chronic kidney disease and arrhythmias

42 Pages·2017·2.76 MB·English

KDIGO 2016 Controversies Conference
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HRONIC IDNEY ISEASE
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AND RRHYTHMIAS
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Wolfgang Winkelmayer
This presentaBon is based on: Turakhia M. et al., SubmiKed.
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ISCLOSURES
•  Salary supported from federal grants (NIDDK, NHLBI, NIAMS,
AHRQ) and clinical acBviBes.
•  Advisory Boards/Consultancies (past 3 years: ACUMEN, Akebia,
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AMAG, Amgen, Astra-Zeneca, Bayer, Daichii Sankyo, Fibrogen,
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Relypsa, Vifor FMC Renal Pharma)
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•  Data Safety Monitoring Board (Medtronic, Zoll)
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•  Co-Editor, AJKD
•  Associate Editor, JAMA
•  Member, Public Policy Board, American Society of Nephrology
•  Co-Chair, Kidney Disease: Improving Global Outcomes, KDIGO®
Kidney Disease: Improving Global Outcomes
P 1:
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NTRODUCTION
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Kidney Disease: Improving Global Outcomes
CKD H R D
AND EART HYTHM ISORDERS
•  PaBents with CKD are predisposed to atrial fibrillaBon/fluKer,
supraventricular tachycardias, ventricular arrhythmias, and
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sudden cardiac death (SCD).
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•  Treatment opBons are complex and limited in CKD.
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•  PaBents with CKD are historically underrepresented in clinical
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trials of treatment for heart rhythm disorders.
•  Considerable gaps exist in the evidence base for treaBng
paBents with CKD and heart rhythm disorders.
Kidney Disease: Improving Global Outcomes
KDIGO C C
ONTROVERSIES ONFERENCE
•  CKD and Arrhythmias—October 27–30, 2016 in Berlin,
Germany.
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•  InternaBonal, mulBdisciplinary conference, divided into five
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breakout groups:
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–  Epidemiology of Atrial FibrillaBon and Stroke in Kidney Disease
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–  Stroke PrevenBon in Atrial FibrillaBon and CKD
–  Rate vs. Rhythm Control in Atrial FibrillaBon in CKD
–  Risk PredicBon and PrevenBon of SCD in CKD
–  Potassium Homeostasis and Handling in CKD and Dialysis
Kidney Disease: Improving Global Outcomes
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ONFERENCE OALS
•  Assess the current state of knowledge related to the
evaluaBon, management, and treatment of arrhythmias
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and CKD.
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•  IdenBfy controversial topics and knowledge gaps.
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•  Propose a research agenda to resolve these issues.
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•  Determine whether there is sufficient evidence to develop a
clinical pracBce guideline
•  Help pave the way to harmonize cross-talk between the heart
and the kidney communiBes.
Kidney Disease: Improving Global Outcomes
P 2:
ART
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A F (AF)
TRIAL IBRILLATION AND
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TROKE IN D
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Kidney Disease: Improving Global Outcomes
A F
TRIAL IBRILLATION
•  Most common arrhythmia
–  AffecBng ~2.7-6.1 million Americans in 2010
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–  May increase to 12.1 million by 2030
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–  Worldwide prevalence, ~33.5 million in 2010
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–  Age-adjusted incidence of AF increased by 12% from 1980-2000
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(Olmstead County, MN)
–  LifeBme AF risks are (Framingham Heart Study)
•  23% for women and 26% for men at age 40
Kidney Disease: Improving Global Outcomes
A F S
TRIAL IBRILLATION AND TROKE
AF increases risk of ischemic stroke 4- to 5-fold
–  Paroxysmal, persistent, and permanent AF all predispose to
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subsequent ischemic stroke
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–  Diagnosed AF responsible for at least 15% to 20% of all ischemic
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strokes
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–  Subclinical AF increasKes subsequent risk of stroke or peripheral
embolism 2.5-fold
–  Subclinical (undiagnosed) AF may be responsible for another 13% of
ischemic strokes
Healey JS, et al. NEJM 2012;366:120
Kidney Disease: Improving Global Outcomes
A F O O
TRIAL IBRILLATION AND THER UTCOMES
•  While stroke is the most “recognizable” outcome of AF,
analysis of the RE-LY trial showed that:
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–  7% of deaths from stroke, but
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–  22% were from sudden cardiac death
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–  15% from heart failure
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–  36% non-cardiovascular death
Marijon E, et al. Circula2on 2015;128:2192
Kidney Disease: Improving Global Outcomes