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Long-Term Survival of Incident Hemodialysis Patients Who Are Hospitalized for Congestive Heart ailure! Pulmonary "dema!

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Debasish Banerjee*, Jennie Z. Ma , Allan J. Collins , Charles A. Herzog + Author Affiliations * Renal and Transplantation Unit, St. George's Hospital NHS Trust, London, United Kingdom; Department o !u"li# Healt$ S#ien#es, Uni%ersit& o 'irginia, ($arlottes%ille, 'irginia; and ) (ardio%as#ular Spe#ial Studies (enter, United States Renal Data S&stem, *inneapolis, *innesota Correspondence$ Dr. Debasish Banerjee, enal an! "rans#lantation $nit, %t. &eorge's Hos#ital (H% "rust, "ooting, )on!on, $*, %+,- ./". 0hone1 2234.5-4674.28 9a:1 2234.5-464.;58 <3=ail1 Debasish.Banerjee>stgeorges.nhs.u? (e:t %e@tion

A%stract
Ba@?groun! an! obje@tiAes1 MortalitB in #atients Cho are on =aintenan@e he=o!ialBsis an! haAe @ongestiAe heart failure is high in s=all @ohort stu!ies. "he ai= of this stu!B Cas to !eter=ine long3ter= surAiAal in a large @ohort of !ialBsis #atients Cith @ongestiAe heart failure an! sus#e@te! flui! oAerloa! or #ul=onarB e!e=a. Design, setting, #arti@i#ants, D =easure=ents1 Data Cere analBze!, retros#e@tiAelB, on ,,,,E,5.5 #atients Cho starte! he=o!ialBsis betCeen JanuarB ,E-- an! De@e=ber ,EEE. %urAiAal Cas esti=ate! fro= the first Fin!e:G hos#ital a!=ission Cith @ongestiAe heart failure, flui! oAerloa!, or #ul=onarB e!e=a, after ;. ! of su@@essful he=o!ialBsis using the life3table =etho!. "he i=#a@t of #atient @hara@teristi@s on out@o=e Cas assesse! bB the Co: #ro#ortional hazar!s =o!el. esults1 Hf the 7,.,26; #atients in@lu!e! in the stu!B, 477,262 Cere a!=itte! Cith @ongestiAe heart failure, ;7,55; Cith flui! oAerloa!, an! ,7,,,; Cith #ul=onarB e!e=a. "he #atients Cith @ongestiAe heart failure Cere ol!er an! often Chite an! ha! !iabetes or hB#ertension as the @ause of renal failure. Deaths !uring the in!e: hos#ital a!=ission Cere 5.-I for @ongestiAe heart failure, 2..I for flui! oAerloa!, an! ;.;I for #ul=onarB e!e=a. 9iAe3Bear surAiAal Cas ,4.6, 4..4, an! 4,.7I, res#e@tiAelB. "he in!e#en!ent #ositiAe #re!i@tors for =ortalitB in these #atients Cere age, =ale gen!er, !iabetes, hB#ertension, historB of @ar!ioAas@ular !isease, an! @ongestiAe heart failure. Con@lusions1 "his stu!B !e=onstrates AerB #oor surAiAal in !ialBsis #atients Cho #resent Cith @ongestiAe heart failure, #ul=onarB e!e=a, or flui! oAerloa! @o=#are! Cith #atients Cho #resent Cith @ongestiAe heart failure Cithout renal failure. Meti@ulous =anage=ent of @ar!ioAas@ular ris? shoul! i=#roAe surAiAal.

