Pubblicazioni recenti - cardiorenal
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Glycolipid Metabolic Disorders, Metainflammation, Oxidative Stress, and Cardiovascular Diseases: Unraveling Pathways.
Biology (Basel)2024 Jul;13(7):. doi: 519.
de Lima Enzo Pereira, Moretti Renato Cesar, Torres Pomini Karina, Laurindo Lucas Fornari, Sloan Kátia Portero, Sloan Lance Alan, Castro Marcela Vialogo Marques de, Baldi Edgar, Ferraz Bruna Fidencio Rahal, de Souza Bastos Mazuqueli Pereira Eliana, Catharin Virgínia Maria Cavallari Strozze, Mellen Carolina Haber, Caracio Flávia Cristina Castilho, Spilla Caio Sérgio Galina, Haber Jesselina F S, Barbalho Sandra Maria,
Abstract
Glycolipid metabolic disorders (GLMDs) are various metabolic disorders resulting from dysregulation in glycolipid levels, consequently leading to an increased risk of obesity, diabetes, liver dysfunction, neuromuscular complications, and cardiorenal vascular diseases (CRVDs). In patients with GLMDs, excess caloric intake and a lack of physical activity may contribute to oxidative stress (OxS) and systemic inflammation. This study aimed to review the connection between GLMD, OxS, metainflammation, and the onset of CRVD. GLMD is due to various metabolic disorders causing dysfunction in the synthesis, breakdown, and absorption of glucose and lipids in the body, resulting in excessive ectopic accumulation of these molecules. This is mainly due to neuroendocrine dysregulation, insulin resistance, OxS, and metainflammation. In GLMD, many inflammatory markers and defense cells play a vital role in related tissues and organs, such as blood vessels, pancreatic islets, the liver, muscle, the kidneys, and adipocytes, promoting inflammatory lesions that affect various interconnected organs through their signaling pathways. Advanced glycation end products, ATP-binding cassette transporter 1, Glucagon-like peptide-1, Toll-like receptor-4, and sphingosine-1-phosphate (S1P) play a crucial role in GLMD since they are related to glucolipid metabolism. The consequences of this is system organ damage and increased morbidity and mortality.
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A Mock Circulatory Loop Analysis of Cardiorenal Hemodynamics With Intra-Aortic Mechanical Circulatory Support.
ASAIO J2024 Jul;():. doi: 10.1097/MAT.0000000000002277.
Barua Sumita, Stevens Michael, Jain Pankaj, Matus Vazquez Gabriel, Boss Laurence, Muthiah Kavitha, Hayward Christopher,
Abstract
Type 1 cardiorenal syndrome is associated with significant excess morbidity and mortality in patients with severe acute decompensated heart failure. Previous trials of vasoactive drugs and ultrafiltration have not shown superiority over placebo or intravenous diuretics. Pilot data suggest short-term mechanical support devices may support diuresis in the cardiorenal syndrome. We evaluated the intra-aortic balloon pump (IABP) and a novel intra-aortic entrainment pump (IAEP) in a mock circulation loop (MCL) biventricular systolic heart failure model, to assess impact on renal flow and cardiac hemodynamics. Both devices produced similar and only modest increase in renal flow (IABP 3.3% vs. IAEP 4.3%) and cardiac output, with associated reduction in afterload elastance in the MCL. There were minor changes in coronary flow, increase with IABP and minor decrease with IAEP. Differences in device preload and afterload did not impact percentage change in renal flow with IABP therapy, however, there was a trend toward higher percentage flow change with IAEP in response to high baseline renal flow. The IAEP performed best in a smaller aorta and with more superior positioning within the descending aorta. Demonstrated changes in MCL flow during IAEP were of lower magnitude than previous animal studies, possibly due to lack of autoregulation and hormonal responses.
Copyright © ASAIO 2024.
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Case report: Challenging kidney transplantation in an adolescent patient with tetralogy of Fallot.
Front Med (Lausanne)2024 ;11():1327363. doi: 1327363.
