Chronische Niereninsuffizienz. Nicht jeder der pinkelt hat auch gesunde Nieren.

Transkript

1 Chronische Niereninsuffizienz Nicht jeder der pinkelt hat auch gesunde Nieren.

2 Chronische Niereninsufizienz 1) 1) Was hat sich nicht geändert? 2) 2) Was hat sich geändert? 3) 3) Was könnte sich ändern? 4) 4) Was muss sich ändern 5) 5) Zusammenfassung

3 Chronische Niereninsufizienz 1) 1) Was hat sich nicht geändert? 2) 2) Was hat sich geändert? 3) 3) Was könnte sich ändern? 4) 4) Was muss sich ändern 5) 5) Zusammenfassung

4 Prevalence of Chronic Kidney Disease in the United States CORESH et al. JAMA 298: , 2007

5 Kidney disease as a risk factor for the development of cardiovascular disease SARNAK et al. Circulation 108: , 2003

6 Chronische Niereninsufizienz 1) 1) Was hat sich nicht geändert? 2) 2) Was hat sich geändert? 3) 3) Was könnte sich ändern? 4) 4) Was muss sich ändern 5) 5) Zusammenfassung

7 Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosclerosis McCully Am J Pathol 56: , Mondlandung:

8 . Vascular pathology of homocysteinemia: implications for the pathogenesis of arteriosklerosis McCULLY Am J Pathol 56: , 1969

9 The Pathogenesis of Coronary Artery Disease A POSSIBLE ROLE FOR METHIONINE METABOLISM WICLCKEN et al. JCI 57: , 1976

10 Homocysteine Lowering with Folic Acid and B Vitamins in Vascular Disease HOPE 2 Investigators N Engl J Med 354: , patients with vascular disease or or diabetes treated for 5 years vitamin treatment lead substantial reduction in in plasma homocysteine no no significant reduction in in the risk of of myocardial infarction, stroke, or or death from cardiovascular causes

11 Effect of Homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and ESRD JAMISON et al. JAMA 298(10): , pts pts median follow-up: years % lowering Hcy (folic acid vitamin B6 B6 and and vitamin B12)

12 The effect of reduced glomerular filtration rate on plasma total homocysteine concentration. ARNADOTTIR et al. Scand J Clin Lab Invest 56(1):41-6, 1996

13 Two cardiovascular risk factors in one? Homocysteine and its correlation to GFR A meta-analysis of 41 studies with 27,000 participants KIELSTEIN et al. Kidney Blood Pres Res, 2008

14 Chronische Niereninsufizienz 1) 1) Was hat sich nicht geändert? 2) 2) Was hat sich geändert? 3) 3) Was könnte sich ändern? 4) 4) Was muss sich ändern 5) 5) Zusammenfassung

15 Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. McIntyre et al. C J Am Soc Nephrol. 3(1):19-26, 2008 PET with H 15 2 O or 13 NH 3 is the only technique that allows the noninvasive measurement of regional absolute (ml/min/g) myocardial blood flow

16 Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. McIntyre et al. C J Am Soc Nephrol. 3(1):19-26, 2008

17 Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. McIntyre et al. C J Am Soc Nephrol. 3(1):19-26, 2008

18 Occurrence of regional left ventricular dysfunction in patients undergoing standard and biofeedback dialysis. SELBY et al. Am J Kidney Dis. 47(5):830-41, 2006

19 Occurrence of regional left ventricular dysfunction in patients undergoing standard and biofeedback dialysis. SELBY et al. Am J Kidney Dis. 47(5):830-41, 2006

20 Dialysis-induced regional left ventricular dysfunction is ameliorated by cooling the dialysate. SELBY et al. C J Am Soc Nephrol. 1(6): , 2006

21 Dialysis-induced regional left ventricular dysfunction is ameliorated by cooling the dialysate. SELBY et al. C J Am Soc Nephrol. 1(6): , 2006

22 Chronische Niereninsufizienz 1) 1) Was hat sich nicht geändert? 2) 2) Was hat sich geändert? 3) 3) Was könnte sich ändern? 4) 4) Was muss sich ändern 5) 5) Zusammenfassung

23 Quality of care and outcomes among patients (n=17,785) with heart failure and chronic kidney disease: A Get With the Guidelines -- Heart Failure Program study. PATEL et al. Am Heart J 156(4):674-81, ,560 patients from 137 hospitals 2/3 had CKD!!!!!!!! 43.9% 14.2% 6.6% moderate CKD severe CKD kidney failure

24 Quality of care and outcomes among patients (n=17,785) with heart failure and chronic kidney disease: A Get With the Guidelines -- Heart Failure Program study. PATEL et al. Am Heart J 156(4):674-81, 2008

25 Quality of care and outcomes among patients (n=17,785) with heart failure and chronic kidney disease: A Get With the Guidelines -- Heart Failure Program study. PATEL et al. Am Heart J 156(4):674-81, 2008

26 Quality of care and outcomes among patients with heart failure and chronic kidney disease: A Get With the Guidelines -- Heart Failure Program study. PATEL et al. Am Heart J 156(4):674-81, 2008

27 Quality of care and outcomes among patients with heart failure and chronic kidney disease: A Get With the Guidelines -- Heart Failure Program study. PATEL et al. Am Heart J 156(4):674-81, 2008

28 Effect of angiotensin receptor blockers on cardiovascular events in patients undergoing hemodialysis: an open-label randomized controlled trial. SUZUKI et al. AJKD 52(3):501-6, 2008 Losartan 50 mg/d Candesartan 8 mg/d Valsartan of 80 mg/d

29 Effect of angiotensin receptor blockers on cardiovascular events in patients undergoing hemodialysis: an open-label randomized controlled trial. SUZUKI et al. AJKD 52(3):501-6, 2008

30 Effect of angiotensin receptor blockers on cardiovascular events in patients undergoing hemodialysis: an open-label randomized controlled trial. SUZUKI et al. AJKD 52(3):501-6, 2008

31 Chronische Niereninsufizienz 1) 1) Was hat sich nicht geändert? 2) 2) Was hat sich geändert? 3) 3) Was könnte sich ändern? 4) 4) Was muss sich ändern 5) 5) Zusammenfassung

32 Zusammenfassung