MortalitB in #atients Cho are on =aintenan@e he=o!ialBsis is high an! #re!o=inantlB @ar!ioAas@ular @o=#are! Cith the general #o#ulation. %u!!en @ar!ia@ !eaths relate! to arrhBth=ias are a =ajor @ontributor to all @ar!ioAas@ular !eaths F,G. Contributing to the a!Aerse @ar!ioAas@ular eAents are asB=#to=ati@ left Aentri@ular !Bsfun@tion, sB=#to=ati@ heart failure, left Aentri@ular hB#ertro#hB, an! @oronarB arterB !isease, Chi@h are highlB #reAalent in #atients Cho are on =aintenan@e he=o!ialBsis F4J2G. "he nature an! out@o=e of su@h @ar!ia@ abnor=alities on he=o!ialBsis are !ifferent fro= the general #o#ulation, not Cell inAestigate!, an! #oorlB un!erstoo! F6,;G. CongestiAe heart failure FCH9G is asso@iate! Cith #oor out@o=e in #atients Cho are on =aintenan@e he=o!ialBsis. %=all @ohorts of sele@te! #atient grou#s !e=onstrate the high !eath rates in #atients Cho haAe heart failure an! are on he=o!ialBsis F-G8 hoCeAer, large @ohort stu!ies Cith long3ter= folloC3u# !ata are la@?ing. "his is the first su@h atte=#t to stu!B a large @ohort Cith CH9 an! flui! oAerloa!, Chi@h in@lu!e! large subgrou#s of #atients Cith !ifferent ethni@itB, #atients Cith !iabetes, an! el!erlB #atients. Distinguishing CH9 fro= flui! oAerloa! in a #atient Cho #resents Cith shortness of breath, ortho#nea, an! lung @ra@?les before he=o!ialBsis @oul! be !iffi@ult F5G. "he flui! oAerloa! @oul! be !ue to la@? of a!heren@e to flui! restri@tion. "he usual =anage=ent in that @lini@al s@enario is ultrafiltration8 hoCeAer, no stu!ies haAe e:a=ine! the long3ter= surAiAal of su@h #atients Cith flui! oAerloa!, #resu=ablB as a result of in@rease! flui! inta?e, Cithout CH9. Kt @oul! be hB#othesize! that theB Cill haAe a better #rognosis than #atients Cith CH9. "his stu!B e:a=ine! the long3ter= surAiAal in #atients Cith flui! oAerloa! in a large @o==unitB3base! !ialBsis @ohort an! @o=#are! it Cith #atients Cho ha! !iagnose! heart failure. 0reAious %e@tion(e:t %e@tion

Concise &ethods
"o e:a=ine the long3ter= surAiAal in #atients Cith CH9 or flui! oAerloa!, Ce @on!u@te! a retros#e@tiAe analBsis on a @ohort of #atients Cho starte! he=o!ialBsis in the $nite! %tates betCeen JanuarB ,E-- an! De@e=ber ,EEE. "he $% enal Data %Bste= !atabase F@o=#ose! #re!o=inantlB of Me!i@are @lai=s !ataG Cas the !ata sour@e for the stu!B. "he first Fin!e:G hos#ital a!=ission Cith heart failure, flui! oAerloa!, or #ul=onarB e!e=a at least ;. ! after !ialBsis initiation Cas @onsi!ere! for analBsis. "he !ata for in!e: hos#italization Cere obtaine! fro= Me!i@are 0art A hos#ital @lai=s, as Aali!ate! in a #reAious stu!B FEG. "he #atient @ohorts Cere i!entifie! fro= the +nternational (lassi i#ation o Diseases, Nint$ Re%ision, (lini#al *odi i#ation @o!es for CH9 F245.LG, flui! oAerloa! F4-;.;G, or #ul=onarB e!e=a F6,5.2G. Knitial assu=#tion in the stu!B Cas that the !iagnosis of M#ul=onarB e!e=aN Cithout heart failure Cas si=ilar to the !iagnosis of Mflui! oAerloa!.N "he @lini@al hB#othesis Cas that both flui! oAerloa! an! #ul=onarB e!e=a Cithout heart failure, in a !ialBsis #atient, Cere the result of inabilitB to @o=#lB Cith flui! restri@tion. "he @ohorts Cere folloCe! fro= the in!e: hos#italization until !eath, trans#lantation, or en! of stu!B. )ong3ter= surAiAal Cas esti=ate! Cith the life3table =etho!. 9urther a!juste! analBses Cere #erfor=e! using the Co: #ro#ortional hazar!s =o!el to assess the i=#a@t of in!e#en!ent #re!i@tors, in@lu!ing age, gen!er, ra@e, ethni@itB, #ri=arB @ause of renal failure, an! @o=orbi!ities before stu!B. "he @o=orbi!ities in@lu!e! !iseases of the @ar!ioAas@ular, neurologi@, res#iratorB, an! gastrointestinal sBste=s. "he !iagnosis of CH9, flui! oAerloa!, or #ul=onarB e!e=a Cas =a!e fro= 0art A of Me!i@are @lai=s !ata at the first #resentation ;. ! after starting !ialBsis, Chereas the !ata on @o=orbi!ities Cere obtaine! fro= both 0art A Fin#atientG an! 0art B Fout#atientG of Me!i@are @lai=s, at anB ti=e, using a #reAiouslB !eAelo#e! =etho! an! Aali!ate! in #atients

