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3. Allopurinol versus usual care in UK patients with ischaemic heart disease (ALL-HEART): a multicentre, prospective, randomised, open-label, blinded-endpoint trial

Author

Ahmed, Husnat, Arthur, Peter, Aziz, Jane, Barnes, Lawrence, Boyle, Sarah, Brighton, Tom, Brown, Morris, Caulfield, Mark, Dawson, Jesse, Denvir, Martin, Doney, Alexander SF, Doshi, Sagar, Dryburgh, Moira, Eddleston, Michael, Finlayson, Jim, Fuat, Ahmet, Furnace, Jacqueline, Grieve, JW Kerr, Guthrie, Greg, Ham, Sharon, Isaard, Emma, Jennings, Claudine, Johnson, Richard, Kerr, Claire, Khan, Sohail, Krishnan, Kailash, Long, Susan, Mackintosh, Anne, Macleod, Mary Joan, McCormack, Terry, McEleny, Paul, Morar, Monique, Nadir, Adnan, Newby, David, Petrie, Colin, Preiss, David, Ralston, Stuart, Randall, Marc, Routledge, Helen, Shakir, Saad, Sharma, Raj, Shepherd, Bridget, Sims, Don, Snedden, Gordon, Trevelyan, Jasper, Weir, Christopher, Weir, Robin, Wetherall, Kirsty, Wilson, Robbie, Wilson, Adam, Zutis, Kris, Mackenzie, Isla S, Hawkey, Christopher J, Ford, Ian, Greenlaw, Nicola, Pigazzani, Filippo, Rogers, Amy, Struthers, Allan D, Begg, Alan G, Wei, Li, Avery, Anthony J, Taggar, Jaspal S, Walker, Andrew, Duce, Suzanne L, Barr, Rebecca J, Dumbleton, Jennifer S, Rooke, Evelien D, Townend, Jonathan N, Ritchie, Lewis D, and MacDonald, Thomas M

Published
2022
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7. Prevalence and Impact of Concomitant Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction.

Author

Shakeel, Iqra, Sharma, Harish, Hodson, James, Iqbal, Hamna, Tashfeen, Rashna, Ludman, Peter F., Steeds, Richard P., Townend, Jonathan N., Doshi, Sagar N., and Nadir, M. Adnan

Subjects
MYOCARDIAL infarction, PERCUTANEOUS coronary intervention, ATRIAL fibrillation
Abstract

Background: Concomitant atrial fibrillation (AF) is associated with an adverse prognosis in patients with acute myocardial infarction (MI). However, it remains unclear whether this is due to a causal effect of AF or whether AF acts as a surrogate marker for comorbidities in this population. Furthermore, there are limited data on whether coronary artery disease distribution impacts the risk of developing AF. Methods: Consecutive patients admitted with acute MI and treated using percutaneous coronary intervention (PCI) at a single centre were retrospectively identified. Associations between AF and major adverse cardiac and cerebrovascular events (MACCEs) over a median of five years of follow-up were assessed using Cox regression, with adjustment for confounding factors performed using both multivariable modelling and a propensity-score-matched analysis. Results: AF was identified in N = 65/1000 (6.5%) of cases; these patients were significantly older (mean: 73 vs. 65 years, p < 0.001), with lower creatinine clearance (p < 0.001), and were more likely to have a history of cerebrovascular disease (p = 0.011) than those without AF. In addition, patients with AF had a greater propensity for left main stem (p = 0.001) or left circumflex artery (p = 0.004) involvement. Long-term MACCE rates were significantly higher in the AF group than in the non-AF group (50.8% vs. 34.2% at five years), yielding an unadjusted hazard ratio (HR) of 1.86 (95% CI: 1.32–2.64, p < 0.001). However, after adjustment for confounding factors, AF was no longer independently associated with MACCEs, either on multivariable (adjusted HR: 1.25, 95% CI: 0.81–1.92, p = 0.319) or propensity-score-matched (HR: 1.04, 95% CI: 0.59–1.82, p = 0.886) analyses. Conclusions: AF is observed in 6.5% of patients admitted with acute MI, and those with AF are more likely to have significant diseases involving left main or circumflex arteries. Although unadjusted MACCE rates were significantly higher in patients with AF, this effect was not found to remain significant after adjustment for comorbidities. As such, this study provided no evidence to suggest that AF is independently associated with MACCEs. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Allopurinol and cardiovascular outcomes in patients with ischaemic heart disease: the ALL-HEART RCT and economic evaluation.

