Rationale and design for the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Sudden cardiac death occurs commonly in the end-stage renal disease population receiving dialysis, with 25% dying of sudden cardiac death over 5 years. Despite this high risk, surprisingly few prospective studies have studied clinical- and dialysis-related risk factors for sudden cardiac death and arrhythmic precursors of sudden cardiac death in end-stage renal disease.

Methods/Design

We present a brief summary of the risk factors for arrhythmias and sudden cardiac death in persons with end-stage renal disease as the rationale for the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study, a prospective cohort study of patients recently initiated on chronic hemodialysis, with the overall goal to understand arrhythmic and sudden cardiac death risk. Participants were screened for eligibility and excluded if they already had a pacemaker or an automatic implantable cardioverter defibrillator. We describe the study aims, design, and data collection of 574 incident hemodialysis participants from the Baltimore region in Maryland, U.S.A.. Participants were recruited from 27 hemodialysis units and underwent detailed clinical, dialysis and cardiovascular evaluation at baseline and follow-up. Cardiovascular phenotyping was conducted on nondialysis days with signal averaged electrocardiogram, echocardiogram, pulse wave velocity, ankle, brachial index, and cardiac computed tomography and angiography conducted at baseline. Participants were followed annually with study visits including electrocardiogram, pulse wave velocity, and ankle brachial index up to 4 years. A biorepository of serum, plasma, DNA, RNA, and nails were collected to study genetic and serologic factors associated with disease.

Discussion

Studies of modifiable risk factors for sudden cardiac death will help set the stage for clinical trials to test therapies to prevent sudden cardiac death in this high-risk population.

Related collections

Most cited references 75

Record: found
Abstract: found
Article: not found

Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function.

John W. Kusek, Denise Cifelli, Jeffrey C. Fink … (2009)

The Chronic Renal Insufficiency Cohort (CRIC) Study was established to examine risk factors for the progression of chronic kidney disease (CKD) and cardiovascular disease (CVD) in patients with CKD. We examined baseline demographic and clinical characteristics. Seven clinical centers recruited adults who were aged 21 to 74 yr and had CKD using age-based estimated GFR (eGFR) inclusion criteria. At baseline, blood and urine specimens were collected and information regarding health behaviors, diet, quality of life, and functional status was obtained. GFR was measured using radiolabeled iothalamate in one third of participants. A total of 3612 participants were enrolled with mean age +/- SD of 58.2 +/- 11.0 yr; 46% were women, and 47% had diabetes. Overall, 45% were non-Hispanic white, 46% were non-Hispanic black, and 5% were Hispanic. Eighty-six percent reported hypertension, 22% coronary disease, and 10% heart failure. Mean body mass index was 32.1 +/- 7.9 kg/m(2), and 47% had a BP >130/80 mmHg. Mean eGFR was 43.4 +/- 13.5 ml/min per 1.73 m(2), and median (interquartile range) protein excretion was 0.17 g/24 h (0.07 to 0.81 g/24 h). Lower eGFR was associated with older age, lower socioeconomic and educational level, cigarette smoking, self-reported CVD, peripheral arterial disease, and elevated BP. Lower level of eGFR was associated with a greater burden of CVD as well as lower socioeconomic and educational status. Long-term follow-up of participants will provide critical insights into the epidemiology of CKD and its relationship to adverse outcomes.

0 comments Cited 204 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The Chronic Renal Insufficiency Cohort (CRIC) Study: Design and Methods.

Harold I. Feldman, Kenneth Jamerson, L. Lee Hamm … (2003)

Insights into end-stage renal disease have emerged from many investigations but less is known about the epidemiology of chronic renal insufficiency (CRI) and its relationship to cardiovascular disease (CVD). The Chronic Renal Insufficiency Cohort (CRIC) Study was established to examine risk factors for progression of CRI and CVD among CRI patients and develop models to identify high-risk subgroups, informing future treatment trials, and increasing application of preventive therapies. CRIC will enroll approximately 3000 individuals at seven sites and follow participants for up to 5 yr. CRIC will include a racially and ethnically diverse group of adults aged 21 to 74 yr with a broad spectrum of renal disease severity, half of whom have diagnosed diabetes mellitus. CRIC will exclude subjects with polycystic kidney disease and those on active immunosuppression for glomerulonephritis. Subjects will undergo extensive clinical evaluation at baseline and at annual clinic visits and via telephone at 6 mo intervals. Data on quality of life, dietary assessment, physical activity, health behaviors, depression, cognitive function, health care resource utilization, as well as blood and urine specimens will be collected annually. (125)I-iothalamate clearances and CVD evaluations including a 12-lead surface electrocardiogram, an echocardiogram, and coronary electron beam or spiral CT will be performed serially. Analyses planned in CRIC will provide important information on potential risk factors for progressive CRI and CVD. Insights from CRIC should lead to the formulation of hypotheses regarding therapy that will serve as the basis for targeted interventional trials focused on reducing the burden of CRI and CVD.