F,.,,,G. "hus, there Cere no #reAious hos#italizations for CH9, flui! oAerloa!, or #ul=onarB e!e=a before the in!e: hos#italization an! ;. ! after the start of he=o!ialBsis. "he stu!B Cas a##roAe! bB the institutional reAieC boar! of Hanne#in CountB Me!i@al Center FMinnea#olis, M(G. %urAiAal Cas esti=ate! for CH9, flui! oAerloa!, an! #ul=onarB e!e=a. %urAiAals of subgrou#s Cere @o=#are! using the log3ran? test. Kt Cas further a!juste! in the Co: #ro#ortional hazar!s =o!el for age, gen!er, ra@e, ethni@itB, #ri=arB @ause of renal failure, an! @o=orbi! =e!i@al @on!itions. %A% 5 F%A% Knstitute, CarB, (CG Cas use! for statisti@al analBsis. 0reAious %e@tion(e:t %e@tion

'esults
Data Cere analBze! on ,,,,E,5.5 in@i!ent he=o!ialBsis #atients. During the stu!B #erio! an! after the first ;. ! of su@@essful he=o!ialBsis, 7,.,26; #atients Cere i!entifie! as being a!=itte! to the hos#ital Cith the !iagnosis of CH9, flui! oAerloa!, or #ul=onarB e!e=a. A @ohort of 477,262 #atients Cere a!=itte! Cith a sole !iagnosis of CH9. "he rest of the #atients Cere a!=itte! Cith either flui! oAerloa! Fn O ;7,55;G or #ul=onarB e!e=a Fn O ,7,,,;G. "he #atients Cith CH9 Cere ol!er. "heB Cere =ore often Chite an! ha! !iabetes an! !iabeti@ ne#hro#athB @o=#are! Cith #atients Cith flui! oAerloa! or #ul=onarB e!e=a F"able ,G. PieC this table1 Kn this Cin!oC Kn a neC Cin!oC Ta"le ,. De=ogra#hi@s Fn O 7,.,26;G of #atients at initiation of he=o!ialBsisa Deaths !uring the in!e: hos#ital a!=ission Cere higher in CH9 F5.-IG @o=#are! Cith flui! oAerloa! F2..IG or #ul=onarB e!e=a F;.;IG. "he ,3 an! 43Br surAiAals Cere 62., an! 7;.2I Cith CH9, ;6.5 an! 25.7I Cith flui! oAerloa!, an! ;2.E an! 2;.5I for #ul=onarB e!e=a. Hn further folloC3u#, the 63Br surAiAal of the #atients Cith flui! oAerloa! an! #ul=onarB e!e=a Cas #oor1 4..4 an! 4,.7I, res#e@tiAelB. "he 63Br surAiAal in CH9 Cas eAen Corse1 ,4.6I F9igure ,G. Kn the Co: #ro#ortional hazar!s =o!el, the in!e#en!ent #ositiAe #re!i@tors of =ortalitB Cere ol!er age, =ale gen!er, Chite ra@e, !iabetes an! hB#ertension as the @ause of renal failure, #reAious @ar!ioAas@ular @o=orbi!ities, an! CH9 F"able 4G.

PieC larger Aersion1 Kn this #age Kn a neC Cin!oC DoCnloa! as 0oCer0oint %li!e -igure ,. All3@ause surAiAal F@o=#osite grou#sG. <Aent3free surAiAal of #atients Cho Cere on =aintenan@e he=o!ialBsis fro= first hos#italization after initiation of renal re#la@e=ent thera#B Cith @ongestiAe heart failure FCH9G, #ul=onarB e!e=a, an! flui! oAerloa!. PieC this table1 Kn this Cin!oC

Kn a neC Cin!oC Ta"le .. Co: #ro#ortional hazar!s =o!el1 Kn!e#en!ent #re!i@tors of all3@ause !eath F@o=#osite grou#sGa 0reAious %e@tion(e:t %e@tion

