The Characteristics of Chest Pain in the Emergency Setting among Patients with Chronic Kidney Disease
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Feb 20, 2024
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Abstract
Background: Chronic kidney disease (CKD) is considered a major public health issue, not only due to the possibility of progressing to end-stage renal disease but also because it is closely related to the development of acute coronary syndrome (ACS). It is still unclear in the literature whether individuals with renal dysfunction present particularities in the clinical manifestations during acute myocardial infarction, similar to individuals with diabetes.
Aims: To evaluate the characteristics of clinical manifestations in patients with CKD and ACS.
Methods: The Chi-square test and Student's t-test were used to analyze the profile of patients with coronary syndrome and renal disease who were admitted for chest pain at the analyzed hospital. Results: The majority of individuals with renal disfunction present highly suspicious characteristics, with statistical significance by presenting a p-value equal to 0.01 and a 95% confidence interval (0.04-0.14). Conclusion: Individuals with kidney disease predominantly exhibit highly suspicious clinical manifestations for acute coronay syndrome.
Keywords:
chest pain, clinical manifestations, acute coronary syndrome, chronic kidney disease
Article Details
How to Cite
RAGONETTI, Carolina et al.
The Characteristics of Chest Pain in the Emergency Setting among Patients with Chronic Kidney Disease.
Medical Research Archives, [S.l.], v. 12, n. 1, feb. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4965>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v12i1.4965.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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24. Oliveira AC, Cunha PMGM, Vitorino PVO, et al. Vascular Aging and Arterial Stiffness. Envelhecimento Vascular e Rigidez Arterial. Arq Bras Cardiol. 2022;119(4):604-615. doi:10.36660/abc.20210708
25. Fernandes BF, Kock KS. Acute coronary syndrome in a hospital in southern Brazil: peak of hospitalizations on Mondays and severe cases on weekends and at night. Am J Cardiovasc Dis. 2022;12(6):307-314. Published 2022 Dec 15.
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27. Bali T, Boda S, Reynard C, Body R. The association between cardiac risk factors and the probability of acute myocardial infarction in the Emergency Department: Analysis from a multicentre prospective observational study in the high sensitivity troponin era. European Journal of Emergency Medicine. 2021;28(3):233-237. doi:10.1097/mej.0000000000000809
28. Mesquita CT, Ker WDS. Cardiovascular Risk Factors in Cardiologists Certified by the Brazilian Society of Cardiology: Lessons to be Learned. Arq Bras Cardiol. 2021;116(4):782-783. doi:10.36660/abc.20210153
29. Cunha CLPD. The Influence of Obesity and Physical Activity on Cardiovascular Risk. Arq Bras Cardiol. 2022;119(2):244-245. doi:10.36660/abc.20220381
30. Bangalore S, Maron DJ, O'Brien SM, et al. Management of Coronary Disease in Patients with Advanced Kidney Disease. N Engl J Med. 2020;382(17):1608-1618. doi:10.1056/NEJMoa1915925
31. Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease. Hypertension. 2003;42(5):1050-1065. doi:10.1161/01.hyp.0000102971.85504.7c
32. Moisi MI, Rus M, Bungau S, et al. Acute coronary syndromes in chronic kidney disease: Clinical and therapeutic characteristics. Medicina. 2020;56(3):118. doi:10.3390/medicina56030118
33. Cachofeiro V, Goicochea M, de Vinuesa SG, Oubiña P, Lahera V, Luño J. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney International. 2008;74. doi:10.1038/ki.2008.516
34. Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of coronary heart disease in patients with chronic kidney disease. Journal of the American College of Cardiology. 2009;53(23):2129-2140. doi:10.1016/j.jacc.2009.02.047
35. Bianco HT, Povoa R, Izar MC, et al. Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors. Arq Bras Cardiol. 2022;119(5):691-702. doi:10.36660/abc.20211055
36. Kyaw K, Latt H, Aung SS, Tun NM, Phoo W-Y, Yin HH. Atypical presentation of acute coronary syndrome and importance of wellens’ syndrome. American Journal of Case Reports. 2018;19:199-202. doi:10.12659/ajcr.907992
37. El-Menyar A, Zubaid M, Sulaiman K, et al. Atypical presentation of acute coronary syndrome: A significant independent predictor of in-hospital mortality. Journal of Cardiology. 2011;57(2):165-171. doi:10.1016/j.jjcc.2010.11.008
38. Sosnov J, Lessard D, Goldberg RJ, Yarzebski J, Gore JM. Differential symptoms of acute myocardial infarction in patients with kidney disease: A community-wide perspective. American Journal of Kidney Diseases. 2006;47(3):378-384. doi:10.1053/j.ajkd.2005.11.017
39. Shroff GR, Frederick PD, Herzog CA. Renal failure and acute myocardial infarction: Clinical characteristics in patients with advanced chronic kidney disease, on dialysis, and without chronic kidney disease. A collaborative project of the United States Renal Data System/National Institutes of Health and the National Registry of Myocardial Infarction. American Heart Journal. 2012;163(3):399-406. doi:10.1016/j.ahj.2011.12.002