Jak?i? Ante, Barbali? Berislav, Orli? Lidija, ?upan ?eljko, Vuji?i? Bo?idar, Gr?kovi? Antun, ?eli? Tanja, Chinchella Ivana Koraca, ?a?e Neven, Flaj?man-Raspor Sanja, Bubi? Ivan, ?panjol Josip, Marki? Dean,
Abstract
Tetralogy of Fallot is the most common cyanotic congenital heart disease. This severe disorder of cardiac physiology can impair renal function and lead to the development of cardiorenal syndrome and eventually to end-stage renal disease. Kidney transplantation may be the best option for renal replacement treatment in patients with tetralogy of Fallot, but only after correcting cardiac abnormalities and optimizing cardiac functions, all of which require a multidisciplinary approach. We report the first case of kidney transplantation in an adolescent patient with tetralogy of Fallot. Our findings confirms that kidney transplantation is a valuable treatment option in selected congenital heart disease cases.
Copyright © 2024 Jak?i?, Barbali?, Orli?, ?upan, Vuji?i?, Gr?kovi?, ?eli?, Chinchella, ?a?e, Flaj?man-Raspor, Bubi?, ?panjol and Marki?.
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Investigation of verapamil-induced cardiorenal dysfunction and compensatory ion regulation in zebrafish embryos.
Comp Biochem Physiol C Toxicol Pharmacol2024 Jul;():109980. doi: 10.1016/j.cbpc.2024.109980.
Horng Jiun-Lin, Hsiao Bu-Yuan, Lin Wen-Ting, Lin Tzu-Ting, Chang Ching-Yen, Lin Li-Yih,
Abstract
The purpose of the present study was to investigate the development of verapamil-induced cardiorenal failure and the response of epidermal ionocytes in zebrafish embryos to this syndrome. Zebrafish embryos were exposed to verapamil for 24?h at different developmental stages (48, 72, and 96?h post-fertilization). The exposure resulted in the generation of edema in the pericardial and yolk sac regions, with more-pronounced effects observed in later-stage embryos. Cardiac parameters showed a suppressed heart rate at all stages, with a more-significant effect appearing in later stages. Verapamil also affected cardiac parameters including the end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and cardiac output (CO), indicating negative overall effects on cardiac performance. mRNA levels of heart failure markers (nppa and nppb genes) were upregulated in verapamil-exposed embryos at all stages. Renal function was impaired as FITC-dextran excretion was suppressed. A whole-embryo ion content analysis revealed significant increases in sodium and calcium contents in verapamil-exposed embryos. The density of epidermal ionocytes increased, and the apical membrane of ionocytes was enlarged, indicating upregulation of ion uptake. In addition, mRNA levels of several ion transporter genes (rhcg1, slc9a3, atp6v1a, atp2b1a, trpv6, and slc12a10.2) were significantly upregulated in verapamil-exposed embryos. In summary, prolonged exposure to verapamil can induce cardiorenal failure which triggers compensatory upregulation of ionocytes in zebrafish embryos.
Copyright © 2024. Published by Elsevier Inc.
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Potential Role of Mineralocorticoid Receptor Antagonists in Nondiabetic Chronic Kidney Disease and Glomerular Disease.
Clin J Am Soc Nephrol2024 Jul;():. doi: 10.2215/CJN.0000000000000540.
Zachariah Teena, Radhakrishnan Jai,
Abstract
Glomerular disease is a leading cause of chronic kidney disease (CKD) and end-stage kidney disease. Although diabetic kidney disease is the most common cause of glomerular disease, non-diabetic causes include malignancy, systemic autoimmune conditions, drug effects, or genetic conditions. Nondiabetic glomerular diseases are rare diseases, with a paucity of high-quality clinical trials in this area. Furthermore, late referral can result in poor patient outcomes. This manuscript reviews the current management of nondiabetic glomerular disease and explores the latest developments in drug treatment in this area. Current treatment of nondiabetic glomerular disease aims to manage complications (edema, hypertension, proteinuria, hyperlipidemia, hypercoagulability, and thrombosis) as well as target the underlying cause of glomerular disease. Treatment options include renin-angiotensin-aldosterone system inhibitors, statins/non-statin alternatives, loop diuretics, anticoagulation agents, immunosuppressives, and lifestyle and dietary modifications. Effective treatment of nondiabetic glomerular disease is limited by heterogeneity and a lack of understanding of the disease pathogenesis. Sodium-glucose cotransporter-2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists (ns-MRAs, such as finerenone), with their broad anti-inflammatory and antifibrotic effects, have emerged as valuable therapeutic options for a range of cardiorenal conditions, including CKD. ns-MRAs are an evolving drug class of particular interest for the future treatment of nondiabetic glomerular disease, and there is evidence that these agents may improve kidney prognosis in various subgroups of patients with CKD. The benefits offered by ns-MRAs may present an opportunity to reduce the progression of CKD from a spectrum of glomerular disease. Several novel ns-MRA are in clinical development for both diabetic and nondiabetic CKD.