Author

Mackenzie, Isla S., Hawkey, Christopher J., Ford, Ian, Greenlaw, Nicola, Pigazzani, Filippo, Rogers, Amy, Struthers, Allan D., Begg, Alan G., Li Wei, Avery, Anthony J., Taggar, Jaspal S., Walker, Andrew, Duce, Suzanne L., Barr, Rebecca J., Dumbleton, Jennifer S., Rooke, Evelien D., Townend, Jonathan N., Ritchie, Lewis D., and MacDonald, Thomas M.

Published
2024
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13. Heart disease and stroke statistics 2023 update from the American Heart Association—implications for nephrology.

Author

Edwards, Nicola C, Ferro, Charles J, and Townend, Jonathan N

Subjects
HEART diseases, STROKE, DISEASE risk factors, CARDIOVASCULAR diseases risk factors, CHRONIC kidney failure, STATISTICS
Abstract

The annual American Heart Association (AHA) and National Institutes of Health statistical report details the most up to date statistics related to heart disease, stroke and cardiovascular risk factors, primarily within the USA. Although not a formal systematic review or meta-analysis, this 600 page report provides the most comprehensive and best summary of cardiovascular statistics for the year in question. Although data are collated from USA data registries, it serves as a critical resource for clinicians, policymakers, administrators and researchers in the northern and southern hemispheres. In this special report, we have chosen to highlight aspects of the document that are relevant to nephrologists, given the overlap of cardiovascular and renal disease. These include (i) key and emerging cardiovascular data signals in the general and chronic kidney disease (CKD) populations, (ii) ethnic and socio-economic disparity, (iii) environmental and behavioural factors that drive high levels of cardiovascular disease and which are key components of the AHA's eight components of the Life Essential cardiovascular health score, and (iv) the impact of COVID-19 both directly and indirectly on heart health. We provide some commentary and critical analysis of both the data and of the production of such data sets suggesting that similar data on CKD could also be published and linked to the AHA and other datasets. [ABSTRACT FROM AUTHOR]

Published
2024
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21. A Meta-analysis of the Association of Estimated GFR, Albuminuria, Diabetes Mellitus, and Hypertension With Acute Kidney Injury

Author

Tonelli, Marcello, Hemmelgarn, Brenda R., James, Matthew T., Turin, Tanvir Chowdhury, Coresh, Josef, Matsushita, Kunihiro, Grams, Morgan, Sang, Yingying, Shlipak, Michael, Sarnak, Mark J., Katz, Ronit, Wheeler, David C., Emberson, Jonathan, Landray, Martin J., Townend, Jonathan N., Green, Jamie, Kirchner, H. Les, Perkins, Robert, Chang, Alex R., Romundstad, Solfrid, Aasarød, Knut, Øien, Cecilia M., Hallan, Stein, Smith, David H., Thorp, Micah L., Johnson, Eric S., Chodick, Gabriel, Herzel, Esma, Katz, Rachel, Shalev, Varda, Gansevoort, Ron T., Bakker, Stephan J.L., Lambers Heerspink, Hiddo J., van der Harst, Pim, Jee, Sun Ha, Kimm, Heejin, Mok, Yejin, Tangri, Navdeep, Naimark, David, Ärnlöv, Johan, Larsson, Anders, Lannfelt, Lars, Kovesdy, Csaba P., Kalantar-Zadeh, Kamyar, de Jong, Paul E., Iseki, Kunitoshi, Levey, Andrew S., Stengel, Benedicte, Warnock, David, Woodward, Mark, Ballew, Shoshana H., Grams, Morgan E., Elley, C. Raina, Green, Jamie A., de Jong, Paul, and Warnock, David G.

