Cardiovascular disease in patients with end stage renal and chronic kidney disease
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Nearly two thirds of patients with Chronic Kidney Disease and End Stage Renal Disease will die prematurely from cardiovascular causes. Understanding pathologic mechanisms and developing tools for evaluation of cardiac function in dialysis patients is necessary for developing preventive strategies and therapeutic intervention.
Our major focus of clinical research will examine a potential cause of sudden cardiac death in patients with chronic renal insufficiency and renal failure. Patients with chronic kidney disease, and ESRD in particular, commonly demonstrate a parasympathetic neuropathy. Measurement of heart rate beat-to-beat variation permits an accurate assessment of sympatho-vagal tone affecting cardiac electrical conduction. Our initial provocative data suggest a significant, though paradoxical, worsening of autonomic function in dialysis patients with beta blockers and ACE inhibitors, both of which are known to protect against cardiac death in the general population. Changes in cardiac output, central blood volume, peripheral vascular resistance, and left ventricular function will be studied as both drugs affect hemodynamics and intracardiac baroreceptors. A novel, non-invasive ultrasound method will be refined with the assistance of private industry scientists and used to measure these hemodynamic parameters.
A second area of clinical research will investigate the role of mineralocorticoid receptor blockade in individuals on hemodialysis using spironolactone with the aim of reducing cardiovascular (CV) morbidity and mortality in this high-risk population. The initial phase of this study involves an examination of safety and efficacy on surrogate markers such as LVH (assessed with gated MRI), cardiac function, and quality of life.