(iscussion
"he stu!B reinfor@es the #oor out@o=e in #atients Cith CH9 in a large @ohort of =aintenan@e he=o!ialBsis #atients. "his #heno=enon has been !es@ribe! #reAiouslB but in a s=all @ohort of #atients F-G. "he strength of this stu!B relates to the large size of the @ohort, Cith all !e=ogra#hi@ subgrou#s folloCe! for a long #erio! until a fir= en! #oint Fall3@ause !eathG. Kn @o=#arison Cith the #reAious @ohort stu!B F-G of 274 he=o!ialBsis #atients in@lu!ing ,77 #atients Cith CH9, this stu!B !es@ribes a #oorer surAiAal. "he =e!ian surAiAal Cas ,5 =o @o=#are! Cith 7; =o in the other stu!B. Kt @oul! be e:#laine! bB the larger #ro#ortion of #atients Cith !iabetes an! el!erlB #atients in this stu!B. MoreoAer, it is an unsele@te! #o#ulation Cith large AariabilitB of @are. 0erha#s the e:tre=elB #oor surAiAal in this stu!B is in agree=ent Cith #reAious eAi!en@e of #oor @ar!ioAas@ular out@o=es in #atients Cith asB=#to=ati@ sBstoli@ !Bsfun@tion F7,,4G. "hese fin!ings @olle@tiAelB suggest that @ar!ia@ abnor=alities in he=o!ialBsis #atients for= a s#e@tru=, ranging fro= left Aentri@ular hB#ertro#hB an! left Aentri@ular !ilation to asB=#to=ati@ sBstoli@ !Bsfun@tion an! sB=#to=ati@ heart failure. "he =ortalitB in@reases along the s#e@tru= an! Cith higher ris? #atients, su@h as those Cith !iabetes an! the el!erlB. "his #heno=enon is Cell establishe! in the general #o#ulation F,7,,2G. Kt =ust be note! that the surAiAal of #atients Cho haAe heart failure an! are on he=o!ialBsis is Corse @o=#are! Cith the general #o#ulation. Kn the 9ra=ingha= #o#ulation in ,EE. to ,EEE, the 63Br surAiAal in #atients Cith heart failure Cas ;.I in Co=en an! 2;I in =en, @o=#are! Cith ,4.6I in our he=o!ialBsis #o#ulation F,7G. "he surAiAal of #atients Cith CH9 in the general #o#ulation has also i=#roAe! oAer the Bears. Kn the #reAiouslB =entione! stu!B, the 63 Br surAiAal in =en has i=#roAe! fro= 72 to 2;I F67 to ;.I in Co=enG betCeen the ,E6.s an! the ,EE.s F,7G. %i=ilar tren!s haAe been !e=onstrate! in the $nite! *ing!o= an! <uro#e F,6,,;G. "his is @ertainlB the result of better =anage=ent of the @on!ition in the general #o#ulation. Kn a #reAious stu!B in a si=ilar #o#ulation of 45;,;47 #atients Cho Cere on =aintenan@e he=o!ialBsis betCeen ,E-- an! 4..., there Cas no i=#roAe=ent in surAiAal oAer the Bears. "he 43Br surAiAal after CH9 a!=ission Cas 7-.6I in ,E-- to ,EE., 76.EI in ,EE, to ,EE2, 7;.;I in ,EE6 to ,EE-, an! 7;.6I in ,EE5 to 4...8 hoCeAer, the ti=e3!e#en!ent analBsis Cas not a!juste! for @o=orbi!ities F,-G. "his stu!B also !e=onstrates that the in@i!en@e of heart failure is =u@h higher in #atients Cho are on =aintenan@e he=o!ialBsis @o=#are! Cith the general #o#ulation8 therefore, it @oul! be suggeste! that !iagnosis an! #ro#er =anage=ent of CH9 =ight i=#roAe long3ter= surAiAal in #atients Cho are on =aintenan@e he=o!ialBsis. "his stu!B atte=#te! to !istinguish betCeen CH9 an! flui! oAerloa! For #ul=onarB e!e=a Cithout heart failureG as se#arate ris? fa@tors for a!Aerse out@o=es. 0atients Cith CH9 in this stu!B ha! AerB #oor surAiAal F,4.6I at 6 BrG, Corse than #atients Cith flui! oAerloa! or #ul=onarB e!e=a Cithout heart failure F4..4 an! 4,.7I at 6 Br, res#e@tiAelBG8 hoCeAer, the surAiAal of #atients Cith !iagnosis of flui! oAerloa! or #ul=onarB e!e=a Cas also alar=ing. HB#otheti@allB, the !istin@tion betCeen the tCo =ight haAe so=e a!!e! benefits. Kt #erha#s raises the #ossibilitB of i!entifBing #atients Cho haAe left Aentri@ular !Bsfun@tion hi!!en in the flui! oAerloa! grou# an! =ight nee! e:tra @are8 hoCeAer, as !e=onstrate! in the stu!B, the #ra@ti@al signifi@an@e of su@h !istin@tion is =ini=al.

