Der Internist
-
Chronic kidney disease (CKD) is associated with substantial cardiovascular morbidity and mortality. This is mediated by the high prevalence of traditional cardiovascular risk factors in patients with CKD such as arterial hypertension and diabetes mellitus, but also by the presence of CKD-specific so-called nontraditional cardiovascular risk factors such as vascular calcification, uremic toxins, uremic dyslipidemia as well as inflammation and oxidative stress. Therefore, the primary and secondary prevention of cardiovascular disease represents an integral part of nephrology. This entails optimal control of blood pressure and diabetes, therapy of the uremic dyslipidemia as well as lifestyle-modifying factors such as weight reduction and smoking cessation.
-
Valvular heart disease is a common comorbidity in patients with impaired renal function, especially in those with end-stage renal disease undergoing dialysis. Sclerosis and calcification of the heart valves and the valve ring are particularly relevant in the etiology of the diseases. ⋯ Catheter-based treatment options have emerged as an effective and safe alternative for patients >75 years and/or with increased surgical risk. Consequently, in patients with appropriate anatomy and elevated risk, interventional treatment options should also be discussed in the heart team.
-
Recurrent stroke is a frequent event and clinical trials that addressed the best secondary prevention are sparse. If patients take a thrombocyte aggregation inhibitor (TAI) before the recurrent stroke, clopidogrel can be chosen instead of aspirin or vice versa but evidence is lacking. A 3-week period of dual antiplatelet treatment might be a good alternative after acute reinfarction. ⋯ Patients with ICH associated with oral anticoagulation (OAC) and atrial fibrillation should be restarted on novel OACs, if there are no relevant contraindications and the risk of ischemia is high. The anticoagulation treatment of patients with cerebral amyloid angiopathy is still a clinical dilemma as there is a high risk of recurrent ICH. These patients might be candidates for left appendage closure.
-
Review
[Cardiovascular diagnostic testing in advanced chronic kidney disease: which tests are useful?]
Against the background of drastically increased cardiovascular comorbidity in patients with chronic kidney disease (CKD), an effective cardiovascular diagnostic approach appears essential. However, patients with CKD are often underdiagnosed. ⋯ Special attention is paid to stress diagnostics in CKD patients. Guidelines recommend cardiovascular diagnostic evaluation prior to inclusion on the transplantation waiting list.
-
Patients with chronic kidney disease (CKD) exhibit an increased risk to develop heart failure and the presence of heart failure in CKD patients is associated with a poorer prognosis. The following overview article summarizes the current standard of drug treatment of heart failure and discusses special aspects in the treatment of patients with CKD.