Copyright © 2024 by the American Society of Nephrology.
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Early neutrophil gelatinase-associated lipocalin (NGAL) measurement could rule out future acute kidney injury in patients with acute coronary syndrome-Prospective observational study.
Health Sci Rep2024 Jul;7(7):e2229. doi: e2229.
Magnusson Nils Erik, Frydman Shir, Freund Ophir, Zornizki Lior, Banai Shmuel, Shacham Yacov,
Abstract
BACKGROUND AND AIMS:
The diagnosis of acute kidney injury (AKI) is of importance among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI). It is often delayed given the need in serial measurements of creatinine or other serum markers. Neutrophil gelatinase-associated lipocalin (NGAL) is a proven marker for AKI, although its role as an early predictor in this setting was scarcely addressed before and was the aim of our study.
METHODS:
Prospective observational study including 133 patients with STEMI treated with PCI. Plasma NGAL was drawn immediately before PCI (NGAL-0) and 24?h after (NGAL-24). Similar analysis of C-reactive protein (CRP) was performed for additional comparison.
RESULTS:
Mean age was 62?±?13 years, 78% were men, and 20 (15%) developed AKI after admission. Patients with AKI after admission demonstrated higher levels of NGAL-0 (164 vs. 95?ng/mL; ?0.001) and NGAL-24 (142 vs. 93?ng/mL; ?0.001). Levels of NGAL-0 and NGAL-24 were similar within the AKI and non-AKI groups. Using ROC curve analysis, NGAL-0 had best predictive ability for AKI development (AUC 0.841, 95% CI 0.80-0.96), compared with NGAL-24 (0.783, 95% CI 0.74-0.85), CRP-0 (0.701, 95% CI 0.58-0.83), and CRP-24 (0.781, 95% CI 0.66-0.90). The optimal NGAL-0 cutoff for AKI prediction was 125?ng/mL, with 70% sensitivity, 84% specificity, and 94% negative predictive value.
CONCLUSIONS:
Among STEMI patients, NGAL measurement upon admission are associated with AKI and may serve as a reliable marker for early AKI detection. Future studies may direct risk stratification using this single test can direct personalized evaluations during the admission, and focused interventions to prevent AKI.
© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.
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Understanding the mechanisms mediating cardio-renal benefit of empagliflozin in type 2 diabetes mellitus.
J Diabetes Complications2023 Dec;37(12):108630. doi: 10.1016/j.jdiacomp.2023.108630.
Patoulias Dimitrios, Eid Ali H, Rizzo Manfredi,
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Blood Volume Analysis and Cardio-renal syndrome: from bench to bedside.
Cardiorenal Med2024 Jul;():. doi: 10.1159/000540497.
Jefferies John Lynn, Stavish Cynthia Ann, Silver Marc A, Butler Javed, Humes Harvey David, Strobeck John,
Abstract
BACKGROUND:
This review delves into the intricate landscape of cardiorenal syndrome (CRS) and highlights the pivotal role of Blood Volume Analysis (BVA) in improving patient care and outcomes.
SUMMARY:
BVA offers a direct and highly accurate quantification of intravascular volume, red blood cell volume, and plasma volume, complete with patient-specific norms. This diagnostic tool enhances the precision of diuretic and red cell therapies, significantly elevating the effectiveness of conventional care.
