Adragao, T., additional, Duarte, J., additional, Oliveira, M. M., additional, Saraiva, A. M., additional, Barata, J. D., additional, Masola, V., additional, Zaza, G., additional, Granata, S., additional, Proglio, M., additional, Pontrelli, P., additional, Abaterusso, C., additional, Schena, F., additional, Gesualdo, L., additional, Gambaro, G., additional, Lupo, A., additional, Pruijm, M., additional, Hofmann, L., additional, Stuber, M., additional, Zweiacker, C., additional, Piskunowicz, M., additional, Muller, M.-E., additional, Vogt, B., additional, Burnier, M., additional, Togashi, N., additional, Yamashita, T., additional, Mita, T., additional, Ohnuma, Y., additional, Hasegawa, T., additional, Endo, T., additional, Tsuchida, A., additional, Ando, T., additional, Yoshida, H., additional, Miura, T., additional, Bevins, A., additional, Assi, L., additional, Ritchie, J., additional, Jesky, M., additional, Stringer, S., additional, Kalra, P., additional, Hutchison, C., additional, Harding, S., additional, Cockwell, P., additional, Viccica, G., additional, Cupisti, A., additional, Chiavistelli, S., additional, Borsari, S., additional, Pardi, E., additional, Centoni, R., additional, Fumagalli, G., additional, Cetani, F., additional, Marcocci, C., additional, Scully, P., additional, O'Flaherty, D., additional, Sankaralingam, A., additional, Hampson, G., additional, Goldsmith, D. J., additional, Pallet, N., additional, Chauvet, S., additional, Beaune, P., additional, Nochy, D., additional, Thervet, E., additional, Karras, A., additional, Bertho, G., additional, Gallyamov, M. G., additional, Saginova, E. A., additional, Severova, M. M., additional, Krasnova, T. N., additional, Kopylova, A. A., additional, Cho, E., additional, Jo, S.-K., additional, Kim, M.-G., additional, Cho, W.-Y., additional, kim, H. K., additional, Trivin, C., additional, Metzger, M., additional, Boffa, J.-J., additional, Vrtovsnik, F., additional, Houiller, P., additional, Haymann, J.-P., additional, Flamant, M., additional, Stengel, B., additional, Roozbeh, J., additional, Yavari, V., additional, Pakfetrat, M., additional, Zolghadr, A. A., additional, Kim, C. S., additional, Kim, M. J., additional, Kang, Y. U., additional, Choi, J. S., additional, Bae, E. H., additional, Ma, S. K., additional, Kim, S. W., additional, Lemoine, S., additional, Guebre-Egziabher, F., additional, Dubourg, L., additional, Hadj-Aissa, A., additional, Blumberg, S., additional, Katzir, Z., additional, Biro, A., additional, Cernes, R., additional, Barnea, Z., additional, Vasquez, D., additional, Gordillo, R., additional, Aller, C., additional, Fernandez, B., additional, Jabary, N., additional, Perez, V., additional, Mendiluce, A., additional, Bustamante, J., additional, Coca, A., additional, Goek, O.-N., additional, Sekula, P., additional, Prehn, C., additional, Meisinger, C., additional, Gieger, C., additional, Suhre, K., additional, Adamski, J., additional, Kastenmuller, G., additional, Kottgen, A., additional, Kuzniewski, M., additional, Fedak, D., additional, Dumnicka, P., additional, Solnica, B., additional, Kusnierz-Cabala, B., additional, Kapusta, M., additional, Sulowicz, W., additional, Drozdz, R., additional, Zawada, A. M., additional, Rogacev, K. S., additional, Hummel, B., additional, Fliser, D., additional, Geisel, J., additional, Heine, G. H., additional, Kretschmer, A., additional, Volsek, M., additional, Krahn, T., additional, Kolkhof, P., additional, Kribben, A., additional, Bruck, H., additional, Koh, E. S., additional, Chung, S., additional, Yoon, H. E., additional, Park, C. W., additional, Chang, Y. S., additional, Shin, S. J., additional, Deagostini, M. C., additional, Vigotti, F. N., additional, Ferraresi, M., additional, Consiglio, V., additional, Scognamiglio, S., additional, Moro, I., additional, Clari, R., additional, Daidola, G., additional, Versino, E., additional, Piccoli, G. B., additional, Mammadrahim Agayev, M., additional, Mehrali