More i=#ortant, these results #ro=#t further attention toCar! =anage=ent of CH9 in he=o!ialBsis #atients. "he aAailable eAi!en@e is li=ite! but suggests that surAiAal @an be i=#roAe!. 9or #atients Cith #ul=onarB e!e=a or flui! oAerloa!, heart failure is alCaBs in the !ifferential !iagnosis an! so shoul! be =anage! along a si=ilar #athCaB. All su@h #atients Cith heart failure, flui! oAerloa!, an! #ul=onarB e!e=a shoul! haAe an e@ho@ar!iogra= at #resentation. An e@ho@ar!iogra=, if not alrea!B !one, =ight assist in esti=ation of eje@tion fra@tion an! subtle Aolu=e oAerloa! after ultrafiltration F,4,,5G. Kn all a@ute #resentation, a@ute @oronarB sBn!ro=e shoul! be e:@lu!e! Cith ele@tro@ar!iogra= an! bio=ar?ers. As an e:a=#le, in a #atient Cho #resents Cith unusual shortness of breath on a Mon!aB =orning, an ele@tro@ar!iogra= =ight be hel#ful in i!entifBing an a@ute @oronarB eAent. "he #rognosis after =Bo@ar!ial infar@tion is #oor, the =anage=ent of Chi@h Coul! be =ore than ultrafiltration for asso@iate! #ul=onarB e!e=a F,EG. A stress e@ho@ar!iogra= Cith or Cithout @oronarB angiogra= =ight be able to i!entifB an! treat reAersible, @hroni@ is@he=ia3in!u@e! =Bo@ar!ial !Bsfun@tion F4.,4,G. "here is eAi!en@e to suggest the benefit of using Q blo@?ers to i=#roAe out@o=es fro= ran!o=ize!, @ontrolle! trials, a treat=ent that is un!eruse! F44J4;G. Kn #atients Cith @hroni@ ?i!neB !isease an! a@ute =Bo@ar!ial infar@tion, the use of as#irin an! angiotensin3 @onAerting enzB=e inhibitors in a!!ition to Q blo@?ers is asso@iate! Cith i=#roAe! surAiAal F4-,45G. Another =anage=ent strategB, Chi@h is #otentiallB benefi@ial in #atients Cho start he=o!ialBsis, is #erfor=ing an e@ho@ar!iogra= F,4,4E,7.G. As highlighte! in the stu!B, on@e #atients !eAelo# @ongestiAe @ar!ia@ failure or eAen flui! oAerloa! Cithout @lini@allB oAert heart failure, the #rognosis is #oor. K!entifi@ation of left Aentri@ular !Bsfun@tion, Cith an e@ho@ar!iogra=, before !eAelo#=ent of @lini@allB oAert heart failure =ight be of assistan@e F7,,4,,5G. Hn i!entifi@ation of left Aentri@ular hB#ertro#hB, sBstoli@ or !iastoli@ !Bsfun@tion, =anage=ent shoul! in@lu!e aggressiAe treat=ent of hB#ertension Cith !rugs an! Aolu=e @ontrol together Cith treat=ent of =Bo@ar!ial is@he=ia Fin@lu!ing @oronarB reAas@ularizationG. %u@h strategies =ight #reAent subseRuent heart failure an! atten!ing =ortalitB F2G. Kn the stu!B that @o=#are! !ifferent subgrou#s, the #atients Cith !iabetes an! the el!erlB ha! Corse out@o=e. "his is #robablB relate! in@rease! bur!en of is@he=i@ heart !isease in these #atients. "he is@he=i@ bur!en @oul! e:#lain ChB !iabetes, age, an! =ale gen!er are signifi@ant ris? fa@tors of subseRuent =ortalitB !uring folloC3u#. "he #oor surAiAal in Chite #atients is a #reAiouslB Cell3!o@u=ente! #heno=enon. %eAeral hB#otheses @oul! be #ro#ose!. Kt @oul! be !ue to in@rease! !eath in si@?er bla@? #atients before starting !ialBsis Cith li=ite! a@@ess to =e!i@al @are. Kt @oul! also be !ue to the !ifferent nature of @ar!io=Bo#athB in bla@? #atients, being =ore hB#ertensiAe than is@he=i@. "he i=#roAe! surAiAal in #atients Cho Cere on he=o!ialBsis after , Br of starting he=o!ialBsis @oul! be relate! to the in@rease! earlB !eaths of si@?er #atients Cho starte! on !ialBsis. "here are seAeral li=itations of the stu!B, =ostlB relate! to the nature of the !ata set. Kt is a retros#e@tiAe stu!B fro= an a!=inistratiAe !ata set an! la@?s i=#ortant @lini@al infor=ation on #hBsi@al e:a=ination, ele@tro@ar!iogra=, an! e@ho@ar!iogra=. "he grou#s Cith flui! oAerloa! an! #ul=onarB e!e=a Cithout CH9 Cere @onsi!ere! si=ilar an! ha! si=ilar #rognosis. "his is onlB a #resu=#tion an! @annot be Aerifie! Cithout a!!itional @lini@al !ata. "he inferen@es on !iagnosis !e#en! entirelB on @o!ing of hos#ital a!=issions, Chi@h is less reliable @o=#are! Cith !ata @olle@te! in #ros#e@tiAe stu!ies. %eAeral other =anage=ent issues that @oul! haAe altere! the #rognosis of these #atients Cith CH9 Cere not aAailable for @onsi!eration !uring analBsis, in@lu!ing use of =e!i@ations. "he @ar!ioAas@ular !eaths Cere not analBze! se#aratelB