KEY MESSAGES:
· Comprehensive Understanding: Our objectives encompass a comprehensive understanding of how BVA informs the evaluation and treatment of CRS, including its subtypes, pathophysiology, and clinical significance. · BVA Principles and Advantages: We delve into BVA principles, techniques, and measurements, elucidating its diagnostic potential and advantages compared to commonly used surrogate measures. · Clinical Relevance: We dissect the clinical relevance of BVA in various CRS scenarios, emphasizing its unique contributions to each subtype. · Improving patient outcomes: By assessing the tangible impact of BVA on patient outcomes through meticulous analysis of relevant clinical studies, we unveil its potential to enhance health outcomes and optimize resource utilization. · Multidisciplinary Collaboration: Acknowledging the challenges and limitations associated with BVA's clinical implementation, we underscore the importance of multidisciplinary collaboration among cardiologists, nephrologists, and other clinicians. · Future Directions: Finally, we identify research gaps and propose future directions for BVA and CRS, contributing to ongoing advancements in this field and patients affected by this complicated clinical syndrome.
The Author(s). Published by S. Karger AG, Basel.
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Sodium-glucose co-transporter-2 inhibitors use in patients with reduced kidney function hospitalized for fluid overload and heart failure: an observational study.
Cardiorenal Med2024 Jul;():. doi: 10.1159/000540493.
Tan Shi Yun, Galang Lourdes Ducusin, Leong Ee Won, Huang Zhihua, Chin De Zhi, Sia Wan Jin, Kang Mei Ling, Tan Chieh Suai, Abdullah Hairil Rizal Bin, Lim Cynthia,
Abstract
INTRODUCTION:
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) is recommended in kidney disease and heart failure to reduce adverse clinical outcomes, but utilization can vary. To understand potential gaps in clinical practice and identify opportunities for improvement, we aimed to describe the prevalence and factors associated with SGLT2i prescription in patients with reduced kidney function hospitalized for fluid overload and/or heart failure.
METHODS:
Single-center observational study of patients with reduced kidney function (eGFR 20-59 ml/min/1.73 m2) hospitalized for fluid overload or heart failure between January 2022 and December 2023. Data was retrieved from electronic medical records. The outcome was SGLT2i prescription at discharge. Potential variables affecting SGLT2i prescription were identified during stakeholder engagement and evaluated using multivariable logistic regression.
RESULTS:
Among 2543 patients, the median age was 79 (71, 86) years and admission eGFR was 38.7 (28.4, 49.4) ml/min/1.73 m2. SGLT2i was prescribed to 630 (24.8%) patients at discharge. SGLT2i prescription at discharge was independently associated with cardiovascular disease (OR 1.76, 95% CI 1.31-2.35), diabetes (OR 1.59, 95% CI: 1.19-2.14), fluid overload or heart failure as the primary discharge diagnosis (OR 1.71, 95% CI: 1.29-2.28), SGLT2i pre-hospitalization (OR 104.91, 95% CI: 63.22-174.08), RAS blocker (OR 2.1, 95% CI: 1.65-2.89) and higher eGFR (OR 1.01, 95% CI: 1.003-1.02) at discharge; but inversely associated with older age (OR 0.97, 95% CI 0.96-0.98).
CONCLUSION:
SGLT2i prescription at discharge was suboptimal among patients with reduced kidney function hospitalized for fluid overload and/or heart failure, especially in older age and more severe kidney disease. Additionally, cardiovascular disease, diabetes, primary discharge diagnosis of fluid overload or heart failure, prior SGLT2i use and concurrent RAS blocker at discharge were independently associated with SGLT2i prescription at discharge. Interventions are needed to increase clinicians' knowledge and overcome clinical inertia to increase SGLT2i use in patients with fluid overload and heart failure.
The Author(s). Published by S. Karger AG, Basel.
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Neonatal hyperoxia exposure leads to developmental programming of cardiovascular and renal disease in adult rats.
Sci Rep2024 Jul;14(1):16742. doi: 16742.
