Investigating the relationship between FRailty And Quality of LIfe in patients with heart faiLure and CKD (FRAIL study).

AIMS: Patients with chronic kidney disease (CKD) or heart failure (HF) are disproportionally affected by frailty, an independent predictor of morbidity. The prevalence of frailty and its impact on quality of life (QoL) in a unique population of patients with both CKD and HF (CKD-HF) is unclear. The aim of this study was to investigate the association between frailty and QoL in patients with CKD-HF. METHODS AND RESULTS: Patients were identified from a tertiary care cardiorenal clinic. Eligible patients had CKD-HF with a stable estimated glomerular filtration rate of <60 mL/min/1.732. Data were collected from each participant at one point in time using surveys delivered by study personnel between 14 July 2022 and 31 March 2023. Frailty was defined as Modified Frailty Phenotype (MFP) score ≥3. The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) was used to assess QoL. Demographic data were retrospectively collected from electronic patient records. Demographics and QoL were compared between frail and non-frail cohorts using Pearson's R and Student's t-test (two-tailed, alpha-priori = 0.05). One hundred five participants consented, and 103 completed the questionnaires in full. Amongst the 103 participants, 49.5% (n = 51) were frail. Frailty was related to sex (P = 0.021) and medication count (P = 0.007), however not to other clinical measures, including estimated glomerular filtration rate (P = 0.437) and ejection fraction (P = 0.911). Frail patients reported poorer QoL across physical functioning (P < 0.001), general health (P < 0.001), bodily pain (P = 0.004), social functioning (P < 0.001), and energy levels (P < 0.001), however not emotional wellbeing (P = 0.058); 51.5% cited 'better quality of life' as their healthcare priority, over longer survival (23.3%) or avoiding hospital admissions (22.3%). This was consistent across frail and non-frail groups. CONCLUSIONS: A large proportion of CKD-HF patients are frail, regardless of disease severity, and more susceptible to significantly poorer QoL across physical and social domains. Improving QoL is the priority of patients across both frail and non-frail cohorts, further emphasizing the need for prompt recognition of frailty as well as possible intervention and prevention.

Catheter Ablation for Atrial Fibrillation in Patients with Chronic Kidney Disease and on Dialysis: A Meta-Analysis and Review.

BACKGROUND: Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients and is difficult to treat with anti-arrhythmics and anticoagulants due to abnormal metabolism and increased side effects. Catheter ablation, if successful, may be a safer alternative. This review aimed to analyse the effect of CKD or haemodialysis (HD) on recurrence of AF after catheter ablation. METHODS: MEDLINE, Embase, and PubMed databases were searched until December 2020. Two authors abstracted the data independently. Relative risks were derived using random-effects meta-analysis. RESULTS: Of the initially identified 782 studies, 6 and 4 observational studies investigating CKD and HD patients, respectively reported AF recurrence rates. During a mean (SD) follow-up of 25.5 (9.8) months, CKD patients demonstrated a higher risk of AF recurrence compared to patients without CKD (RR 2.34, 95% CI: 1.36-4.02, p < 0.01). The heterogenicity test highlighted significant differences between individual studies (I2 = 91.0%, 95% CI: 82.2-95.6%). In a mean (SD) follow-up of 32.6 (26.8) months, HD patients may be at a higher risk of AF recurrence compared to healthy non-dialysis AF patients (RR 1.50, 95% CI: 0.84-2.67, p = 0.17). Heterogeneity analysis showed the studies were heterogeneous (I2 = 90.1%, 95% CI: 77.5-95.6%, p < 0.01). CONCLUSION: Our meta-analysis suggests patients with CKD and on HD are more likely to have AF recurrences compared to AF patients who do not have CKD. However, more robust evidence from randomized controlled trials comparing catheter ablation to pharmaceutical rhythm therapy is urgently needed to guide therapy in this difficult to treat population.

Arrhythmias in Chronic Kidney Disease.

