Biomedical subjects

Claudine Jurkovitz

Publications and source records attributed to Claudine Jurkovitz.

7 recordsLinked to original sources

PubMed2006

Anemia and cardiovascular and kidney disease.

PURPOSE OF REVIEW: The joint occurrence of cardiovascular disease, kidney disease and anemia has been termed the 'cardio-renal-anemia syndrome'. This review will examine each of these relationships as they pertain to coronary heart disease. RECENT FINDINGS: Important contributions from the recent literature included observations suggesting that African-Americans with chronic kidney disease and no previous history of cardiovascular disease were more likely than caucasians to have incident cardiovascular disease than caucasians with chronic kidney disease but that this difference did not apply to risk of recurrent cardiovascular disease. Recent reports have brought attention to a continued lack of clinical trials evidence to support anemia treatment for cardioprotection, further concern that higher hemoglobin levels may increase cardiovascular risk and evidence that anemia and kidney function interact to increase risk for coronary heart disease. Finally, additional observational studies and small clinical trials continue to support a role of anemia treatment in protection of residual kidney function, although a recent meta-analysis failed to demonstrate a conclusive benefit of erythropoietin treatment on progressive kidney disease. SUMMARY: The cardio-renal-anemia syndrome is a set of complex and interrelated phenomena that are poorly understood. Current evidence is insufficient to demonstrate a conclusive benefit of treatment with erythropoietin on risk of cardiovascular disease or progression of kidney disease. Future research is needed to further clarify these issues.

Adult↗

PubMed2005

Coronary stent restenosis in patients treated with cilostazol.

BACKGROUND: Restenosis after implantation of coronary artery stents remains a significant clinical problem. We undertook a randomized, double-blind, placebo-controlled trial to determine whether cilostazol, a drug that suppresses intimal proliferation, would reduce renarrowing in patients after stent implantation in native coronary arteries. METHODS AND RESULTS: We assigned 705 patients who had successful coronary stent implantation to receive, in addition to aspirin, cilostazol 100 mg BID or placebo for 6 months; clopidogrel 75 mg daily was administered to all patients for 30 days. Restenosis was determined by quantitative coronary angiography at 6 months. The minimal luminal diameter at 6 months for cilostazol-treated patients was 1.77 mm for the analysis segment (stent plus 5-mm borders) compared with 1.62 mm in the placebo group (P=0.01). Restenosis, defined as > or =50% narrowing, occurred in 22.0% of patients in the cilostazol group and in 34.5% of the placebo group (P=0.002), a 36% relative risk reduction. Restenosis was significantly lower in cilostazol-treated diabetics (17.7% versus 37.7%, P=0.01) and in those with small vessels (23.6% versus 35.2%, P=0.02), long lesions (29.9% versus 46.6%, P=0.04), and left anterior descending coronary artery site (19.3% versus 39.8%, P=0.001). There was no difference in bleeding, rehospitalization, target-vessel revascularization, myocardial infarction, or death. CONCLUSIONS: Treatment with the drug cilostazol resulted in a significantly larger minimal luminal diameter and a significantly lower binary restenosis rate compared with placebo-treated patients. These favorable effects were apparent in patients at high risk for restenosis.

Aged↗

PubMed2005

Population-based screening for family history of end-stage renal disease among incident dialysis patients.

BACKGROUND: We determined the familial aggregation of end-stage renal disease (ESRD) in a large, population-based sample of incident ESRD cases to assess the feasibility of developing a targeted screening and prevention program directed at members of families at high risk for kidney disease. METHODS: Between January 1, 1995, and December 31, 2003, incident dialysis patients in ESRD Network 6 facilities were asked to complete a voluntary questionnaire on family history (FH) of ESRD. Cases with ESRD attributed to Mendelian diseases or urologic causes were excluded. FH was considered present if first- or second-degree relatives had ESRD. De-identified FH data were collated with demographic data at dialysis initiation. RESULTS: More than 46% of eligible patients (25,883/55,929) provided FH information and 22.8% (5,901/25,883) of these reported having a FH of ESRD. FH of ESRD was positively associated with female gender, earlier age at ESRD onset, and primary cause of ESRD, and negatively associated with white race. FH associations with age, race, gender, and primary cause of renal failure remained statistically significant after simultaneous adjustment in a multivariate logistic regression model. CONCLUSIONS: Approximately 23% of incident dialysis patients have close relatives with ESRD. Far more are likely to have relatives with clinically silent proteinuria or chronic kidney disease (CKD), both risk factors for future cardiovascular events and ESRD. Physicians caring for patients with CKD should be aware of the marked familial aggregation of ESRD and consider focusing screening efforts on high-risk family members in an attempt to slow the exponential growth rate of kidney disease.

Black or African American↗

PubMed2005

Prevalence of family history of kidney disease and perception of risk for kidney disease: a population-based study.