DeFreitas Marissa J, Shelton Elaine L, Schmidt Augusto F, Ballengee Sydne, Tian Runxia, Chen PingPing, Sharma Mayank, Levine Amanda, Katz Emily Davidovic, Rojas Claudia, Abitbol Carolyn L, Hunter Juanita, Kulandavelu Shathiyah, Wu Shu, Young Karen C, Benny Merline,
Abstract
Premature infants are often exposed to hyperoxia. However, there is limited data regarding the mechanistic underpinnings linking neonatal hyperoxia exposure and its contribution to cardio-renal dysfunction in adults born preterm. Our objective was to determine whether neonatal hyperoxia induces systemic vascular stiffness and cardio-renal dysfunction in adulthood. Newborn rats were randomly assigned to room air (RA) or hyperoxia (85% O) from postnatal day 1 to 14, then recovered in RA until 1 year of life. Arterial stiffness, cardio-renal histomorphometry, and fibrosis in the aorta, heart, and kidney were assessed. RNA-sequencing (RNA-seq) of the aorta and kidney was also done. Adult rats exposed to neonatal hyperoxia had increased aortic and mesenteric artery stiffness as demonstrated by wire and pressure myography. They also had cardiomyocyte hypertrophy, glomerulomegaly, and tubular injury. Hyperoxia exposure altered the transcriptome profile associated with fibrosis and matrix remodeling in the aorta and kidney. There was also increased TGF-?1 levels and fibrosis in the aorta, left ventricle, and kidney. In conclusion, neonatal hyperoxia exposure was associated with systemic vascular and cardio-renal alterations in 1-year-old rats. Further studies to determine how targeted therapies could reprogram cardio-renal injury after neonatal hyperoxia exposure are indicated.
© 2024. The Author(s).
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Prognostic value of weight loss in hospitalized patients with heart failure.
Eur Heart J Qual Care Clin Outcomes2024 Jul;():. doi: qcae058.
Nagahiro Takanori, Konishi Masaaki, Kagiyama Nobuyuki, Kasai Takatoshi, Kamiya Kentaro, Saito Hiroshi, Saito Kazuya, Maekawa Emi, Kitai Takeshi, Iwata Kentaro, Jujo Kentaro, Wada Hiroshi, Momomura Shin-Ichi, Hibi Kiyoshi, Tamura Kouichi, Matsue Yuya,
Abstract
BACKGROUND:
Weight loss is a poor prognostic factor in patients with chronic heart failure (HF). However, whether the same is true for hospitalized patients with HF is unknown, even though hospitalization is the first opportunity for many patients to be diagnosed with HF. This study aimed to investigate the prognostic value of weight loss in patients hospitalized for HF.
METHODS:
This was a post-hoc analysis of the FRAGILE-HF study, a prospective multi-center, observational study including 1,332 hospitalized older (?65 years) patients with HF. The primary outcome was all-cause death within two years of discharge.
RESULTS:
Self-reported body weight data one year prior to hospital admission were available for 1,106 patients (83.0%) and were compared with their weight after decongestion therapy. The median weight change was -6.9% [-2.4 - -11.9] and 86.8% of the overall cohort experienced some weight loss. Whereas patients with weight loss ? 5%, which is a well-validated cut-off in chronic HF, had comparable mortality to those with less weight loss (p = 0.96 by log-rank test), patients with weight loss > 12%, the lowest quartile value, had higher mortality than those with less weight loss (p = 0.024 for all-cause mortality, p = 0.028 for non-cardiovascular mortality, and p = 0.28 for cardiovascular mortality, respectively). In a Cox proportional hazard model, > 12% weight loss was associated with high mortality after adjusting for known prognostic factors and history of malignancy (adjusted hazard ratio: 1.485 [1.070-2.062], p=0.018).
CONCLUSION:
Weight loss derived from patient-reported body weight one year before hospitalization was significantly associated with increased mortality after discharge, mainly due to non-cardiovascular etiology, in elderly patients hospitalized for HF.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Clinically Evident Cardiopulmonary Congestion Does Not Significantly Impact the Prognosis of Patients With Septic Acute Kidney Injury.
J Clin Med Res2024 Jun;16(6):302-309. doi: 10.14740/jocmr5190.