Mammadova, I., additional, Qarib Ismayilova, S., additional, Anguiano, L., additional, Riera, M., additional, Pascual, J., additional, Barrios, C., additional, Valdivielso, J. M., additional, Fernandez, E., additional, Soler, M. J., additional, Tsarpali, V., additional, Liakopoulos, V., additional, Panagopoulou, E., additional, Kapoukranidou, D., additional, Spaia, S., additional, Kostopoulou, M., additional, Michalaki, A., additional, Nikitidou, O., additional, Dombros, N., additional, Zhu, F., additional, Abba, S., additional, Flores-Gama, C., additional, Williams, C., additional, Cartagena, C., additional, Carter, M., additional, Kotanko, P., additional, Levin, N. W., additional, Kolesnyk, M., additional, Stepanova, N., additional, Driyanska, V., additional, Stashevska, N., additional, Kundin, V., additional, Shifris, I., additional, Dudar, I., additional, Zaporozhets, O., additional, Keda, T., additional, Ishchenko, M., additional, Khil, M., additional, Choe, J.-Y., additional, Nam, S.-A., additional, Kim, J., additional, Cha, J.-H., additional, Gliga, M. L., additional, Irimescu, C. G., additional, Caldararu, C. D., additional, Gliga, M. G., additional, Toma, L. V., additional, Gomotarceanu, A., additional, Park, Y., additional, Jeon, J., additional, Kwon, S. K., additional, Kim, S. J., additional, Kim, S. M., additional, Kim, H.-Y., additional, Montero, N., additional, Marquez, E., additional, Berrada, A., additional, Arias, C., additional, Prada, J. A., additional, Orfila, M. A., additional, Mojal, S., additional, Vilaplana, C., additional, Attini, R., additional, Parisi, S., additional, Fassio, F., additional, Ghiotto, S., additional, Biolcati, M., additional, Todros, T., additional, Jin, K., additional, Vaziri, N. D., additional, Tramonti, G., additional, Romiti, N., additional, Chieli, E., additional, Maksudova, A. N., additional, Khusnutdinova, L. A., additional, Reque, J. E., additional, Quiroga, B., additional, Lopez, J. M., additional, Verdallez, U. G., additional, Garcia de Vinuesa, M., additional, Goicoechea, M., additional, Nayara, P. G., additional, Arroyo, D. R., additional, Luno, J., additional, Tanaka, H., additional, Abbas, S. R., additional, Thijssen, S., additional, Berthoux, F. C., additional, Azzouz, L., additional, Afiani, A., additional, Ziane, A., additional, Mariat, C., additional, Fournier, H., additional, Kusztal, M., additional, Dzierzek, P., additional, Witkowski, G., additional, Nurzynski, M., additional, Golebiowski, T., additional, Weyde, W., additional, Klinger, M., additional, Altiparmak, M. R., additional, Seyahi, N., additional, Trabulus, S., additional, Bolayirli, M., additional, Andican, Z. G., additional, Suleymanlar, G., additional, Serdengecti, K., additional, Niculae, A., additional, Checherita, I.-A., additional, Neagoe, D.-N., additional, Ciocalteu, A., additional, Seiler, S., additional, Pickering, J. W., additional, Emrich, I., additional, Heine, G., additional, Bargnoux, A.-S., additional, Obiols, J., additional, Kuster, N., additional, Fessler, P., additional, Badiou, S., additional, Dupuy, A.-M., additional, Ribstein, J., additional, Cristol, J.-P., additional, Yanagisawa, N., additional, Ando, M., additional, Ajisawa, A., additional, Tsuchiya, K., additional, Nitta, K., additional, Bouquegneau, A., additional, Cavalier, E., additional, Krzesinski, J.-M., additional, Delanaye, P., additional, Tominaga, N., additional, Shibagaki, Y., additional, Kida, K., additional, Miyake, F., additional, Kimura, K., additional, Ayvazyan, A., additional, Rameev, V., additional, Kozlovskaya, L., additional, Simonyan, A., additional, Scholze, A., additional, Marckmann, P., additional, Tepel, M., additional, Rasmussen, L. M., additional, Hara, M., additional, Kanai, H., additional, Harada, K., additional, Tamura, Y., additional, Kawai, Y., additional, Al-Jebouri, M. M., additional, Madash, S. A., additional, Leonidovna Berezinets, O., additional, and Nicolaevich Rossolovskiy, A., additional