Arrhythmias cause disability and an increased risk of premature death in the general population but far more so in patients with renal failure. The association between the cardiac and renal systems is complex and derives in part from common causality of renal and myocardial injury from conditions including hypertension and diabetes. In many cases, there is a causal relationship, with renal dysfunction promoting arrhythmias and arrhythmias exacerbating renal dysfunction. In this review, the authors expand on the challenges faced by cardiologists in treating common and uncommon arrhythmias in patients with renal failure using pharmacological interventions, ablation and cardiac implantable device therapies. They explore the most important interactions between heart rhythm disorders and renal dysfunction while evaluating the ways in which the coexistence of renal dysfunction and cardiac arrhythmia influences the management of both.

Role of a cardio-renal multi-disciplinary team meeting in managing cardiovascular risk in patients on kidney transplant waitlists.

BACKGROUND: Waitlisted kidney transplant patients suffer from excess cardiovascular events. The benefits of regular cardiac investigations, potentially harmful and expensive, are unknown. We investigate the effectiveness of a cardio-renal MDT in managing high cardiovascular risk waitlisted transplant patients to prevent events and enable transplantation. METHODS: Clinical outcomes in waitlisted transplant candidates managed by our cardio-renal MDT protocol were compared against our standard protocol. Data compared include the transplantation, event, and death rates, cost of cardiac investigations and procedures, and graft, patient survival, and re-hospitalization rates in transplanted patients. RESULTS: 207 patients were studied (81 standard, 126 cardio-renal MDT). Over 2.7 years, the cardio-renal MDT protocol transplanted more patients than the standard group (35% vs 21%; P = .02). The managing cost per patient per year was higher in the standard group (£692 vs £610). This was driven by more echocardiograms and more tests per patient in the standard group (P < .01). There was no difference in adverse events or death. There was no difference in re-hospitalization, graft or patient survival rate in transplanted patients. CONCLUSIONS: Our cardio-renal MDT was effective in managing high-risk kidney transplant candidates with greater rates of transplantation and low rates of events at a lower cost.

Effect of oxidizable electrode material on resistive switching characteristics of ZnO(x)S(1-x) films.

We investigate the memory characteristics of ZnO(x(S(1-x) based resistive switching random access memory (ReRAM) devices with Al and Pt bottom electrodes (BEs). Both the ReRAM devices with Al and Pt BEs exhibit unipolar resistive switching behaviors, regardless of the materials of the BEs. The ratios of the high resistance state (HRS) to the low resistance state (LRS) of the Au/annealed ZnO(x)S(1-x)/Al and the Au/annealed ZnO(x)S(1-x)/Pt devices are more than 10(6) and 10(4), respectively. The HRS depends more significantly on the material of the BE than the LRS. The resistance in the HRS of the device with the Al BE is more stable in the endurance characteristics and higher in magnitude than that of the device with the Pt BE. For an anealed ZnO(x)S(1-x)/Al film, the oxygen signal in the auger depth profile shows the formation of an AIO(x) layer at the interface between the annealed ZnO(x)S(1-x) layer and the Al BE. The difference between the memory characteristics of the annealed ZnO(x)S(1-x) devices with the Al and Pt BEs is explained with the presence or absence of the oxidized layers formed in the interfaces between the annealed ZnO(x)S(1-x) films and the BEs.

Influences of electrode materials on the resistive memory switching properties of ZnOxS1-x:Mn thin films.

In this study, we investigate the effect of top electrode (TE) materials on the resistive switching characteristics of TE/ZnOxS1-x:Mn/Al devices. Al, Cu, Au, Ni, and ITO are used as the TE materials of our devices. Except for the ITO TE devices, all the devices show unipolar resistive switching and maintain memory characteristics even after 10(4) s. The ratios of high resistance state (HRS) and low resistance state (LRS) for the Al, Cu, Au, and Ni TE devices are 10(5), 10(5), 10(4), and 10(2), respectively. The low ratio of HRS and LRS of the Ni TE device is attributed to a high magnitude of current at HRS. The Cu/ZnOxS1-x:Mn/Al device shows the smallest distribution of set voltages. The ITO TE device exhibits bipolar resistive switching and suffers change in the resistance at HRS after 10(3) s. Considering the distribution of set voltages and the ratio of HRS and LRS, Cu is the most suitable TE material for the TE/ZnOxS1-x:Mn/Al devices.