be@ause of the #otentiallB unreliable nature of the !ata on @ause of !eath in the aAailable !ata set. 0reAious %e@tion(e:t %e@tion

Conclusions
"his stu!B !e=onstrates an e:tre=elB #oor surAiAal Cith #atients Cho haAe CH9 an! are on he=o!ialBsis @o=#are! Cith the general #o#ulation. 0atients Cith flui! oAerloa! an! #ul=onarB e!e=a haAe a #oor #rognosis as Cell. "hese results #ro=#t further inAestigations into the #ossible #reAention an! #ro#er =anage=ent of CH9 in #atients Cho are on =aintenan@e he=o!ialBsis. 0reAious %e@tion(e:t %e@tion

(isclosures
(one. 0reAious %e@tion(e:t %e@tion

Ac)no*ledgments
"he Car!ioAas@ular %#e@ial %tu!ies Center of the $% enal Data %Bste= is su##orte! bB @ontra@t HH%(4;-4..-,6..7C F(ational Knstitute of Diabetes an! DigestiAe an! *i!neB Diseases, (ational Knstitutes of Health, Bethes!a, MDG. 0reAious %e@tion(e:t %e@tion

ootnotes
0ublishe! online ahea! of #rint. 0ubli@ation !ate aAailable at CCC.@jasn.org. "he !ata re#orte! here Cere su##lie! bB the $% enal Data %Bste=. "he inter#retation an! re#orting of these !ata are the res#onsibilitB of the authors an! in no CaB shoul! be seen as an offi@ial #oli@B or inter#retation of the $% goAern=ent. e@eiAe! Mar@h 2, 4..-. A@@e#te! JulB 42, 4..-. Co#Bright S 4..- bB the A=eri@an %o@ietB of (e#hrologB 0reAious %e@tion

'eferences
Her/og (0, Li S, 1ein$andl 2D, Strie 31, (ollins 03, Gil"ertson DT4 Sur%i%al o dial&sis patients a ter #ardia# arrest and t$e impa#t o implanta"le #ardio%erter de i"rillators. Kidne& +nt56 46,67 6.8,.998 Cross efMe!line !ar re& !S, -ole& RN, Harnett 3D, Kent G*, *urra& D(, :arre !24 ;ut#ome and ris< a#tors or le t %entri#ular disorders in #$roni# uraemia. Nep$rol Dial Transplant,, 4,.==7 ,.68,,>>5 Abstra@tT9 << 9ull "e:t ?o##ali (, :enedetto -0, Tripepi G, *allama#i -, Rapisarda -, Seminara G, :onanno G, *alatino LS4 Le t %entri#ular s&stoli# un#tion monitoring in as&mptomati# dial&sis patients4 0 prospe#ti%e #o$ort stud&. 3 0m So# Nep$rol,= 4,@597 ,@58,.995 Abstra@tT9 << 9ull "e:t