Published
2013
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22. Cardio-ocular syndrome: Retinal microvascular changes in acutely decompensated heart failure.

Author

Abdin A, Abdin AD, Merone G, Aljundi W, Haring B, Abu Dail Y, Mahfoud F, Emrich I, Al Ghorani H, Böhm EW, Seitz B, and Böhm M

Subjects
Humans, Female, Male, Aged, Acute Disease, Echocardiography methods, Furosemide administration & dosage, Furosemide therapeutic use, Aged, 80 and over, Diuretics therapeutic use, Diuretics administration & dosage, Retinal Diseases physiopathology, Retinal Diseases diagnosis, Retinal Diseases drug therapy, Natriuretic Peptide, Brain blood, Heart Failure physiopathology, Heart Failure drug therapy, Heart Failure diagnosis, Tomography, Optical Coherence methods, Retinal Vessels diagnostic imaging, Retinal Vessels physiopathology, Microvessels physiopathology, Microvessels diagnostic imaging
Abstract

Aims: To investigate the changes in retinal microvasculature by contemporary imaging techniques during episodes of acute decompensated heart failure (ADHF) and following recompensation compared to age-matched controls without known cardiac or retinal disease., Methods and Results: Adult patients hospitalized with a primary diagnosis of ADHF, regardless of left ventricular ejection fraction (LVEF) and treated with a minimum dose of 40 mg of intravenous furosemide or equivalent were included. Transthoracic echocardiography was conducted in all patients. Eye examinations were performed out within the initial 24 h after admission and after recompensation before discharge. All eyes underwent a general examination, including a best corrected visual acuity test, dilated fundoscopy, spectral-domain optical coherence tomography (OCT) as well as OCT angiography (OCT-A). In addition, 40 participants without documented cardiac or retinal diseases served as controls. Forty patients with ADHF (mean age 78.9 ± 8.8 years; 32% female) with a mean LVEF of 43 ± 12.8% were included. All patients were treated with intravenous diuretics for a median of 4.3 ± 2.8 days. There was a significant reduction in N-terminal pro-B-type natriuretic peptide from baseline up to discharge (10 396 [interquartile range 6410] vs. 6380 [interquartile range 3933] pg/ml, p ≤ 0.001) and inferior vena cava diameters (2.13 ± 0.4 vs. 1.63 ± 0.3 cm, p = 0.003). Compared to the control group, patients with ADHF showed on admission impaired visual acuity (0.15 ± 0.1 vs. 0.35 ± 0.1 logMAR, p < 0.001), reduced macular vessel density (18.0 ± 1.9 vs. 14.3 ± 3.6 mm/mm 2 , p < 0.001) and perfusion density (42.6 ± 3.2 vs. 35.2 ± 9.7%, p < 0.001). After recompensation, the mean overall vessel density and mean overall perfusion density were markedly increased at discharge (14.3 ± 3.6 vs. 19.7 ± 2.6 mm/mm 2 , p = 0.001, and 35.2 ± 9.7 vs. 39.2 ± 6.5%, p = 0.005, respectively). The mean diameter of the superior temporal retinal vein at admission was significantly larger compared to the control group (136 ± 19 vs. 124 ± 22 μm, p = 0.008) and decreased significantly to 122 ± 15 μm at discharge (p < 0.001)., Conclusion: This analysis revealed a remarkable reversible change in retinal microvasculature after ADHF. This could provide a valuable evidence for use of OCT-A in the assessment of overall microperfusion and haemodynamic status in patients with acute heart failure., (© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Published
2024
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24. Efficacy and safety of intravenous iron repletion in patients with heart failure: a systematic review and meta-analysis.

