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K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients Tables

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K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients Tables The Official Journal of the National Kidney Foundation VOL 45, NO 4, SUPPL 3, APRIL 2005 CONTENTS American Journal of AJKD Kidney Diseases K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients Tables............................................................................................................................... S1 Figures ............................................................................................................................. S2 Acronyms and Abbreviations........................................................................................ S3 Work Group Members..................................................................................................... S5 K/DOQI Advisory Board Members................................................................................. S6 Foreword.......................................................................................................................... S7 Overview of Epidemiology of Cardiovascular Disease............................................... S8 Overview of Epidemiology of Cardiovascular Disease in Children ........................... S10 SECTION I. GUIDELINES ON EVALUATION AND MANAGEMENT OF CARDIO- VASCULAR DISEASES Guideline 1: Evaluation of Cardiovascular Disease in Adult and Pediatric Patients .. S17 Guideline 2: Coronary Artery Disease ....................................................................... S18 Guideline 3: Acute Coronary Syndromes .................................................................. S21 Guideline 4: Chronic Coronary Artery Disease ......................................................... S23 Guideline 5: Valvular Heart Disease .......................................................................... S27 Guideline 6: Cardiomyopathy (Systolic or Diastolic Dysfunction) ........................... S30 Guideline 7: Dysrhythmia ......................................................................................... S34 Guideline 8: External Defibrillation .......................................................................... S37 Guideline 9: Cerebrovascular Disease ....................................................................... S39 Guideline 10: Peripheral Vascular Disease ................................................................ S43 SECTION II. GUIDELINES ON MANAGEMENT OF CARDIOVASCULAR RISK FACTORS Guideline 11: Diabetes .............................................................................................. S46 Guideline 12: Blood Pressure .................................................................................... S49 Guideline 13: Dyslipidemia....................................................................................... S58 Guideline 14: Smoking, Physical Activity, and Psychological Factors....................... S60 Guideline 15: Anemia................................................................................................ S68 Guideline 16: Arterial Stiffness, Vascular and Valvular Calcification, Calcium, Phosphorus and PTH ............................................................................................ S69 SECTION III. STATE OF THE SCIENCE: NOVEL AND CONTROVERSIAL TOPICS IN CARDIOVASCULAR DISEASES Intradialytic Hypotension ......................................................................................... S76 Biomarkers................................................................................................................ S81 Troponin ............................................................................................................... S81 Inflammation......................................................................................................... S82 Oxidative Stress..................................................................................................... S86 Nutritional and Metabolic Factors ............................................................................ S90 Body Weight and Management.............................................................................. S90 Omega-3 Fatty Acids ............................................................................................. S91 Homocysteine ....................................................................................................... S95 Lipoprotein(a) and Apolipoprotein(a) Polymorphism.......................................... S98 Malnutrition.......................................................................................................... S102 Risk Stratification...................................................................................................... S107 Overview of Risk Stratification .............................................................................. S107 Family History and Genetics ................................................................................. S107 Menopause................................................................................................................ S110 Preventive Foot Care in Diabetes .............................................................................. S113 Aspirin ...................................................................................................................... S114 Methods for Review of Articles...................................................................................... S115 Work Group Biographies................................................................................................ S121 Acknowledgments .......................................................................................................... S127 References....................................................................................................................... S128 K/DOQI Disclaimer Section I: Use of the Guidelines These Guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision-making. They are not intended to define a standard of care, and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every health-care professional making use of these Guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. The recommendations for research contained within this document are general and do not imply a specific protocol. Section II: Development of the Guidelines The National Kidney Foundation makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the working group. Specifically, all members of the working group are required to complete, submit, and sign a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. All affiliations are published in their entirety at the end of this publication in the Work Group Biographies section. In citing this document, the following format should be used: National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients. Am J Kidney Dis 45:S1-S154, 2005 (suppl 3) The development of the K/DOQI Cardiovascular Disease in Dialysis Patients Clinical Practice Guidelines was supported by an educational grant from Satellite Healthcare, Inc. Additional support was received from Genzyme Therapeutics. The National Kidney Foundation gratefully acknowledges the support of Amgen Inc. as the founding and principal sponsor of K/DOQI. Tables Table A. Cardiovascular Mortality in Pediatric CKD Stage 5.......................................................... S11 Table B. Autopsy Studies of Cardiac Pathology in Pediatric CKD Stage 5..................................... S12 Table C. Prevalence of Cardiovascular Risk Factors in Pediatic CKD Stage 5 ............................... S12 Table 1. Comparison of Surgical Interventions for CAD To Prevent Future Cardiovascular Outcomes........................................................................................................................... S25 Table 2. Effect of Tissue versus Nontissue Valve Replacement on Prevention of Future Cardiovascular Outcomes.................................................................................................. S28 Table 3. Presence of Systolic Dysfunction on Echocardiogram as a Predictor of Future CVD Outcomes.................................................................................................................. S31 Table 4. Increased LV Mass Index on Echocardiogram as a Predictor of Future Cardiovascular Outcomes.................................................................................................. S32 Table 5. Dosage Adjustments and Drugs To Be Avoided ................................................................ S35 Table 6. AHA Guidelines for the Prevention, Screening and Evaluation, and Treatment of Stroke, with K/DOQI Modifications ............................................................................. S40 Table 7. Association of Low Ankle-Arm Brachial Index with Risk of Cardiovascular Outcomes..........................................................................................................................
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