Published
2015
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22. A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury

Author

Tonelli, Marcello, Hemmelgarn, Brenda R., James, Matthew T., Turin, Tanvir Chowdhury, Coresh, Josef, Matsushita, Kunihiro, Grams, Morgan, Sang, Yingying, Shlipak, Michael, Sarnak, Mark J., Katz, Ronit, Wheeler, David C., Emberson, Jonathan, Landray, Martin J., Townend, Jonathan N., Green, Jamie, Kirchner, H. Les, Perkins, Robert, Chang, Alex R., Romundstad, Solfrid, Aasarød, Knut, Øien, Cecilia M., Hallan, Stein, Smith, David H., Thorp, Micah L., Johnson, Eric S., Chodick, Gabriel, Herzel, Esma, Katz, Rachel, Shalev, Varda, Gansevoort, Ron T., Bakker, Stephan J.L., Lambers Heerspink, Hiddo J., van der Harst, Pim, Jee, Sun Ha, Kimm, Heejin, Mok, Yejin, Tangri, Navdeep, Naimark, David, Ärnlöv, Johan, Larsson, Anders, Lannfelt, Lars, Kovesdy, Csaba P., Kalantar-Zadeh, Kamyar, de Jong, Paul E., Iseki, Kunitoshi, Levey, Andrew S., Stengel, Benedicte, Warnock, David, Woodward, Mark, Ballew, Shoshana H., Grams, Morgan E., and Oien, Cecilia

Published
2015
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23. Management of heart failure in patients with kidney disease—updates from the 2021 ESC guidelines.

Author

Edwards, Nicola C, Price, Anna M, Steeds, Richard P, Ferro, Charles J, and Townend, Jonathan N

Subjects
HEART failure, IMPLANTABLE cardioverter-defibrillators, ARTIFICIAL implants, KIDNEY diseases, HEART failure patients, KIDNEY failure, BUNDLE-branch block, CARDIAC pacing
Abstract

The wide overlap between the syndromes of chronic kidney disease (CKD) and chronic heart failure (HF) means that familiarity with the 2021 European Society of Cardiology guidelines is of importance to nephrologists. The common risk factors for the two syndromes together with the adverse cardiac structural remodelling associated with CKD means that many kidney disease patients experience breathlessness and fall within the HF phenotypes categorized in the guidelines. The management of HF is evolving rapidly leading to significant changes in the latest guideline iteration. The 2021 guidelines have changed from the 2016 version firstly by an increased focus on identifying the three phenotypes of HF to guide appropriate evidence-based management. Secondly, a new and simplified treatment algorithm for HF with reduced ejection fraction involving the rapid sequential initiation and up-titration of four 'pillars' of drug treatment—angiotensin-converting enzyme inhibitors or angiotensin-neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists and now, thanks to convincing trial data, sodium-glucose co-transporter 2 inhibitors. Thirdly, guidelines for device therapy have been changed with down-graded advice on indications for primary prevention implantable cardioverter defibrillator therapy for patients with non-ischaemic HF and for cardiac resynchronization therapy with left bundle branch block (LBBB) and a QRS duration <150 ms. There are updated treatment plans for HF associated with non-cardiovascular comorbidities including CKD. [ABSTRACT FROM AUTHOR]

Published
2023
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28. A randomized, multicenter, open-label, blinded end point trial comparing the effects of spironolactone to chlorthalidone on left ventricular mass in patients with early-stage chronic kidney disease: Rationale and design of the SPIRO-CKD trial

Author

Hayer, Manvir K., Edwards, Nicola C., Slinn, Gemma, Moody, William E., Steeds, Rick P., Ferro, Charles J., Price, Anna M., Andujar, Cecilio, Dutton, Mary, Webster, Rachel, Webb, David J., Semple, Scott, MacIntyre, Iain, Melville, Vanessa, Wilkinson, Ian B., Hiemstra, Thomas F., Wheeler, David C., Herrey, Anna, Grant, Margaret, Mehta, Samir, Ives, Natalie, and Townend, Jonathan N.