Author

Vukadinović D, Abdin A, Emrich I, Schulze PC, von Haehling S, and Böhm M

Subjects
Humans, Iron, Anemia, Iron-Deficiency diagnosis, Anemia, Iron-Deficiency drug therapy, COVID-19, Heart Failure diagnosis, Heart Failure drug therapy
Abstract

Introduction: AFFIRM-AHF and IRONMAN demonstrated lower rates of the combined endpoint recurrent heart failure (HF) hospitalizations and cardiovascular death (CVD) using intravenous (IV) ferric carboxymaltose (FCM) and ferric derisomaltose (FDI), respectively in patients with HF and iron deficiency (ID) utilizing prespecified COVID-19 analyses., Material and Methods: We meta-analyzed efficacy, between trial heterogeneity and data robustness for the primary endpoint and CVD in AFFIRM-AHF and IRONMAN. As sensitivity analysis, we analyzed data from all eligible exploratory trials investigating FCM/FDI in HF., Results: FCM/FDI reduced the primary endpoint (RR = 0.81, 95% CI 0.69-0.95, p = 0.01, I 2  = 0%), with the number needed to treat (NNT) being 7. Power was 73% and findings were robust with fragility index (FI) of 94 and fragility quotient (FQ) of 0.041. Effects of FCM/FDI were neutral concerning CVD (OR = 0.88, 95% CI 0.71-1.09, p = 0.24, I 2  = 0%). Power was 21% while findings were fragile with reverse FI of 14 and reversed FQ of 0.006. The sensitivity analysis from all eligible trials (n = 3258) confirmed positive effects of FCM/FDI on the primary endpoint (RR = 0.77, 95% CI 0.66-0.90, p = 0.0008, I 2  = 0%), with NNT being 6. Power was 91% while findings were robust (FI of 147 and FQ of 0.045). Effect on CVD was neutral (RR = 0.87, 95% CI 0.71-1.07, p = 0.18, I 2  = 0%). Power was 10% while findings were fragile (reverse FI of 7 and reverse FQ of 0.002). Rate of infections (OR = 0.85, 95% CI 0.71-1.02, p = 0.09, I 2  = 0%), vascular disorder (OR = 0.84, 95% CI 0.57-1.25, p = 0.34, I 2  = 0%) and general or injection-site related disorders (OR = 1.39, 95% CI 0.88-1.29, p = 0.16, I 2  = 30%) were comparable between groups. There was no relevant heterogeneity (I 2  > 50%) between the trials for any of the analyzed outcomes., Conclusions: Use of FCM/FDI is safe and reduces the composite of recurrent HF hospitalizations and CVD, while effects on CVD alone are based on available level of data indeterminate. Findings concerning composite outcomes exhibit a high level of robustness without heterogeneity between trials with FCM and FDI., (© 2023. The Author(s).)

Published
2023
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25. Cardio-renal interaction - Clinical trials update 2022.

Author

Kunz M, Götzinger F, Emrich I, Schwenger V, Böhm M, and Mahfoud F

Subjects
Chlorthalidone therapeutic use, Clinical Trials as Topic, Glucose, Humans, Kidney, Mineralocorticoid Receptor Antagonists therapeutic use, Sodium, Sodium-Glucose Transporter 2, Thiazides therapeutic use, Diabetes Mellitus, Type 2 drug therapy, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic drug therapy, Sodium-Glucose Transporter 2 Inhibitors
Abstract

