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Medicina
Special Issues
Cardiovascular Disease and Hemodialysis
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Cardiovascular Disease and Hemodialysis

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Urology & Nephrology".

Deadline for manuscript submissions: 15 May 2024 | Viewed by 4094

Special Issue Editors

Dr. Keren Cohen-Hagai

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Guest Editor
Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 4428163, Israel
Interests: cardiovascular disease among hemodialysis patients
Dr. Moshe Shashar

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Guest Editor
Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
Interests: nephrology
Dr. Sydney Benchetrit

E-Mail Website
Guest Editor
Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 4428163, Israel
Interests: nephrology

Special Issue Information

Dear Colleagues,

Chronic kidney disease (CKD) is a global health problem with an estimated prevalence of 13.4%. It is strongly associated with cardiovascular disease and imposes huge medical and financial burdens on societies and healthcare systems. The increasing prevalence of CKD, with its dramatic influence on morbidity and cardiovascular disease and the increased risk of mortality among patients with CKD, emphasize the need for further research in this field.

Due to the increased life expectancy and treatment options for patients with CKD and associated comorbidities, the prevalence of patients with end-stage kidney disease who require renal replacement therapy is increasing. Currently, only about 3 million patients are receiving kidney replacement therapy for end-stage kidney disease worldwide, among the 10 million who would qualify for kidney replacement therapy. These numbers are expected to increase by 50% to 100% by 2030.

Hemodialysis is the most common renal replacement therapy worldwide and, as such, the increasing rate of cardiovascular disease in this unique and specific population is valuable. Cardiovascular disease is not only common but also fatal in this population. It is the leading cause of death among hemodialysis patients, accounting for about 40% to 50% of all deaths in this high-risk population. 

In addition to the pronounced cardiovascular risks among hemodialysis patients, they are often being excluded from clinical trials, their pathophysiology is complicated and includes traditional risk factors that coexist with chronic kidney disease (e.g., diabetes, dyslipidemia and hypertension), as well as non-traditional risk-factors, such as malnutrition, inflammation and mineral bone disorder, which accelerate atherosclerosis and vascular calcifications. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative and the international guideline group, Kidney Disease Improving Global Outcomes, have highlighted the importance of early detection and treatment of cardiovascular disease in patients with CKD.

The purpose of this Special Issue in Medicina is to discuss matters associated with cardiovascular disease in hemodialysis patients, including pathophysiology, treatment options and outcomes. The scope of the Issue is deliberately broad to encourage coverage of a wide range of topics and perspectives related to the management of cardiovascular disease among hemodialysis patients.

Dr. Keren Cohen-Hagai
Dr. Moshe Shashar
Dr. Sydney Benchetrit
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiovascular disease
  • vascular calcifications
  • atherosclerosis
  • chronic kidney disease
  • mineral bone disorder
  • end-stage kidney disease
  • renal replacement therapy
  • endothelial dysfunction

Published Papers (3 papers)