40. Herzog CA, Littrell K, Arko C, Frederick PD, Blaney M. Clinical characteristics of dialysis patients with acute myocardial infarction in the United States. Circulation. 2007;116(13):1465-1472. doi:10.1161/circulationaha.107.696765
2. Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. The Lancet. 2021;398(10302):786-802. doi:10.1016/s0140-6736(21)00519-5
3. Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: Approaches and initiatives – a position statement from kidney disease improving global outcomes. Kidney International. 2007;72(3):247-259. doi:10.1038/sj.ki.5002343
4. de Sousa LC, Silva NR, Azeredo CM, Rinaldi AE, da Silva LS. Health-related patterns and chronic kidney disease in the Brazilian population: National Health Survey, 2019. Frontiers in Public Health. 2023;11. doi:10.3389/fpubh.2023.1090196
5. Borg R, Carlson N, Sondergaard J, Persson F. The growing challenge of chronic kidney disease: An overview of current knowledge. International Journal of Nephrology. 2023;2023:1-8. doi:10.1155/2023/9609266
6. National Guideline Centre (UK). Modalities of RRT: Renal replacement therapy and conservative management. London: National Institute for Health and Care Excellence (NICE); October 2018.
7. Herzog CA, Asinger RW, Berger AK, et al. Cardiovascular disease in chronic kidney disease. A clinical update from kidney disease: Improving global outcomes (KDIGO). Kidney International. 2011;80(6):572-586. doi:10.1038/ki.2011.223
8. Marenzi G. Chronic kidney disease in acute coronary syndromes. World Journal of Nephrology. 2012;1(5):134. doi:10.5527/wjn.v1.i5.134
9. Lenci Marques G, Assano Stangler NH, Ferro H, et al. Kidney disease as risk of in-hospital mortality in patients with acute coronary syndrome. Cureus. Published online 2021. doi:10.7759/cureus.19557
10. Wright RS, Reeder GS, Herzog CA, et al. Acute myocardial infarction and renal dysfunction: A high-risk combination. Annals of Internal Medicine. 2002;137(7):563. doi:10.7326/0003-4819-137-7-200210010-00007
11. Yamamoto S, Kon V. Mechanisms for increased cardiovascular disease in chronic kidney dysfunction. Current Opinion in Nephrology and Hypertension. 2009;18(3):181-188. doi:10.1097/mnh.0b013e328327b360
12. Marques GL, Hayashi S, Bjällmark A, et al. Osteoprotegerin is a marker of cardiovascular mortality in patients with chronic kidney disease stages 3–5. Scientific Reports. 2021;11(1). doi:10.1038/s41598-021-82072-z
13. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [published correction appears in Circulation. 2021 Nov 30;144(22):e455]. Circulation. 2021;144(22):e368-e454. doi:10.1161/CIR.0000000000001029
14. Jones ID, Slovis CM. Emergency department evaluation of the chest pain patient. Emergency Medicine Clinics of North America. 2001;19(2):269-282. doi:10.1016/s0733-8627(05)70183-8
15. Araújo C, Laszczyńska O, Viana M, et al. Sex differences in presenting symptoms of acute coronary syndrome: The EPIHEART cohort study. BMJ Open. 2018;8(2). doi:10.1136/bmjopen-2017-018798
16. Cader FA, Banerjee S, Gulati M. Sex differences in acute coronary syndromes: A global perspective. Journal of Cardiovascular Development and Disease. 2022;9(8):239. doi:10.3390/jcdd9080239
17. Engberding N, Wenger NK. Acute coronary syndromes in the elderly. F1000Research. 2017;6:1791. doi:10.12688/f1000research.11064.1
18. Khafaji HA. Atypical presentation of acute and chronic coronary artery disease in diabetics. World Journal of Cardiology. 2014;6(8):802. doi:10.4330/wjc.v6.i8.802
19. Gondim L de, Oliveira WA, Grossi SA. A Diferenciação da Dor do Infarto Agudo do Miocárdio Entre Pacientes Diabéticos e Não-Diabéticos. Revista Latino-Americana de Enfermagem. 2003;11(6):720-726. doi:10.1590/s0104-11692003000600004
20. DeVon HA, Mirzaei S, Zègre‐Hemsey J. Typical and atypical symptoms of acute coronary syndrome: Time to retire the terms? Journal of the American Heart Association. 2020;9(7). doi:10.1161/jaha.119.015539
21. Vicent L, Martínez-Sellés M. Frailty and acute coronary syndrome: does gender matter?. J Geriatr Cardiol. 2019;16(2):138-144. doi:10.11909/j.issn.1671-5411.2019.02.007
22. dos Santos ES, Minuzzo L, Pereira MP, et al. Acute coronary syndrome registry at a cardiology emergency center. Arq Bras Cardiol. 2006;87(5):597-602. doi:10.1590/s0066-782x2006001800008
23. Damluji AA, Forman DE, Wang TY, et al. Management of acute coronary syndrome in the older adult population: A scientific statement from the American Heart Association. Circulation. 2023;147(3). doi:10.1161/cir.0000000000001112
24. Oliveira AC, Cunha PMGM, Vitorino PVO, et al. Vascular Aging and Arterial Stiffness. Envelhecimento Vascular e Rigidez Arterial. Arq Bras Cardiol. 2022;119(4):604-615. doi:10.36660/abc.20210708
25. Fernandes BF, Kock KS. Acute coronary syndrome in a hospital in southern Brazil: peak of hospitalizations on Mondays and severe cases on weekends and at night. Am J Cardiovasc Dis. 2022;12(6):307-314. Published 2022 Dec 15.