Aims: Chronic kidney disease is a common cardiovascular risk indicator and strongly associated with increased morbidity and mortality. The heart and kidneys are pathophysiologically closely connected, which becomes particularly obvious in patients with cardiorenal syndrome. This review summarizes clinically relevant studies on the cardio-renal interaction published in 2021 and 2022., Data Synthesis: Selected trials published in high-impact journals were chosen from the database Pubmed and included in this review. New evidence about the selective mineralocorticoid receptor antagonist finerenone and the renoprotective sodium-glucose co-transporter-2-inhibitors (SGLT2-Inhibitors) are discussed and we update on novel insights about the treatment of arterial hypertension in patients with severe chronic kidney disease with the thiazide-like diuretic chlorthalidone. Finally, data on infective endocarditis in patients on chronic hemodialysis and the treatment of secondary hyperparathyroidism with the calcimimetic drug etelcalcetide in patients with end stage kidney disease are critically reviewed., Conclusion: Several important studies investigating cardio-renal interactions were recently published may affect clinical practice. The graphical abstract (Fig. 1) depicts the most relevant clinical studies investigating cardio-renal interactions., Competing Interests: Declaration of competing interest FM is supported by Deutsche Gesellschaft für Kardiologie (DGK), Deutsche Forschungsgemeinschaft (SFB TRR219), and Deutsche Herzstiftung and has received scientific support and/or speaker honoraria from Astra-Zeneca, Bayer, Boehringer Ingelheim, Medtronic, Merck, and ReCor Medical. IE has received speaker honoraria from Pharmacosmos and Astellas. VS has received speaker honoraria from Astra Zeneca and Novartis. MB is supported by the Deutsche Forschungsgemeinschaft (German Research Foundation; TTR 219, project number 322900939) and reports personal fees from Abbott, Amgen, Astra Zeneca, Bayer, Boehringer-Ingelheim, Cytokinetic, Edwards, Medtronic, Novartis, Recor, Servier and Vifor. FG and MK do not have conflicts of interest., (Copyright © 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Published
2022
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26. [Update on diagnostics and treatment of heart failure].

Author

Wintrich J, Berger AK, Bewarder Y, Emrich I, Slawik J, and Böhm M

Subjects
Chronic Disease, Germany, Hospitalization, Humans, Heart Failure drug therapy, Heart Failure therapy
Abstract

The incidence and prevalence of heart failure are increasing worldwide. Despite numerous scientific and clinical innovations the mortality and morbidity rates in heart failure patients remain high, so that guideline-conform diagnostics and treatment are of decisive importance. Cardiac decompensation is one of the leading reasons for hospital admissions in Germany. Thus, the treatment of patients with heart failure represents a substantial challenge for the German healthcare system. This article highlights the latest scientific knowledge on acute and chronic heart failure from the years 2018-2020., (© 2021. The Author(s).)

Published
2022
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27. [Evidence-based drug therapy for heart failure-an update].

Author

Emrich IE, Wintrich J, Kindermann I, and Böhm M

Subjects
Comorbidity, Germany, Hospitalization, Humans, Heart Failure drug therapy, Heart Failure epidemiology, Myocardial Infarction epidemiology
Abstract

Chronic heart failure affects millions of people worldwide and is associated with high morbidity and mortality. Because of steadily increasing ageing populations and improved survival rates after myocardial infarction, the incidence of chronic heart failure is rising. As acute decompensated heart failure is one of the leading causes for hospitalization in Germany, heart failure imposes a huge economic burden on its health care system. Guideline directed therapy is important to improve prognosis. In the following, we give an overview about novel heart failure clinical trial results and point to important comorbidities.

Published
2020
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30. [Preoperative cardiovascular risk evaluation before elective noncardiac surgical interventions].

Author

Kulenthiran S, Emrich I, Bewarder Y, Hubner WKK, Mahfoud F, Böhm M, and Ewen S

Subjects
Humans, Preoperative Care, Risk Assessment, Risk Factors, Cardiovascular Diseases surgery, Elective Surgical Procedures
Abstract

A careful and standardized but nevertheless individually adapted and targeted medical history and physical examination are essential components of a preoperative evaluation. The individual cardiovascular risk profile characterized by noninvasive diagnostics requires a targeted further assessment with noninvasive and invasive diagnostic investigations, which should be targeted to the medical needs of the individual patient. The aim is to assess the individual risk of undesired major adverse cardiac events (MACE). The preoperative examination procedures should be limited to the medically necessary needs in order to be able to optimally utilize the material and personnel resources. This review article presents a practical guide for preoperative cardiovascular risk evaluation in patients scheduled for elective, noncardiac surgery.

Published
2020
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31. [Cardiovascular pharmacotherapy and coronary revascularization in end-stage renal failure].