Mund Charlotte, Asmus Katharina, Safi Wajima, Ritter Oliver, Petrus Dominique, Patschan Susann, Patschan Daniel,
Abstract
BACKGROUND:
Acute kidney injury (AKI) is a common issue among in-hospital patients, with high mortality rates. Sepsis is a primary cause of AKI, particularly in the intensive care unit. Patients with septic AKI often experience cardiovascular congestion, leading to the formal classification of cardiorenal syndrome type 5. The study aimed to evaluate the prognosis of septic AKI patients with and without clinical evidence of cardiovascular congestion.
METHODS:
This was a retrospective observational study. AKI patients were identified using the in-hospital AKI alert system. Sepsis was diagnosed based on laboratory, clinical, and hemodynamic characteristics, with additional consideration of the quickSOFA score. Cardiovascular congestion was diagnosed by assessing clinical (edema), radiographic (pulmonary congestion), echocardiographic (e.g., wall motion abnormalities), and laboratory variables (e.g., N-terminal pro-B-type natriuretic peptide). Endpoints included in-hospital survival, the need for kidney replacement therapy (KRT), and recovery of kidney function (ROKF).
RESULTS:
In total, 102 patients were included, and cardiopulmonary congestion was diagnosed in 78.4%. Individuals with congestion did not differ from patients without congestion in any of the pre-defined endpoints.
CONCLUSIONS:
It is justified not to consider clinically apparent cardiovascular congestion in septic AKI patients as a risk factor for death . Rather, especially in the case of sepsis, clinically apparent positive fluid balance does not seem to be a disadvantage in terms of survival, KRT, and ROKF.
Copyright 2024, Mund et al.
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Comparative efficacy and safety of SGLT2is and ns-MRAs in patients with diabetic kidney disease: a systematic review and network meta-analysis.
Front Endocrinol (Lausanne)2024 ;15():1429261. doi: 1429261.
Yang Si-Qi, Zhao Xi, Zhang Jing, Liu Huan, Wang Yu-Han, Wang Yao-Guang,
Abstract
OBJECTIVES:
To evaluate the efficacy and safety of non-steroid mineralocorticoid receptor antagonists (ns-MRAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) in patients with diabetic kidney disease (DKD).
METHODS:
Systematic literature searches were performed using PubMed, Embase and Web of Science encompassing inception until January 20, 2024. Randomized control trials (RCTs) comparing ns-MRAs and SGLT2is in DKD were selected. The efficacy outcomes of interest included kidney-specific composite outcome, cardiovascular (CV)-specific composite outcome, end-stage kidney disease (ESKD), and overall mortality. We also investigated safety outcomes, including acute kidney injury (AKI) and hyperkalemia.
RESULTS:
A total of 10 randomized clinical trials with 35,786 patients applying various treatments were included. SGLT2is (SUCRA 99.84%) have potential superiority in kidney protection. SGLT2is (RR 1.41, 95%CI 1.26 to 1.57) and ns-MRAs (RR 1.17, 95% CI 1.08 to 1.27) were associated with significantly lower kidney-specific composite outcome than the placebo. Regarding the reduction in CV-specific composite outcome and ESKD, SGLT2is (SUCRA 91.61%; 91.38%) have potential superiority in playing cardiorenal protection. Concerning the CV-specific composite outcome (RR 1.27, 95%CI 1.09 to 1.43) and ESKD (RR 1.43, 95%CI 1.20 to 1.72), SGLT2is significantly reduced the risks compared to placebo. Regarding the reduction in overall mortality, SGLT2is (SUCRA 83.03%) have potential superiority in postponing mortality. Concerning the overall mortality, SGLT2is have comparable effects (RR 1.27, 95%CI 1.09 to 1.43) with placebo to reduce the risk of overall mortality compared to placebo. For AKI reduction, ns-MRAs (SUCRA 63.58%) have potential superiority. SGLT2is have comparable effects (RR 1.24, 95%CI 1.05 to 1.46) with placebo to reduce the risk of AKI. For hyperkalemia reduction, SGLT2is (SUCRA 93.12%) have potential superiority. SGLT2is have comparable effects (RR 1.24, 95%CI 1.05 to 1.46) with placebo to reduce the risk of AKI. Concerning hyperkalemia reduction, nsMRAs (RR 1.24 95%CI 0.39 to 3.72) and SGLT2is (RR 1.01 95%CI 0.40 to 3.02) did not show significant benefit compared to placebo.