0 comments Cited 192 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Sudden cardiac death in the United States, 1989 to 1998.

Zhi-Jie Zheng, Janet B Croft, Wayne Giles … (2001)

Sudden cardiac death (SCD) is a major clinical and public health problem. United States (US) vital statistics mortality data from 1989 to 1998 were analyzed. SCD is defined as deaths occurring out of the hospital or in the emergency room or as "dead on arrival" with an underlying cause of death reported as a cardiac disease (ICD-9 code 390 to 398, 402, or 404 to 429). Death rates were calculated for residents of the US aged >/=35 years and standardized to the 2000 US population. Of 719 456 cardiac deaths among adults aged >/=35 years in 1998, 456 076 (63%) were defined as SCD. Among decedents aged 35 to 44 years, 74% of cardiac deaths were SCD. Of all SCDs in 1998, coronary heart disease (ICD-9 codes 410 to 414) was the underlying cause on 62% of death certificates. Death rates for SCD increased with age and were higher in men than women, although there was no difference at age >/=85 years. The black population had higher death rates for SCD than white, American Indian/Alaska Native, or Asian/Pacific Islander populations. The Hispanic population had lower death rates for SCD than the non-Hispanic population. From 1989 to 1998, SCD, as the proportion of all cardiac deaths, increased 12.4% (56.3% to 63.9%), and age-adjusted SCD rates declined 11.7% in men and 5.8% in women. During the same time, age-specific death rates for SCD increased 21% among women aged 35 to 44 years. SCD remains an important public health problem in the US. The increase in death rates for SCD among younger women warrants additional investigation.

0 comments Cited 191 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Rulan S Parekh: rulan.parekh@sickkids.ca

Lucy A Meoni: lmeoni@jhsph.edu

Bernard G Jaar: bjaar@jhmi.edu

Stephen M Sozio: ssozio@jhmi.edu

Tariq Shafi: tshafi@jhmi.edu

Gordon F Tomaselli: gtomasel@jhmi.edu

Joao A Lima: jlima@jhmi.edu

Larisa G Tereshchenko: tereshch@ohsu.edu

Michelle M Estrella: mestrel1@jhmi.edu

W H Linda Kao: wkao@jhsph.edu

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2369

Publication date (Electronic): 24 April 2015

Publication date PMC-release: 24 April 2015

Publication date Collection: 2015

Volume: 16

Electronic Location Identifier: 63

Affiliations

[ ]Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, USA

[ ]Department of Epidemiology, Bloomberg School of Public Health|, Johns Hopkins University, Baltimore, USA

[ ]Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA

[ ]Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, USA

[ ]Nephrology Center of Maryland, Baltimore, USA

[ ]Departments of Paediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, ON Canada

[ ]Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR USA

Article

Publisher ID: 50

DOI: 10.1186/s12882-015-0050-4

PMC ID: 4434806

PubMed ID: 25903746

SO-VID: 5ad381d3-20bd-40ee-abae-33bff5c39fd0

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 18 December 2014

Date accepted : 1 April 2015

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: dialysis,hemodialysis,mortality,sudden death,sudden cardiac death,arrhythmia,end stage renal disease

Data availability:

ScienceOpen disciplines: Nephrology

Keywords: dialysis, hemodialysis, mortality, sudden death, sudden cardiac death, arrhythmia, end stage renal disease

Rationale and design for the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study

Read this article at

Abstract

Background

Methods/Design

Discussion

Related collections

Karger: Nephrology

Most cited references 75

Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function.

The Chronic Renal Insufficiency Cohort (CRIC) Study: Design and Methods.

Sudden cardiac death in the United States, 1989 to 1998.

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 273

Cited by 11

Most referenced authors 1,310