The mechanisms and consequences of haemodialysis induced acute cardiac injury

Patients on dialysis are subject to a hugely elevated risk of cardiovascular mortality. Incidence and prevalence of, and mortality and morbidity from heart failure is significantly higher in the haemodialysis population than the general population as a whole. This thesis describes research work focusing on the large scale haemodynamic changes that occur during haemodialysis and how they may negatively impact on the cardiovascular system. Our results show that the haemodynamic disturbances which occur during haemodialysis are capable of causing a reduction in myocardial blood flow sufficient in magnitude to induce myocardial ischaemia. This is associated with a matched reduction in regional left ventricular (LV) function and is entirely in keeping with other published work describing haemodialysis induced myocardial stunning reflecting subclinical myocardial ischaemia (myocardial stunning). In addition, we now know that this phenomenon of haemodialysis induced myocardial ischaemia and stunning is common and associated with both short and long term complications including ventricular arrhythmias, left ventricular dysfunction, an increased hazard of death and time to first cardiovascular event. This is pertinent as in non-dialysis patients repeated episodes of myocardial stunning lead to chronic heart failure, and in dialysis patients the presence of LV dysfunction dramatically increases the risk of death. We also identified a number of factors associated with the presence of myocardial stunning including age, raised biochemical markers of cardiac damage (troponin-T), higher ultrafiltration volumes and lower intradialytic blood pressure. This is of crucial importance as ultrafiltration volumes and intradialytic haemodynamics are potentially modifiable risk factors that could provide targets for dialysis based interventions aimed at improving cardiovascular outcomes in the haemodialysis population

Information for Conservation Decisions: The IIASA Approach

Sound policy decisions concerning the complex interrelationships between sustainable agricultural production potential, resource use, technical change, and the environment, require much detailed information on the site-specific nature of resource inputs and alternative land-use practices over time. Realizing that these information requirements transcend geographic, economic, and potential boundaries, the Food and Agriculture program (FAP) of the International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria, has initiated a series of case studies directed at examining the relationships for the United States (Iowa), Hungary, U.S.S.R. (Stavropol Regions0), Czechoslovakia (Nitra Region), Italy (Tuscany Region), Northeastern Bulgaria, and Japan. The purpose of this paper is to provide an overview of the objectives, methodological framework, and potential information available from this aspect of FAP\u27s research, with emphasis on the Iowa Case Study

The mechanisms and consequences of haemodialysis induced acute cardiac injury

Patients on dialysis are subject to a hugely elevated risk of cardiovascular mortality. Incidence and prevalence of, and mortality and morbidity from heart failure is significantly higher in the haemodialysis population than the general population as a whole. This thesis describes research work focusing on the large scale haemodynamic changes that occur during haemodialysis and how they may negatively impact on the cardiovascular system. Our results show that the haemodynamic disturbances which occur during haemodialysis are capable of causing a reduction in myocardial blood flow sufficient in magnitude to induce myocardial ischaemia. This is associated with a matched reduction in regional left ventricular (LV) function and is entirely in keeping with other published work describing haemodialysis induced myocardial stunning reflecting subclinical myocardial ischaemia (myocardial stunning). In addition, we now know that this phenomenon of haemodialysis induced myocardial ischaemia and stunning is common and associated with both short and long term complications including ventricular arrhythmias, left ventricular dysfunction, an increased hazard of death and time to first cardiovascular event. This is pertinent as in non-dialysis patients repeated episodes of myocardial stunning lead to chronic heart failure, and in dialysis patients the presence of LV dysfunction dramatically increases the risk of death. We also identified a number of factors associated with the presence of myocardial stunning including age, raised biochemical markers of cardiac damage (troponin-T), higher ultrafiltration volumes and lower intradialytic blood pressure. This is of crucial importance as ultrafiltration volumes and intradialytic haemodynamics are potentially modifiable risk factors that could provide targets for dialysis based interventions aimed at improving cardiovascular outcomes in the haemodialysis population

Effects of No-Tillage Production Practices on Crop Yields as Influenced by Crop and Growing Environment Factors

This paper evaluated differences between yields of no-tillage compared to conventional or reduced tillage and their associated downside risk. Six crops were evaluated along with how those yields and risks differed by various environmental factors such geographic location, precipitation, soil type and how long the practice had been used.no-tillage, conservation, conventional tillage, downside-risk, yield, Agribusiness, Environmental Economics and Policy, Farm Management, Land Economics/Use, Production Economics, Risk and Uncertainty,

The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation - Preliminary Results of a Pilot Study

This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.Background/Aims: Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. Results: Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated

Microparticles and exercise in clinical populations

Microparticles (MPs) are shed membrane vesicles released from a variety of cell types in response to cellular activation or apoptosis. They are elevated in a wide variety of disease states and have been previously measured to assess both disease activity and severity. However, recent research suggests that they also possess bioeffector functions, including but not limited to promoting coagulation and thrombosis, inducing endothelial dysfunction, increasing pro‐inflammatory cytokine release and driving angiogenesis, thereby increasing cardiovascular risk. Current evidence suggests that exercise may reduce both the number and pathophysiological potential of circulating MPs, making them an attractive therapeutic target. However, the existing body of literature is largely comprised of in vitro or animal studies and thus drawing meaningful conclusions with regards to health and disease remains difficult. In this review, we highlight the role of microparticles in disease, comment on the use of exercise and dietary manipulation as a therapeutic strategy, and suggest future research directions that would serve to address some of the limitations present in the research to date

The impact of exercising during haemodialysis on blood pressure, markers of cardiac injury and systemic inflammation - preliminary results of a pilot study

Background/Aims: Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. Results: Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated

An increase in circulating monocyte and platelet derived microparticles during haemodialysis

An increase in circulating monocyte and platelet derived microparticles during haemodialysi