Interplay of Cardiovascular Disease and Renal Disease

Abstract

Patients with chronic kidney disease are at increased risk of cardiovascular disease. These patients are often excluded in randomized controlled trials of treatments for cardiovascular disease, leading to greater uncertainty behind treatment effects in this population. Further, patients with kidney disease experience unique complications from accepted therapies for the general population, e.g.; long-term anticoagulation may be result in further kidney injury called anticoagulation-related nephropathy. However, incidence and magnitude of this acute kidney injury are not adequately measured in past randomized controlled trials of anticoagulation. Chapters in this thesis aim to increase our understanding the relationship between cardiac and kidney disease. Chapters 2 and 3 focus on the optimal prosthetic valve in dialysis patients requiring valve replacement surgery. Chapter 2 is a systematic review and meta-analysis comparing the short and long-term outcomes of two prosthetic valves implanted in dialysis patients. Chapter 3 is a survey of physicians aiming to understand the current practice of nephrologists, cardiologists, and cardiac surgeons caring for dialysis patients requiring valve replacement surgery and their preference for either prosthetic valve based on patient factors. Chapter 4 explores the interaction between an individual’s baseline kidney function and the effect on stroke reduction of occluding the left atrial appendage. This is accomplished by a secondary analysis of the Left Atrial Appendage Occlusion Study 3 (LAAOS III). Chapter 5 is a rationale and study design of LIMIT-Renal, a substudy of Low INR to Minimize Bleeding with Mechanical Valves Trial (LIMIT). This substudy aims to validate the existence of anticoagulation-related nephropathy, a form of acute kidney injury in patients receiving long-term anticoagulation, and its magnitude on renal health. Chapter 6 is the conclusion of the thesis and discusses key findings, strengths and limitations, future directions, and potential obstacles.