26. Malakar AKr, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. Journal of Cellular Physiology. 2019;234(10):16812-16823. doi:10.1002/jcp.28350
27. Bali T, Boda S, Reynard C, Body R. The association between cardiac risk factors and the probability of acute myocardial infarction in the Emergency Department: Analysis from a multicentre prospective observational study in the high sensitivity troponin era. European Journal of Emergency Medicine. 2021;28(3):233-237. doi:10.1097/mej.0000000000000809
28. Mesquita CT, Ker WDS. Cardiovascular Risk Factors in Cardiologists Certified by the Brazilian Society of Cardiology: Lessons to be Learned. Arq Bras Cardiol. 2021;116(4):782-783. doi:10.36660/abc.20210153
29. Cunha CLPD. The Influence of Obesity and Physical Activity on Cardiovascular Risk. Arq Bras Cardiol. 2022;119(2):244-245. doi:10.36660/abc.20220381
30. Bangalore S, Maron DJ, O'Brien SM, et al. Management of Coronary Disease in Patients with Advanced Kidney Disease. N Engl J Med. 2020;382(17):1608-1618. doi:10.1056/NEJMoa1915925
31. Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease. Hypertension. 2003;42(5):1050-1065. doi:10.1161/01.hyp.0000102971.85504.7c
32. Moisi MI, Rus M, Bungau S, et al. Acute coronary syndromes in chronic kidney disease: Clinical and therapeutic characteristics. Medicina. 2020;56(3):118. doi:10.3390/medicina56030118
33. Cachofeiro V, Goicochea M, de Vinuesa SG, Oubiña P, Lahera V, Luño J. Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney International. 2008;74. doi:10.1038/ki.2008.516
34. Hage FG, Venkataraman R, Zoghbi GJ, Perry GJ, DeMattos AM, Iskandrian AE. The scope of coronary heart disease in patients with chronic kidney disease. Journal of the American College of Cardiology. 2009;53(23):2129-2140. doi:10.1016/j.jacc.2009.02.047
35. Bianco HT, Povoa R, Izar MC, et al. Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors. Arq Bras Cardiol. 2022;119(5):691-702. doi:10.36660/abc.20211055
36. Kyaw K, Latt H, Aung SS, Tun NM, Phoo W-Y, Yin HH. Atypical presentation of acute coronary syndrome and importance of wellens’ syndrome. American Journal of Case Reports. 2018;19:199-202. doi:10.12659/ajcr.907992
37. El-Menyar A, Zubaid M, Sulaiman K, et al. Atypical presentation of acute coronary syndrome: A significant independent predictor of in-hospital mortality. Journal of Cardiology. 2011;57(2):165-171. doi:10.1016/j.jjcc.2010.11.008
38. Sosnov J, Lessard D, Goldberg RJ, Yarzebski J, Gore JM. Differential symptoms of acute myocardial infarction in patients with kidney disease: A community-wide perspective. American Journal of Kidney Diseases. 2006;47(3):378-384. doi:10.1053/j.ajkd.2005.11.017
39. Shroff GR, Frederick PD, Herzog CA. Renal failure and acute myocardial infarction: Clinical characteristics in patients with advanced chronic kidney disease, on dialysis, and without chronic kidney disease. A collaborative project of the United States Renal Data System/National Institutes of Health and the National Registry of Myocardial Infarction. American Heart Journal. 2012;163(3):399-406. doi:10.1016/j.ahj.2011.12.002
40. Herzog CA, Littrell K, Arko C, Frederick PD, Blaney M. Clinical characteristics of dialysis patients with acute myocardial infarction in the United States. Circulation. 2007;116(13):1465-1472. doi:10.1161/circulationaha.107.696765