Author

Lauder L, Ewen S, Emrich IE, Böhm M, and Mahfoud F

Subjects
Glomerular Filtration Rate, Humans, Prospective Studies, Cardiovascular Diseases complications, Cardiovascular Diseases surgery, Kidney Failure, Chronic, Myocardial Revascularization, Renal Insufficiency, Renal Insufficiency, Chronic complications
Abstract

There is a close physiological relationship between the kidneys and the heart. Cardiovascular diseases are the most prevalent cause of death in patients with chronic kidney disease (CKD), whereas CKD may directly accelerate the progression of cardiovascular diseases and is considered to be a cardiovascular risk factor. In patients with mild CKD, i.e. an estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m 2 , treatment of coronary artery disease and chronic heart failure is not essentially different from patients with preserved renal function; however, as most pivotal trials have systematically excluded patients with advanced renal failure, many treatment recommendations in this patient group are based on observational studies, post hoc subgroup analyses and meta-analyses or pathophysiological considerations, which are not supported by controlled studies. Therefore, prospective randomized studies on the management of heart failure and coronary artery disease are needed, which should specifically focus on the growing number of patients with advanced renal functional impairment.

Published
2019
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32. PCSK9 Plasma Concentrations Are Independent of GFR and Do Not Predict Cardiovascular Events in Patients with Decreased GFR.

Author

Rogacev KS, Heine GH, Silbernagel G, Kleber ME, Seiler S, Emrich I, Lennartz S, Werner C, Zawada AM, Fliser D, Böhm M, März W, Scharnagl H, and Laufs U

Subjects
Aged, Cardiovascular Diseases blood, Cardiovascular Diseases pathology, Female, Follow-Up Studies, Humans, Kidney Failure, Chronic complications, Kidney Function Tests, Male, Middle Aged, Prognosis, Proprotein Convertase 9, Prospective Studies, Risk Factors, Biomarkers blood, Cardiovascular Diseases etiology, Glomerular Filtration Rate, Kidney Failure, Chronic surgery, Kidney Transplantation adverse effects, Postoperative Complications, Proprotein Convertases blood, Serine Endopeptidases blood
Abstract

Background: Impaired renal function causes dyslipidemia that contributes to elevated cardiovascular risk in patients with chronic kidney disease (CKD). The proprotein convertase subtilisin/kexin type 9 (PCSK9) is a regulator of the LDL receptor and plasma cholesterol concentrations. Its relationship to kidney function and cardiovascular events in patients with reduced glomerular filtration rate (GFR) has not been explored., Methods: Lipid parameters including PCSK9 were measured in two independent cohorts. CARE FOR HOMe (Cardiovascular and Renal Outcome in CKD 2-4 Patients-The Forth Homburg evaluation) enrolled 443 patients with reduced GFR (between 90 and 15 ml/min/1.73 m2) referred for nephrological care that were prospectively followed for the occurrence of a composite cardiovascular endpoint. As a replication cohort, PCSK9 was quantitated in 1450 patients with GFR between 90 and 15 ml/min/1.73 m2 enrolled in the Ludwigshafen Risk and Cardiovascular Health Study (LURIC) that were prospectively followed for cardiovascular deaths., Results: PCSK9 concentrations did not correlate with baseline GFR (CARE FOR HOMe: r = -0.034; p = 0.479; LURIC: r = -0.017; p = 0.512). 91 patients in CARE FOR HOMe and 335 patients in LURIC reached an endpoint during a median follow-up of 3.0 [1.8-4.1] years and 10.0 [7.3-10.6] years, respectively. Kaplan-Meier analyses showed that PCSK9 concentrations did not predict cardiovascular events in either cohort [CARE FOR HOMe (p = 0.622); LURIC (p = 0.729)]. Sensitivity analyses according to statin intake yielded similar results., Conclusion: In two well characterized independent cohort studies, PCSK9 plasma levels did not correlate with kidney function. Furthermore, PCSK9 plasma concentrations were not associated with cardiovascular events in patients with reduced renal function.

Published
2016
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33. Lower Apo A-I and lower HDL-C levels are associated with higher intermediate CD14++CD16+ monocyte counts that predict cardiovascular events in chronic kidney disease.

