Diabetes/Kidney/Heart Disease, An Issue of Cardiology Clinics PDF

Preface: Diabetes/Kidney/Heart Disease ix
Silvi Shah and Charuhas V. Thakar
Cardiorenal Syndrome: Pathophysiology 251
Ujjala Kumar, Nicholas Wettersten, and Pranav S. Garimella
Cardiorenal syndrome commonly refers to the collective dysfunction of heart and kidney
resulting in a cascade of feedback mechanismcausing damage to both the organs
and is associated with adverse clinical outcomes. The pathophysiology of cardiorenal
syndromeis complex,multifactorial, and dynamic. Improving the understanding of disease
mechanisms will aid in developing targeted pharmacologic and nonpharmacologic
therapies for the management of this syndrome. This article discusses the
various mechanisms involved in the pathophysiology of the cardiorenal syndrome.
Treatment of Cardiorenal Syndrome 267
Jack Rubinstein and Darek Sanford
The treatment of cardiorenal syndrome is as complex as the various mechanisms
underlying its pathophysiology. Randomized controlled data typically focus on the
treatment of heart failure with cardiac specific endpoints and a lack of worsening
renal function used as a surrogate for efficacy. When heart failure is considered
the inciting event, the acute state is managed with vasodilators, inotropic support,
and decongestion; whereas neurohormonal axis inhibition is more commonly
applied to chronic state. A recent shift in thought process regarding the interplay
of cardiac and renal dysfunction suggests that renal congestion may be the primary
driver of worsening renal function.
Hypertensive Emergencies: A Review of Common Presentations and Treatment
Options 275
Latoya Brathwaite and Max Reif
Approximately 33% of adults in the United States have high blood pressure; approximately
1% will present with a hypertensive emergency. Hypertension emergency is
typically defined as a blood pressure great than 180/120mmHg leading to end organ
damage. However, it is important to note that an acute rise in blood pressure may
also lead to end organ damage before achieving the blood pressure threshold. Therapeutic
intervention should be a short-acting, easily titratable, intravenous antihypertensive
medication based on the type of end-organ damage, pharmacokinetics, and
comorbidities. This review focuses on presentations and treatment of hypertensive
emergency.
Contrast Nephropathy Associated with Percutaneous Coronary Angiography and
Intervention 287
James E. Novak and Richa Handa
Contrast nephropathy (CN) is acute kidney injury (AKI) that occurs within 24 to 72
hours of iodinated contrast medium (ICM) administration. Mechanisms of
CN include hyperviscosity, free radical formation, and renal medullary oxygen
Diabetes/Kidney/Heart Disease
supply/demand mismatch. Although risk factors for CN have been identified, it remains
uncertain whether ICM causes or is simply associated with AKI. The cornerstones
of CN prevention are using low-osmolal ICM, intravenous hydration, and
statins, especially in patients with chronic kidney disease. With appropriate CN
risk mitigation, coronary angiography and intervention should not be routinely withheld
from patients with acute coronary syndromes.
Acute Kidney Injury, Heart Failure, and Health Outcomes 297
Prakash S. Gudsoorkar and Charuhas V. Thakar
Acute kidney injury in acute decompensated heart failure leads to increased readmissions
regardless of being transient or sustained at the time of discharge. Timely identification
of acute kidney injury and worsening heart failure in patients with acute
decompensated heart failure is of utmost importance to optimize different components
of heart failure treatment. Acute kidney injury is a strong predictor of poor outcomes
and early death in patients with pulmonary artery hypertension and acute rightsided
heart failure. Extracorporeal ultrafiltration should not be used as an initial or
alternative to diuretic therapy. It should be reserved for diuretic-resistant individuals.
Hypertension Management in Chronic Kidney Disease and Diabetes: Lessons from
the Systolic Blood Pressure Intervention Trial 307
George Thomas
Based on observational and clinical trials, formulation of hypertension guidelines
began in 1977. Successive guideline reports recommended lower blood pressure
goals, with emphasis shifting to treatment of systolic hypertension. In 2013, responsibility
for hypertension guidelines was assigned to the American College of Cardiology
and the American Heart Association. The new hypertension guideline was published
in 2017, and the Systolic Blood Pressure Intervention Trial (SPRINT) informed many of
the recommendations in the new guidelines. This article describes the SPRINT study
results and the new guideline recommendations regarding hypertension management
and blood pressure goals, with emphasis on chronic kidney disease and diabetes.
Sudden Cardiac Death in End-Stage Renal Disease 319
Page V. Salenger
The challenge presented by sudden cardiac death in dialysis patients is to better
define risk factors and delineate multiple etiologies. Only then can therapy be
tailored to the highest risk patients and the incidence of sudden cardiac death be
reduced. This article details the many possible etiologies and presents a brief overview
of more recent research that may in the future prove of great benefit in
improving the mortality of our patients with end-stage renal disease.
Apolipoprotein L1, Cardiovascular Disease and Hypertension: More Questions than
Answers 327
Niralee Patel and Girish N. Nadkarni
Ethnic disparities in health outcomes exist among multiple complex diseases especially
cardiovascular disease, hypertension, and kidney disease. Recent discoveries
in genetics have taught us that these disparities go beyond environmental and socioeconomic
factors. The discovery of ethnic-specific risk variants in the Apolipoprotein
L1 (APOL1) gene on chromosome 22 seen only in individuals of recent
African ancestry explains a large proportion of kidney disease disparities. In addition,
recent large-scale genotype-phenotype association studies have identified associations
with cardiovascular disease and hypertension. This review aims to review
the recent literature in this field and point toward future directions for research.
Novel Antidiabetic Therapies and Cardiovascular Risk Reduction: The Role of the
Noninferiority Trial 335
Jillian Thompson, Sydney Schacht, and Florence Rothenberg
Diabetes is a major risk factor for cardiovascular disease, yet until now treatments
for diabetes had only a modest impact on cardiovascular events. New interventions
for patients with type 2 diabetes mellitus (oral empagliflozin and injectable liraglutide)
are associated with unprecedented reductions in composite cardiovascular outcomes
that seem disproportionate to the impact on glycated hemoglobin. This review
examines in detail the recent trials that arrived at these conclusions,
limitations of these studies, and how these outcomes may influence patient management
in the future.
Hypertensive Disorders of Pregnancy 345
Silvi Shah and Anu Gupta
Hypertensive disorders of pregnancy are common and contribute inordinately to
maternal and fetal morbidity and mortality. Although not completely understood,
recent clinical trials have provided important insights into pathogenesis of preeclampsia.
Preeclampsia is considered a systemic disease with generalized endothelial
dysfunction and risk of future cardiovascular disease. This review revisits
the definitions and classifications of hypertensive disorders of pregnancy; discusses
updates on pathophysiology, prevention, and early prediction of preeclampsia; reviews
current management guidelines; and discusses potential risks and benefits
associated with treatment. Improvement in management and outcomes of women
with hypertensive disorders of pregnancy seems in sight in the near future.
Diabetes/Kidney/Heart Disease, An Issue of Cardiology Clinics PDF Ebook

JORDAN M. PRUTKIN
DAVID M. SHAVELLE
TERRENCE D. WELCH
AUDREY H. WU