Published
2017
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34. Improving the diagnosis of heart failure in patients with atrial fibrillation

Author

Bunting, Karina V, Gill, Simrat K, Sitch, Alice, Mehta, Samir, O'Connor, Kieran, Lip, Gregory YH, Kirchhof, Paulus, Strauss, Victoria Y, Rahimi, Kazem, Camm, A John, Stanbury, Mary, Griffith, Michael, Townend, Jonathan N, Gkoutos, Georgios V, Karwath, Andreas, Steeds, Richard P, Kotecha, Dipak, Pe, RAte Control Therapy Evaluation, and group, RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) trial

Subjects
Male, medicine.medical_specialty, Systole, Coefficient of variation, Diastole, heart failure, Ventricular Function, Left, Internal medicine, Atrial Fibrillation, Natriuretic Peptide, Brain, medicine, Humans, echocardiography, atrial fibrillation, In patient, Heart Failure and Cardiomyopathies, Aged, Aged, 80 and over, Echocardiography, Doppler, Pulsed, Heart Failure, Reproducibility, Ejection fraction, business.industry, Reproducibility of Results, Stroke Volume, Atrial fibrillation, medicine.disease, Peptide Fragments, diastolic, Heart failure, cardiovascular system, Cardiology, Female, systolic, Median Heart Rate, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract

ObjectiveTo improve the echocardiographic assessment of heart failure in patients with atrial fibrillation (AF) by comparing conventional averaging of consecutive beats with an index-beat approach, whereby measurements are taken after two cycles with similar R-R interval.MethodsTransthoracic echocardiography was performed using a standardised and blinded protocol in patients enrolled in the RATE-AF (RAte control Therapy Evaluation in permanent Atrial Fibrillation) randomised trial. We compared reproducibility of the index-beat and conventional consecutive-beat methods to calculate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e’ (mitral E wave max/average diastolic tissue Doppler velocity), and assessed intraoperator/interoperator variability, time efficiency and validity against natriuretic peptides.Results160 patients were included, 46% of whom were women, with a median age of 75 years (IQR 69–82) and a median heart rate of 100 beats per minute (IQR 86–112). The index-beat had the lowest within-beat coefficient of variation for LVEF (32%, vs 51% for 5 consecutive beats and 53% for 10 consecutive beats), GLS (26%, vs 43% and 42%) and E/e’ (25%, vs 41% and 41%). Intraoperator (n=50) and interoperator (n=18) reproducibility were both superior for index-beats and this method was quicker to perform (pConclusionsCompared with averaging of multiple beats in patients with AF, the index-beat approach improves reproducibility and saves time without a negative impact on validity, potentially improving the diagnosis and classification of heart failure in patients with AF.

Published
2021

42. Risk for subsequent hypertension and cardiovascular disease after living kidney donation: is it clinically relevant?

Author

Ferro, Charles J and Townend, Jonathan N

Subjects
*CARDIOVASCULAR diseases, *CHRONIC kidney failure, *LIFE expectancy, *KIDNEYS, CARDIOVASCULAR disease related mortality
Abstract

The first successful live donor kidney transplant was performed in 1954. Receiving a kidney transplant from a live kidney donor remains the best option for increasing both life expectancy and quality of life in patients with end-stage kidney disease. However, ever since 1954, there have been multiple questions raised on the ethics of live kidney donation in terms of negative impacts on donor life expectancy. Given the close relationship between reduced kidney function in patients with chronic kidney disease (CKD) and hypertension, cardiovascular disease and cardiovascular mortality, information on the impact of kidney donation on these is particularly relevant. In this article, we review the existing evidence, focusing on the more recent studies on the impact of kidney donation on all-cause mortality, cardiovascular mortality, cardiovascular disease and hypertension, as well as markers of cardiovascular damage including arterial stiffness and uraemic cardiomyopathy. We also discuss the similarities and differences between the pathological reduction in renal function that occurs in CKD, and the reduction in renal function that occurs because of a donor nephrectomy. Kidney donors perform an altruistic act that benefits individual patients as well as the wider society. They deserve to have high-quality evidence on which to make informed decisions. [ABSTRACT FROM AUTHOR]

Published
2022
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43. Changes in Blood Pressure and Arterial Hemodynamics following Living Kidney Donation

Author

Price, Anna M, Greenhall, George HB, Moody, William E, Steeds, Richard P, Mark, Patrick B, Edwards, Nicola C, Hayer, Manvir K, Pickup, Luke C, Radhakrishnan, Ashwin, Law, Jonathan P, Banerjee, Debasish, Campbell, Tunde, Tomson, Charles RV, Cockcroft, John R, Shrestha, Badri, Wilkinson, Ian B, Tomlinson, Laurie A, Ferro, Charles J, Townend, Jonathan N, and EARNEST investigators