-ole& RN, !ar re& !S, Kent G*, Harnett 3D, *urra& D(, :arre !24 Serial #$ange in e#$o#ardiograp$i# parameters and #ardia# ailure in endAstage renal disease. 3 0m So# Nep$rol,, 4>,.7 >,5,.999 Abstra@tT9 << 9ull "e:t (ollins 03, Li S, *a 3?, Her/og (4 (ardio%as#ular disease in endAstage renal disease patients. 0m 3 Kidne& DisB6 4S.57 S.>,.99, Me!line Her/og (04 HoC to manage t$e renal patient Cit$ #oronar& $eart disease4 T$e agon& and t$e e#stas& o opinionA"ased medi#ine. 3 0m So# Nep$rol,@ 4.8857 .8=.,.99B 9 << 9ull "e:t Harnett 3D, -ole& RN, Kent G*, :arre !2, *urra& D, !ar re& !S4 (ongesti%e $eart ailure in dial&sis patients4 !re%alen#e, in#iden#e, prognosis and ris< a#tors. Kidne& +nt@= 466@7 6>9,,>>8 Me!line Rit/ 2, Di<oC R, 0dam/#a< *, ?eier *4 (ongesti%e $eart ailure due to s&stoli# d&s un#tion4 T$e (inderella o #ardio%as#ular management in dial&sis patients. Semin Dial,8 4,B87 ,@9,.99. Cross efMe!line :irmanADe&#$ 2, 1aterman 0D, Dan D, Nilasena DS, Rad ord *3, Gage :-4 0##ura#& o +(DA >A(* #odes or identi &ing #ardio%as#ular and stro<e ris< a#tors. *ed (are@B 4@697 @68,.998 Cross efMe!line He"ert !L, Geiss LS, Tierne& 2-, 2ngelgau **, DaCn :!, *#:ean 0*4 +denti &ing persons Cit$ dia"etes using *edi#are #laims data. 0m 3 *ed Eual,@ 4.=97 .==,,>>> Abstra@tT9 << 9ull "e:t 3ollis 3G, 0n#u<ieCi#/ *, DeLong 2R, !r&or D:, *u$l"aier LH, *ar< D:4 Dis#ordan#e o data"ases designed or #laims pa&ment %ersus #lini#al in ormation s&stems4 +mpli#ations or out#omes resear#$. 0nn +ntern *ed,,> 46@@7 689,,>>B Me!line ?o##ali (, :enedetto -0, *allama#i -, Tripepi G, Gia#one G, (ataliotti 0, Seminara G, Stan#anelli :, *alatino LS4 !rognosti# %alue o e#$o#ardiograp$i# indi#ators o le t %entri#ular s&stoli# un#tion in as&mptomati# dial&sis patients. 3 0m So# Nep$rol,8 4,9.>7 ,9B=,.99@ Abstra@tT9 << 9ull "e:t Le%& D, Ken#$aia$ S, Larson *G, :enFamin 23, Kup<a *3, Ho KK, *ura"ito 3*, 'asan RS4 LongAterm trends in t$e in#iden#e o and sur%i%al Cit$ $eart ailure. N 2ngl 3 *edB@= 4,B>=7 ,@9.,.99. Cross efMe!line

