02:32pm Tuesday 26 September 2017

Penn Researchers Present Findings on Cardiac Risks for Patients with Chronic Kidney Disease

PHILADELPHIA – Chronic Kidney Disease (CKD), which afflicts more than 26 million Americans, is a condition in which individuals experience a slow loss of kidney function over time. At the American Heart Association Scientific Sessions 2015, researchers from the Perelman School of Medicine at the University of Pennsylvania today presented findings from their analysis of the Chronic Renal Insufficiency Cohort (CRIC) study to evaluate risk markers for adverse cardiac events in patients with CKD. 

Sex Differences in the Incidence of Peripheral Artery Disease (PAD) in the CRIC Study

Researchers examined data from the CRIC study to determine how the epidemiology of peripheral artery disease (PAD) in patients with CKD differs according to patient’s age and gender. Data revealed that the risk of PAD is higher in women as compared to men. Results also showed that while age affected the risk of PAD in men more directly, the risk in women was consistent from year to year, and it began earlier in life. But by the time both men and women reached their 70s, the rate of risk was relatively similar.

“We set out to determine whether there were gender differences in peripheral artery disease in patients with CKD, and found that women had an increased risk compared to men; however, this relationship was modified by age,” said the study’s lead author, Grace Wang, MD, an assistant professor of Surgery and Radiology, and director of the Vascular Laboratory at the Hospital of the University of Pennsylvania. “The analysis showed that women were more at risk for PAD early on, starting around age 40, but the risk in men became greater as they aged.”

Results showed that the risk of PAD in women was 1.5 times higher than the risk in men, prior to age 70. Overall, women with CKD have a higher PAD incidence at nearly 23 percent, as compared to an almost 14 percent in men. Researchers also noted that additional studies should be conducted to understand the impact of earlier detection of PAD in women, as a means for preventing or proactively treating peripheral artery disease.

Funding for the Sex Differences in the Incidence of Peripheral Artery Disease (PAD) in the Chronic Renal Insufficiency Cohort (CRIC) study was supported in part by the University of Pennsylvania Clinical and Translational Science Award NIH/NCATS UL1TR000003; Johns Hopkins University UL1 TR-000424; University of Maryland GCRC M01 RR-16500; Clinical and Translational Science Collaborative of Cleveland UL1TR000439; Michigan Institute for Clinical and Health Research UL1TR000433; University of Illinois at Chicago CTSA UL1RR029879; Tulane University Translational Research in Hypertension and Renal Biology P30GM103337; and Kaiser Permanente NIH/NCRR UCSF-CTSI UL1 RR-024131.

Association of Left Atrial Size and Incident Heart Failure: The CRIC Study

A second Penn research team analyzed CRIC data to identify whether the size of a patient’s left atrium – one of the two upper chambers of the heart – is an indicator of potential heart failure and death among those with chronic kidney disease. Evaluating data collected from 2,936 CKD patients, researchers concluded that left atrial size is in fact a risk marker for heart failure.

“One of the main purposes of the CRIC study is to identify novel risk factors for cardiovascular events in CKD patients,” said the study’s lead author, Payman Zamani, MD, MTR, a heart failure physician and instructor of Medicine in Penn’s Heart Failure and Transplant Cardiology Program. “We know that patients with CKD are at high-risk for cardiovascular events in general, but we need better tools to identify which CKD patients are at the highest risk. Left atrial size is an easily quantifiable metric that provides prognostic information in non-CKD patients, so we evaluated this patient population to determine if it is also an indicator of risk in those with CKD. Our analysis shows that larger left atrial size is associated with an increased risk of heart failure.”

The team adjusted their data analysis to account for the influence of race and gender, as well as other known markers of heart failure risk such as hypertension. The analysis demonstrates that left atrial size continued to provide additional risk information in these high-risk patients.

Funding for the CRIC Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902).

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Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $5.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report‘s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center — which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report — Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.


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