Abstract

BACKGROUND AND OBJECTIVES: The Effect of a Reduction in GFR after Nephrectomy on Arterial Stiffness and Central Hemodynamics (EARNEST) study was a multicenter, prospective, controlled study designed to investigate the associations of an isolated reduction in kidney function on BP and arterial hemodynamics. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Prospective living kidney donors and healthy controls who fulfilled criteria for donation were recruited from centers with expertise in vascular research. Participants underwent office and ambulatory BP measurement, assessment of arterial stiffness, and biochemical tests at baseline and 12 months. RESULTS: A total of 469 participants were recruited, and 306 (168 donors and 138 controls) were followed up at 12 months. In the donor group, mean eGFR was 27 ml/min per 1.73 m2 lower than baseline at 12 months. Compared with baseline, at 12 months the mean within-group difference in ambulatory day systolic BP in donors was 0.1 mm Hg (95% confidence interval, -1.7 to 1.9) and 0.6 mm Hg (95% confidence interval, -0.7 to 2.0) in controls. The between-group difference was -0.5 mm Hg (95% confidence interval, -2.8 to 1.7; P=0.62). The mean within-group difference in pulse wave velocity in donors was 0.3 m/s (95% confidence interval, 0.1 to 0.4) and 0.2 m/s (95% confidence interval, -0.0 to 0.4) in controls. The between-group difference was 0.1 m/s (95% confidence interval, -0.2 to 0.3; P=0.49). CONCLUSIONS: Changes in ambulatory peripheral BP and pulse wave velocity in kidney donors at 12 months after nephrectomy were small and not different from controls. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: NCT01769924 (https://clinicaltrials.gov/ct2/show/NCT01769924).

Published
2020

49. effect of admission and pre-admission serum creatinine as baseline to assess incidence and outcomes of acute kidney injury in acute medical admissions.

Author

Pickup, Luke, Loutradis, Charalampos, Law, Jonathan P, Arnold, Julia J, Dasgupta, Indranil, Sarafidis, Pantelis, Townend, Jonathan N, Cockwell, Paul, and Ferro, Charles J

Subjects
ACUTE kidney failure, CREATININE, MORTALITY, HOSPITAL statistics, KIDNEY diseases
Abstract

Background Acute kidney injury (AKI) in hospital-admitted patients is a common complication associated with increased mortality. The diagnosis of AKI relies on the ascertainment of peak increase in serum creatinine (SCr). This study evaluated the incidence of AKI using the increase from mean 7–365 days pre-admission (AKIpre) and admission (AKIadm) SCr levels, and examined the associations of AKI and changes in SCr levels with all-cause mortality. Methods A total of 2436 patients admitted to a tertiary hospital were recruited and followed-up for a median of 47.70 (interquartile range 18.20) months. AKI incidence and severity were defined according to the Kidney Disease: Improving Global Outcomes-AKI Guidelines. Follow-up data were collected from the Hospital Episode Statistics and Office of National Statistics. Mortality was evaluated during a short- (30 days), mid- (1 year) and long-term (4 years) period. Results No difference in the AKI rates using AKIpre and AKIadm (12.5% versus 12.2%; P = 0.695) or in the AKI severity (P = 0.261) was evident. Agreement between the two definitions was modest (Kappa-statistic = 0.596, P < 0.001). Patients with AKIpre or AKIadm had increased all-cause mortality compared with those without AKI during all follow-up periods. In fully adjusted regression analysis, AKIpre [hazard ratio (HR) = 2.226, 95% confidence interval (CI) 1.140–4.347; P = 0.027] and AKIadm (HR = 2.105, 95% CI 1.090–4.064; P = 0.027) remained associated with 30-day mortality. Results for the 1- and 4-year periods were similar. Increases of >4.00 μmol/L and >6.06% from pre-admission or >6.00 μmol/L and >17.24% from admission SCr levels presented increased mortality risk during follow-up. Conclusions Use of admission or pre-admission SCr provides similar incidence rates, but they diagnose different sets of patients. Even minor increases in SCr, below those required for the classification of AKI, were associated with increased mortality. These findings can help the clinicians to identify patients at higher risk for adverse outcomes. [ABSTRACT FROM AUTHOR]

Published
2022
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