Author

Rogacev KS, Zawada AM, Emrich I, Seiler S, Böhm M, Fliser D, Woollard KJ, and Heine GH

Subjects
ATP Binding Cassette Transporter 1 blood, Aged, Cardiovascular Diseases etiology, Female, GPI-Linked Proteins analysis, Humans, Immunophenotyping, Interleukin-1beta blood, Interleukin-6 biosynthesis, Interleukin-6 blood, Leukocyte Count, Lipids blood, Lipopolysaccharide Receptors analysis, Lipoproteins, LDL blood, Male, Middle Aged, Prospective Studies, Receptors, IgG analysis, Renal Insufficiency, Chronic complications, Single-Blind Method, Tumor Necrosis Factor-alpha analysis, Apolipoprotein A-I analysis, Cardiovascular Diseases epidemiology, Cholesterol, HDL blood, Monocytes classification, Renal Insufficiency, Chronic blood
Abstract

Objective: Patients with chronic kidney disease (CKD) display impaired cholesterol efflux capacity and elevated CD14(++)CD16(+) monocyte counts. In mice, dysfunctional cholesterol efflux causes monocytosis. It is unknown whether cholesterol efflux capacity and monocyte subsets are associated in CKD., Approach and Results: In 438 patients with CKD, mediators of cholesterol efflux capacity (high-density lipoprotein cholesterol/apolipoprotein A-I) and monocyte subsets were analyzed as predictors of cardiovascular events. Monocyte subset-specific intracellular lipid content, CD36, CD68, and ABCA1 were measured in a subgroup. Experimentally, we analyzed subset-specific cholesterol efflux capacity and response to oxidized low-density lipoprotein cholesterol stimulation in CKD. Epidemiologically, both low Apo-I and low high-density lipoprotein cholesterol were associated with high CD14(++)CD16(+) monocyte counts in linear regression analyses (apolipoprotein A-I: β=-0.171; P<0.001; high-density lipoprotein cholesterol: β=-0.138; P=0.005), but not with counts of other monocyte subsets. In contrast to apolipoprotein A-I or high-density lipoprotein cholesterol, higher CD14(++)CD16(+) monocyte counts independently predicted cardiovascular events (hazard ratio per increase of 1 cell/μL: 1.011 [1.003-1.020]; P=0.007). Experimentally, CD14(++)CD16(+) monocytes demonstrated preferential lipid accumulation, high CD36, CD68, and low ABCA1 expression and, consequently, displayed low cholesterol efflux capacity, avid oxidized low-density lipoprotein cholesterol uptake, and potent intracellular interleukin-6, interleukin-1β, and tumor necrosis factor-α production., Conclusions: Taken together, mediators of cholesterol efflux are associated with CD14(++)CD16(+) monocyte counts, which independently predict adverse outcome in CKD., (© 2014 American Heart Association, Inc.)

Published
2014
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34. Associations of FGF-23 and sKlotho with cardiovascular outcomes among patients with CKD stages 2-4.

Author

Seiler S, Rogacev KS, Roth HJ, Shafein P, Emrich I, Neuhaus S, Floege J, Fliser D, and Heine GH

Subjects
Aged, Aged, 80 and over, Atherosclerosis blood, Atherosclerosis epidemiology, Cause of Death, Female, Fibroblast Growth Factor-23, Heart Failure blood, Heart Failure epidemiology, Hospitalization, Humans, Incidence, Klotho Proteins, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Renal Insufficiency, Chronic epidemiology, Time Factors, Vascular Grafting, Cardiovascular Diseases blood, Cardiovascular Diseases epidemiology, Fibroblast Growth Factors blood, Glucuronidase blood, Renal Insufficiency, Chronic blood
Abstract

