Mario Naranjo

Cost-effectiveness of Intensive Blood Pressure Management—Is There an Additional Price to Pay?

Cost-effectiveness of Intensive Blood Pressure Management—Is There an Additional Price to Pay? To the Editor We read with interest the recent article by Richman et al published in JAMA Cardiology.1 Their analysis looked at outcomes and costs for a Markov cohort model using treatment effects and adverse event rates as reported in the Systolic Blood Pressure Interventional Trial.2 The authors concluded that standard blood pressure (BP) management yielded 9.6 quality-adjusted life-years and accrued

Cardio-Renal Syndrome: A double edged sword

155 261 in lifetime costs, while intensive BP management yielded 10.5 quality-adjusted life-years and accrued

Cervical diffuse idiopathic skeletal hyperostosis (DISH) causing oropharyngeal dysphagia

176 584 in costs, with intensive BP management costing

Preeclampsia as a Form of Type 5 Cardiorenal Syndrome: An Underrecognized Entity in Women’s Cardiovascular Health

23 777 per year gained. To prefer standard BP management, serious adverse events would need to occur at 3-fold the rate observed in the Systolic Blood Pressure Interventional Trial and be 3-fold more common in the intensively managed group. However, this study did not focus on the costs that could potentially be associated with acute kidney injury (AKI) as part of the analysis. This trial showed a higher rate of AKI in the arm with intensive BP control, and because the trial terminated prematurely, no conclusions exist on long-term renal outcomes. While intensive BP management may reduce costs from cardiovascular and cerebrovascular complications, as shown in this study, the long-term effects on worsening renal function cannot be extrapolated from this. Chertow et al3 demonstrated in a cohort of 19 982 adults that an increase in serum creatinine greater than 0.5 mg/dL was associated with a 6.5-fold increase in the odds of death, a 3.5-day increase in hospital stay, and nearly

Letter by Naranjo et al Regarding Article, “Hemodynamic Support With a Micro-Axial Percutaneous Left Ventricular Assist Device (Impella) Protects Against Acute Kidney Injury in Patients Undergoing High-Risk Percutaneous Coronary Intervention”

7500 in excess hospital costs. Over time, recurrent renal insults from relative hypoperfusion in the intensive BP group can potentially add costs associated with AKI and, at some point, progression to chronic kidney disease.4 The US Renal Data System 2015 Annual Data Report5 summarized that Medicare spending for patients with chronic kidney disease exceeded

WHITE BLOOD CELL COUNT TO PLATELET RATIO: A NOVEL BIOMARKER FOR PREDICTING OUTCOMES IN PATIENTS ON CIRCULATORY SUPPORT DEVICES

50 billion. Given the lack of long-term data on the outcomes with increased AKI rates in the intensively managed group, it is important to factor in the costs associated with AKI and chronic kidney disease progression to be able to achieve optimal yet cost-effective outcomes until more longterm data are available.

Effects of Pulmonary Hypertension and Right Ventricular Function in Short and Long-Term Kidney Function.

Cardiorenal Syndrome (CRS) rep interaction is bidirectional, as acute resents a number of important interactions between heart and kidney disease. The or chronic dysfunction of the heart or kidneys can induce acute or chronic dysfunction in the other organ. CRS has traditionally been explained by hemodynamic factors as manifested by a low cardiac output state. However, clinical presentations where concomitant cardiac and kidney dysfunction exist, including heterogeneous conditions, and hence more complex bidirectional interplays between the heart and the kidney have been recognized through a number of physiologic, biochemical, structural and hormonal abnormalities in the pathogenesis of CRS.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict Acute Cellular Rejection in the Kidney Allograft

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition characterised by calcification and ossification of the vertebral ligaments. It is most commonly seen to affect the thoracic and lumbar vertebrae and is usually seen among elderly men. The cause of this condition is unknown. Risk factors include male gender, obesity, diabetes and advancing age. The majority of these cases are found incidentally on imaging and patients are generally asymptomatic. Cervical DISH is less common than its thoracic and lumbar counterparts. When symptomatic, it can cause dysphagia or sometimes airway compromise. If this happens, surgical intervention should be performed. Although a rare cause of dysphagia, DISH is easily diagnosed with imaging. When identified, surgical decompression produces very good clinical outcomes.

Outcomes of Intensive Blood Pressure Lowering in Older Hypertensive Patients: Should AKI Be Watched?

Background: Preeclampsia is a multisystem vascular disorder of pregnancy that remains a leading cause of maternal and fetal morbidity and mortality. Preeclampsia remains an underrecognized risk factor for future cardiovascular and kidney disease in women and represents the confluence of preexisting vascular risk factors with superimposed endothelial injury from placental mediated anti-angiogenic factors. Summary: This review highlights the close relationship between preeclampsia and future cardiovascular and kidney disease. It describes the pathophysiology and current understanding of biomarkers that form the molecular signature for long-term endothelial dysfunction in preeclamptic women. Finally, it describes strategies for early identification and management of women with preeclampsia with elevated risk for cardiovascular and kidney disease. Key Messages: Future rigorous studies on cardiovascular risk modification in this phenotype of disease are essential to reduce the burden of cardiovascular and kidney disease, in women with preeclampsia.

CORONARY STEAL FROM A LEFT INTERNAL MAMMARY ARTERY BYPASS GRAFT VIA HIGH OUTPUT HEMODIALYSIS ARTERIOVENOUS FISTULA

We read with interest the recent article by Flaherty et al1 published in Circulation Research . In the analysis of this retrospective, single-center study, patients were randomized into 2 groups, percutaneous left ventricular assist device (pLVAD) supported and unsupported undergoing high-risk percutaneous coronary intervention. All patients had severely reduced ejection fractions (<35%) and high-risk clinical features. Because acute kidney injury is quite common in this cohort, Impella 2.5 pLVAD support was independently associated with a significant reduction in the risk of …