BACKGROUND: A family history of kidney disease is associated with an increased risk for end-stage renal disease (ESRD). However, it is unclear whether blacks are more likely to have a family history of ESRD than other groups independently of kidney disease risk factors. Moreover, their risk perception for kidney disease is unknown. METHODS: The association of race with family history of ESRD and perception of risk for kidney disease was examined in a representative random sample of 402 Georgia residents who completed a telephone interview. Logistic regression analysis was used to derive adjusted odds ratios and 95% confidence intervals for the association between race and family history of ESRD, controlling for age, sex, education level, being a Georgia native, diabetes, hypertension, and personal history of kidney disease. A multinomial logit model was used to derive adjusted estimates for the association between race and perception of risk for kidney disease. RESULTS: Mean age was 43.2 years, 41.0% of respondents were men, 20.1% were black, 6.6% had diabetes, 21.4% had hypertension, 1.6% had a personal history of kidney disease, and 3.7% reported a family member with ESRD. Although blacks were more likely to report a family history of ESRD (odds ratio, 6.43; 95% confidence interval, 2.02 to 20.43), their perception of risk was not greater. CONCLUSION: Although blacks are approximately 6 times as likely to report a family history of ESRD independently of a personal history of kidney disease, diabetes, or hypertension, they do not perceive themselves as more vulnerable for kidney disease.

Adult↗

PubMed2003

Screening for chronic kidney disease: unresolved issues.

End-stage renal disease is epidemic in the United States. As a measure to control this epidemic, it has been recommended that individuals who are at risk for CKD be tested for undetected kidney disease during routine health care encounters. There are generally accepted criteria against which screening recommendations for CKD control and prevention programs should be judged. If detection strategies are to be adopted for the screening of kidney disease, then CKD must represent a significant public health problem, be characterized by a clear natural history with a detectable asymptomatic period, outcomes should be improved by early treatment, and acceptable screening tests should be available. Health systems must provide adequate and appropriate follow-up medical care for individuals with newly detected CKD. Finally, the cost-effectiveness of screening needs to be demonstrated and the effectiveness of screening as a means of achieving reductions in CKD should be proven in randomized trials.

Chronic Disease↗

PubMed2002

Family members of patients treated for ESRD have high rates of undetected kidney disease.

BACKGROUND: Early intervention during the course of chronic kidney disease (CKD) may delay the progression to end-stage renal disease (ESRD). Several studies have reported that relatives of patients with ESRD are at risk for kidney disease (KD), but little is known about the prevalence and awareness of CKD in this population, which is the object of this report. METHODS: We conducted a cross-sectional survey by way of a voluntary screening of relatives of patients with ESRD in 10 communities in one southeastern state. Age; race; sex; family and personal history of KD, hypertension, and diabetes; height; weight; and blood pressure were determined. Proteinuria and random blood glucose and serum creatinine were measured. Creatinine clearance (CrCl) was assessed using the Cockroft-Gault formula. RESULTS: Among 769 screened adults, 29.2% with a family history of ESRD were included in the study sample. CKD (CrCl < 90 mL/min) was present in 49.3%, 13.9% had a CrCl less than 60 mL/min, and 9.9% had proteinuria of 1+ or greater. Among those with a CrCl less than 60 mL/min or a proteinuria of 1+ or greater, or both, only 13.0% were aware of their KD. Awareness of CKD was not associated with age, race, sex, education, control of diabetes and hypertension, or physician's visits. Among those who had seen a physician recently, only 7.9% were aware of their KD. CONCLUSION: Awareness of KD is less than expected among relatives of patients with ESRD considering the high prevalence of CKD in this population. Screening these individuals might help identify people with early KD.

Adolescent↗

PubMed2002

Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study.

The purpose of this retrospective cohort study was to examine the associations among chronic kidney disease, anemia, and risk of death among patients with heart failure. Retrospective cohort study. Patients with a principal diagnosis of heart failure (ICD9 codes 402.01, 402.11, 402.91, 404.01, 404.11, 404.91, and 428.xx) were included. Chronic kidney disease (CKD) was defined as a serum creatinine >1.4 mg/dl for women and >1.5 mg/dl for men. There were 665 eligible patients in the sample with a mean (SD) age of 75.7 (10.9) yr; 60% were women, 71% were white, and 38% had CKD. On admission, a hematocrit > or =40% was found for 30.3% of the patients; 22.9% had a hematocrit between 36% and 40%, 33.2% between 30% and 35%, and 13.6% had a hematocrit of <30%. The 1-yr death rates among individuals with and without CKD were 44.9% and 31.4%, respectively (relative risk [RR], 1.43; 95% confidence interval [CI], 1.17 to 1.75). The mortality at 1 yr was 31.2% for individuals with a hematocrit > or =40%; 33.8% (RR, 1.08; 95% CI. 0.79 to 1.47) for hematocrit 36 to 39%; 36.7% (RR, 1.17; 95% CI, 0.89 to 1.54) for hematocrit between 30 and 35%; and 50.0% (RR, 1.60; 95% CI, 1.19 to 2.16) for those with a hematocrit <30% (chi(2) for trend was 7.37; P = 0.007). Both hematocrit and serum creatinine were independently associated with increased risk of death during follow-up after controlling for other patient risk factors. In conclusion, CKD and anemia are frequent among older patients with heart failure and are independent predictors of subsequent risk of death.

Aged↗