Background and Objectives: CKD-mineral and bone disorders (CKD-MBD) measures contribute to cardiovascular morbidity in patients with CKD. Among these, fibroblast growth factor (FGF)-23 and its coreceptor Klotho may exert direct effects on vascular and myocardial tissues. Klotho exists in a membrane-bound and a soluble form (sKlotho). Recent experimental evidence suggests sKlotho has vasculoprotective functions., Design, Settings, Participants, & Measurements: Traditional and novel CKD-MBD variables were measured among 444 patients with CKD stages 2-4 recruited between September 2008 and November 2012 into the ongoing CARE FOR HOMe study. Across tertiles of baseline sKlotho and FGF-23, the incidence of two distinct combined end points was analyzed: (1) the first occurrence of an atherosclerotic event or death from any cause and (2) the time until hospital admission for decompensated heart failure or death from any cause., Results: Patients were followed for 2.6 (interquartile range, 1.4-3.6) years. sKlotho tertiles predicted neither atherosclerotic events/death (fully adjusted Cox regression analysis: hazard ratio [HR] for third versus first sKlotho tertile, 0.75 [95% confidence interval (95% CI), 0.43-1.30]; P=0.30) nor the occurrence of decompensated heart failure/death (HR for third versus first sKlotho tertile, 0.81 [95% CI, 0.39-1.66]; P=0.56). In contrast, patients in the highest FGF-23 tertile had higher risk for both end points in univariate analysis. Adjustment for kidney function attenuated the association between FGF-23 and atherosclerotic events/death (HR for third versus first FGF-23 tertile, 1.23 [95% CI, 0.58-2.61]; P=0.59), whereas the association between FGF-23 and decompensated heart failure/death remained significant after adjustment for confounders (HR for third versus first FGF-23 tertile, 4.51 [95% CI, 1.33-15.21]; P=0.02)., Conclusions: In this prospective observational study of limited sample size, sKlotho was not significantly related to cardiovascular outcomes. FGF-23 was significantly associated with future decompensated heart failure but not incident atherosclerotic events., (Copyright © 2014 by the American Society of Nephrology.)

Published
2014
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35. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation incorporating both cystatin C and creatinine best predicts individual risk: a cohort study in 444 patients with chronic kidney disease.

Author

Rogacev KS, Pickering JW, Seiler S, Zawada AM, Emrich I, Fliser D, and Heine GH

Subjects
Aged, Biomarkers blood, Cardiovascular Diseases blood, Cardiovascular Diseases etiology, Cause of Death trends, Cross-Sectional Studies, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Male, New Zealand epidemiology, Predictive Value of Tests, Prognosis, Renal Insufficiency, Chronic blood, Renal Insufficiency, Chronic complications, Risk Factors, Survival Rate trends, Time Factors, Cardiovascular Diseases epidemiology, Cooperative Behavior, Creatinine blood, Cystatin C blood, Renal Insufficiency, Chronic epidemiology, Risk Assessment methods
Abstract

Background: The recently introduced CKD-EPIcreat-cys equation surpassed creatinine-based equations for GFR estimation in a large cross-sectional analysis. However, its performance to predict individual risk of CKD progression and death in patients with various underlying CKD etiologies is unknown., Methods: We recruited 444 patients with CKD GFR categories 2-4 (eGFR 15-89 mL/min/1.73 m2); baseline eGFR was estimated by the established MDRD and CKD-EPIcreat equations and by the novel CKD-EPIcreat-cys equation., Results: Patients were followed for 2.7±1.2 years for the occurrence of the combined predefined endpoint event: death, need for renal replacement therapy or halving of eGFR. The endpoint occurred in 62 patients. Reclassification from MDRD determined categories to CKD-EPIcreat-cys categories yielded net reclassification improvements for those with the endpoint event (NRIevents) of 27.4% (95% CI: 16.7-40.0%) and for those without the event (NRInon-events) of -3.1% (-8.2 to 1.6%). Similarly, reclassification from CKD-EPIcreat categories to CKD-EPIcreat-cys categories yielded an NRIevents of 22.6% (10.2-34.3%) and NRInon-events of -11.3% (-15.9 to -6.5%). Addition of albuminuria to each eGFR equation increased the calculated risk of the outcome for a net 26-32% of those who subsequently reached the endpoint, and reduced the calculated risk in a net 21-23% in non-event patients, but only minimally., Conclusions: The CKD-EPIcreat-cys equation assigned patients who went on to have the event to more appropriate CKD risk categories than MDRD and CKD-EPIcreat, but patients without the event to less appropriate categories than CKD-EPIcreat. Addition of albuminuria marginally improved risk classification for those who had the event.

Published
2014
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