Diagnosis of cardiovascular disease in patients with chronic kidney disease.
Zoccali, Carmine Mark, Patrick B Sarafidis, Pantelis Agarwal, Rajiv Adamczak, Marcin Bueno de Oliveira, Rodrigo Massy, Ziad A Kotanko, Peter Ferro, Charles J Wanner, Christoph
Zoccali, Carmine
Mark, Patrick B
Sarafidis, Pantelis
Agarwal, Rajiv
Adamczak, Marcin
Bueno de Oliveira, Rodrigo
Massy, Ziad A
Kotanko, Peter
Ferro, Charles J
Wanner, Christoph
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2023-08-23
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Abstract
Patients with chronic kidney disease (CKD) are at high risk of cardiovascular disease (CVD) and cardiovascular death. Identifying and monitoring cardiovascular complications and hypertension is important for managing patients with CKD or kidney failure and transplant recipients. Biomarkers of myocardial ischaemia, such as troponins and electrocardiography (ECG), have limited utility for diagnosing cardiac ischaemia in patients with advanced CKD. Dobutamine stress echocardiography, myocardial perfusion scintigraphy and dipyridamole stress testing can be used to detect coronary disease in these patients. Left ventricular hypertrophy and left ventricular dysfunction can be detected and monitored using various techniques with differing complexity and cost, including ECG, echocardiography, nuclear magnetic resonance, CT and myocardial scintigraphy. Atrial fibrillation and other major arrhythmias are common in all stages of CKD, and ambulatory heart rhythm monitoring enables precise time profiling of these disorders. Screening for cerebrovascular disease is only indicated in asymptomatic patients with autosomal dominant polycystic kidney disease. Standardized blood pressure is recommended for hypertension diagnosis and treatment monitoring and can be complemented by ambulatory blood pressure monitoring. Judicious use of these diagnostic techniques may assist clinicians in detecting the whole range of cardiovascular alterations in patients with CKD and enable timely treatment of CVD in this high-risk population.
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Zoccali C, Mark PB, Sarafidis P, Agarwal R, Adamczak M, Bueno de Oliveira R, Massy ZA, Kotanko P, Ferro CJ, Wanner C, Burnier M, Vanholder R, Mallamaci F, Wiecek A. Diagnosis of cardiovascular disease in patients with chronic kidney disease. Nat Rev Nephrol. 2023 Nov;19(11):733-746. doi: 10.1038/s41581-023-00747-4. Epub 2023 Aug 23. PMID: 37612381.
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