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Research

12 pages, 338 KiB  
Article
Cardiovascular Calcifications Are Correlated with Inflammation in Hemodialysis Patients
by Dorin Dragoș, Delia Timofte, Mihai-Teodor Georgescu, Maria-Mirabela Manea, Ileana Adela Vacaroiu, Dorin Ionescu and Andra-Elena Balcangiu-Stroescu
Medicina 2023, 59(10), 1801; https://doi.org/10.3390/medicina59101801 - 10 Oct 2023
Viewed by 1385
Abstract
Background and Objectives: The main cause of morbidity and mortality in hemodialysis patients is cardiovascular disease, which is quite common. The main objective of our study was to investigate the relationship between oxidative stress, inflammation, and vascular and valvular calcifications in hemodialysis [...] Read more.
Background and Objectives: The main cause of morbidity and mortality in hemodialysis patients is cardiovascular disease, which is quite common. The main objective of our study was to investigate the relationship between oxidative stress, inflammation, and vascular and valvular calcifications in hemodialysis patients. Materials and Methods: This observational study had 54 hemodialysis patients, with an average age of 60.46 ± 13.18 years. Cardiovascular ultrasound was used to detect and/or measure aortic and mitral valve calcifications, carotid and femoral atheroma plaques, and common carotid intima-media thickness. The aortic calcification score was determined using a lateral abdomen plain radiograph. The inflammatory, oxidative, metabolic, and dietary statuses, as well as demographic characteristics, were identified. Results: There were significant correlations between the levels of IL-6 and carotid plaque number (p = 0.003), fibrinogen level and aortic valve calcifications (p = 0.05), intima-media thickness (p = 0.0007), carotid plaque number (p = 0.035), femoral plaque number (p = 0.00014), and aortic calcifications score (p = 0.0079). Aortic annulus calcifications (p = 0.03) and intima-media thickness (p = 0.038) were adversely linked with TNF-α. Nutrition parameters were negatively correlated with atherosclerosis markers: number of carotid plaques with albumin (p = 0.013), body mass index (p = 0.039), and triglycerides (p = 0.021); number of femoral plaques with phosphorus (0.013), aortic calcifications score with albumin (p = 0.051), intima-media thickness with LDL-cholesterol (p = 0.042). Age and the quantity of carotid plaques, femoral plaques, and aortic calcifications were linked with each other (p = 0.0022, 0.00011, and 0.036, respectively). Aortic annulus calcifications (p = 0.011), aortic valve calcifications (p = 0.023), and mitral valve calcifications (p = 0.018) were all associated with an increased risk of death. Conclusions: Imaging measures of atherosclerosis are adversely connected with dietary status and positively correlated with markers of inflammation and risk of mortality. Full article
(This article belongs to the Special Issue Cardiovascular Disease and Hemodialysis)
9 pages, 919 KiB  
Article
Intra-Cranial Arterial Calcifications in Hemodialysis Patients
by Feda Fanadka, Ilan Rozenberg, Naomi Nacasch, Yael Einbinder, Sydney Benchetrit, Ori Wand, Tammy Hod and Keren Cohen-Hagai
Medicina 2023, 59(10), 1706; https://doi.org/10.3390/medicina59101706 - 24 Sep 2023
Viewed by 932
Abstract
Background and objectives: Vascular calcification is an integral part of atherosclerosis and has been reported to be an independent risk factor for cardiovascular diSsease. Intra Cranial Arterial Calcifications (ICAC) in maintenance hemodialysis (MHD) is highly prevalent. Materials and Methods: The aim [...] Read more.
Background and objectives: Vascular calcification is an integral part of atherosclerosis and has been reported to be an independent risk factor for cardiovascular diSsease. Intra Cranial Arterial Calcifications (ICAC) in maintenance hemodialysis (MHD) is highly prevalent. Materials and Methods: The aim of this retrospective study was to assess the predictors and outcomes of ICAC in MHD patients compared to a control group without kidney disease. A blinded neuroradiologist graded ICAC in brain imaging (computerized tomography) of MHD patients. Age- and sex-matched patients with normal kidney function served as the control group. Results: A total of 280 patients were included in the cohort; 140 of them were MHD patients with a mean ICAC score of 2.3 ± 0.2 versus a mean ICAC score of 1.4 ± 0.2 in the control group (p < 0.01). More than 90% of hemodialysis patients in our study had some degree of ICAC. Lower albumin and higher phosphorus and CRP levels were associated with increased ICACs. The multivariate analysis model for predictors of 1-year mortality demonstrated an increased odds ratio for mortality as the ICAC score increased. Conclusions: ICAC is very prevalent among MHD patients and results not simply from passive deposition of calcium and phosphate but rather from complex and active processes involving inflammation and structural changes in blood vessels. ICAC independently predicted all-cause mortality and may help with risk stratification of this high-risk population. Full article
(This article belongs to the Special Issue Cardiovascular Disease and Hemodialysis)
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11 pages, 979 KiB  
Article
The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome
by Keren Cohen-Hagai, Sydney Benchetrit, Ori Wand, Ayelet Grupper, Moshe Shashar, Olga Solo, David Pereg, Tali Zitman-Gal, Feras Haskiah and Daniel Erez
Medicina 2023, 59(7), 1312; https://doi.org/10.3390/medicina59071312 - 15 Jul 2023
Viewed by 1314
Abstract
Background and objectives: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. Materials and Methods: This retrospective cohort study includes [...] Read more.
Background and objectives: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. Materials and Methods: This retrospective cohort study includes HD patients hospitalized due to acute coronary syndrome (ACS) in the period 2015–2020 with lipid profile data during ACS. A control group with preserved kidney function was matched. Risk factors for 30-day and 1-year mortality were assessed. Results: Among 349 patients included in the analysis, 246 were HD-dependent (“HD group”). HD group patients had higher prevalence of diabetes, hypertension, and heart disease than the control group. At ACS hospitalization, lipid profile and chronic statin treatment were comparable between groups. Odds ratios for 30-day mortality in HD vs. control group was 5.2 (95% CI 1.8–15; p = 0.002) and for 1-year, 3.4 (95% CI 1.9–6.1; p <0.001). LDL and LDL < 70 did not change 30-day and 1-year mortality rates in the HD group (p = 0.995, 0.823, respectively). However, survival after ACS in HD patients correlated positively with nutritional parameters such as serum albumin (r = 0.368, p < 0.001) and total cholesterol (r = 0.185, p < 0.001), and inversely with the inflammatory markers C-reactive protein (CRP; r = −0.348, p < 0.001) and neutrophils-to-lymphocytes ratio (NLR; r = −0.181, p = 0.019). Multivariate analysis demonstrated that heart failure was the only significant predictor of 1-year mortality (OR 2.8, p = 0.002). LDL < 70 mg/dL at ACS hospitalization did not predict 1-year mortality in the HD group. Conclusions: Despite comparable lipid profiles and statin treatment before and after ACS hospitalization, mortality rates were significantly higher among HD group. While malnutrition–inflammation markers were associated with survival of dialysis patients after ACS, LDL cholesterol was not. Thus, our study results emphasize that better nutritional status and less inflammation are associated with improved survival among HD patients. Full article
(This article belongs to the Special Issue Cardiovascular Disease and Hemodialysis)
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