1ang T3, 2%ans 3(, :enFamin 23, Le%& D, LeRo& 2(, 'asan RS4 Natural $istor& o as&mptomati# le t %entri#ular s&stoli# d&s un#tion in t$e #ommunit&. (ir#ulation,96 4>==7 >6.,.99B Abstra@tT9 << 9ull "e:t Grigorian SL, Gon/ale/A3uanate& 3R, Roman 0', 0#una 3*, Lamela 0'4 T$e deat$ rate among $ospitali/ed $eart ailure patients Cit$ normal and depressed le t %entri#ular eFe#tion ra#tion in t$e &ear olloCing dis#$arge4 2%olution o%er a ,9A&ear period. 2ur Heart 3.5 4..8,7 ..86,.998 Abstra@tT9 << 9ull "e:t *a#+nt&re K, (apeCell S, SteCart S, ($almers 31, :o&d 3, -inla&son 0, Redpat$ 0, !ell 3!, *#*urra& 334 2%iden#e o impro%ing prognosis in $eart ailure4 Trends in #ase atalit& in 55 8@= patients $ospitali/ed "etCeen ,>65 and ,>>8. (ir#ulation,9. 4,,.57 ,,B,,.999 Abstra@tT9 << 9ull "e:t Her/og (, *a 3?, -ole& RN, (ollins 034 LongAterm sur%i%al o dial&sis patients in t$e United States $ospitali/ed or #ongesti%e $eart ailure G0"stra#tH. 3 0m So# Nep$rol,B 4@B.0 ,.99. ?o##ali (, :enedetto -0, *allama#i -, Tripepi G, Gia#one G, (ataliotti 0, Seminara G, Stan#anelli :, *alatino LS4 !rognosti# impa#t o t$e indeIation o le t %entri#ular mass in patients undergoing dial&sis. 3 0m So# Nep$rol,. 4.=567 .==@,.99, Abstra@tT9 << 9ull "e:t Her/og (0, *a 3?, (ollins 034 !oor longAterm sur%i%al a ter a#ute m&o#ardial in ar#tion among patients on longAterm dial&sis. N 2ngl 3 *edBB> 4=>>7 698,,>>6 Cross efMe!line :oudreau R3, Stron& 3T, du(ret R!, Kuni ((, 1ang D, 1ilson R-, S#$Cart/ 3S, (astanedaA ?uniga 1R4 !er usion t$allium imaging o t&pe + dia"etes patients Cit$ end stage renal disease4 (omparison o oral and intra%enous dip&ridamole administration. Radiolog&,=8 4 ,9B7 ,98,,>>9 Abstra@tT9 << 9ull "e:t Her/og (0, *arCi#< TH, !$ele& 0*, 1$ite (1, Rao 'K, Di#< (D4 Do"utamine stress e#$o#ardiograp$& or t$e dete#tion o signi i#ant #oronar& arter& disease in renal transplant #andidates. 0m 3 Kidne& DisBB 4,9697 ,9>9,,>>> Me!line 0""ott K(, Trespala#ios -(, 0godoa LD, Ta&lor 03, :a<ris GL4 :etaA"lo#<er use in longAterm dial&sis patients4 0sso#iation Cit$ $ospitali/ed $eart ailure and mortalit&. 0r#$ +ntern *ed,5@ 4.@587 .@=,,.99@ Cross efMe!line (i#e G, Tagliamonte 2, -errara L, +a#ono 04 2 i#a#& o #ar%edilol on #ompleI %entri#ular arr$&t$mias in dilated #ardiom&opat$&4 Dou"leA"lind, randomi/ed, pla#e"oA#ontrolled stud&. 2ur Heart 3., 4,.8>7 ,.5@,.999

Abstra@tT9 << 9ull "e:t (i#e G, -errara L, Di :enedetto 0, Russo !2, *arinelli G, !a%ese -, +a#ono 04 Dilated #ardiom&opat$& in dial&sis patients4 :ene i#ial e e#ts o #ar%edilolJ0 dou"leA"lind, pla#e"oA #ontrolled trial. 3 0m (oll (ardiolB= 4@9=7 @,,,.99, Cross efMe!line (i#e G, -errara L, D'0ndrea 0, D'+sa S, Di :enedetto 0, (ittadini 0, Russo !2, Golino !, (ala"ro R4 (ar%edilol in#reases tCoA&ear sur%i%al in dial&sis patients Cit$ dilated #ardiom&opat$&4 0 prospe#ti%e, pla#e"oA#ontrolled trial. 3 0m (oll (ardiol@, 4,@B67 ,@@@,.99B Cross efMe!line Hara D, Hamada *, S$igematsu D, *ura<ami :, HiCada K4 :ene i#ial e e#t o "etaA adrenergi# "lo#<ade on le t %entri#ular un#tion in $aemodial&sis patients. (lin S#i KLondL,9, 4.,>7 ..8,.99, Me!line *#(ulloug$ !0, Sand"erg KR, :or/a< S, Hudson *!, Garg *, *anle& H34 :ene its o aspirin and "etaA"lo#<ade a ter m&o#ardial in ar#tion in patients Cit$ #$roni# <idne& disease. 0m Heart 3,@@ 4..57 .B.,.99. Cross efMe!line 1rig$t RS, Reeder GS, Her/og (0, 0l"rig$t R(, 1illiams :0, D%ora< DL, *iller 1L, *urp$& 3G, Kope#<& SL, 3a e 0S4 0#ute m&o#ardial in ar#tion and renal d&s un#tion4 0 $ig$Aris< #om"ination. 0nn +ntern *ed,B= 485B7 8=9,.99. Cross efMe!line -ole& RN, !ar re& !S, Harnett 3D, Kent G*, *urra& D(, :arre !24 T$e prognosti# importan#e o le t %entri#ular geometr& in uremi# #ardiom&opat$&. 3 0m So# Nep$rol8 4.9.@7 .9B,,,>>8 Abstra@t -ole& RN, !ar re& !S, Harnett 3D, Kent G*, *artin (3, *urra& D(, :arre !24 (lini#al and e#$o#ardiograp$i# disease in patients starting endAstage renal disease t$erap&. Kidne& +nt@= 4 ,657 ,>.,,>>8 Me!line

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