CONCLUSION:
Concerning the efficacy and safety outcomes, SGLT2is may be recommended as a treatment regimen for maximizing kidney and cardiovascular protection, with a minimal risk of hyperkalemia in DKD.
SYSTEMATIC REVIEW REGISTRATION:
https://www.crd.york.ac.uk/prospero/, identifier CRD42023458613.
Copyright © 2024 Yang, Zhao, Zhang, Liu, Wang and Wang.
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Acute Kidney Injury After Cardiac Surgery.
Cardiorenal Med2024 Jul;():. doi: 10.1159/000540396.
Beaver Thomas M, Dass Bhagwan, Patel Ami M, Ejaz A Ahsan,
Abstract
Acute kidney injury associated with cardiac surgery (CS-AKI) remains a vexing issue. Clinical trials for the prevention of CS-AKI have been disappointing despite enormous initial enthusiasm based on experimental data. The schism in experimental and clinical data has triggered a relook at our understanding of CS-AKI and the experimental and preclinical models. The silver lining in the midst is the standardization of anesthetic and perioperative care proposed by national societies. In this review we discuss the therapeutic targets of major clinical trials.
The Author(s). Published by S. Karger AG, Basel.
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State-of-the-art-review Mechanisms of action of SGLT2 inhibitors and clinical implications.
Am J Hypertens2024 Jul;():. doi: hpae092.
Vallon Volker,
Abstract
Inhibitors of the Na+-coupled glucose transporter SGLT2 (SGLT2i) primarily shift the reabsorption of large amounts of glucose from the kidney's early proximal tubule to downstream tubular segments expressing SGLT1, and the non-reabsorbed glucose is spilled into the urine together with some osmotic diuresis. How can this protect the kidneys and heart from failing as observed in individuals with and without type 2 diabetes? Mediation analyses identified clinical phenotypes of SGLT2i associated with improved kidney and heart outcome, including a reduction of plasma volume or increase in hematocrit, and lowering of serum urate levels and albuminuria. This review outlines how primary effects of SGLT2i on the early proximal tubule can explain these phenotypes. The physiology of tubule-glomerular communication provides the basis for acute lowering of GFR and glomerular capillary pressure, which contributes to lowering of albuminuria but also to long term preservation of GFR, at least in part by reducing kidney cortex oxygen demand. Functional co-regulation of SGLT2 with other sodium and metabolite transporters in the early proximal tubule explains why SGLT2i initially excrete more sodium than expected and are uricosuric, thereby reducing plasma volume and serum urate. Inhibition of SGLT2 reduces early proximal tubule gluco-toxicity and by shifting transport downstream may simulate "systemic hypoxia", and the resulting increase in erythropoiesis, together with the osmotic diuresis, enhances hematocrit and improves blood oxygen delivery. Cardio-renal protection by SGLT2i is also provided by a fasting-like and insulin-sparing metabolic phenotype and, potentially, by off-target effects on the heart and microbiotic formation of uremic toxins.
© The Author(s) 2024. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site?for further information please contact journals.permissions@oup.com.
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Parental genetic effects on the offspring`s phenotype without direct transmission of the parental gene itself - pathophysiology and clinical evidence.
Am J Physiol Cell Physiol2024 Jul;():. doi: 10.1152/ajpcell.00359.2024.
Zhang Xiaoli, Hocher Berthold,
Abstract
Parental genes can influence the phenotype of their offspring through genomic-epigenomic interactions even without the direct inheritance of specific parental genotypes. Maternal genetic variations can affect the ovarian and intrauterine environments and potentially alter lactation behaviors, impacting offspring nutrition and health outcomes independently of the fetal genome. Similarly, paternal genetic changes can affect the endocrine system and vascular functions in the testes, influencing sperm quality and seminal fluid composition. These changes can initiate early epigenetic modifications in sperm, including alterations in microRNAs, tRNA-derived small RNAs, and DNA methylation patterns. These epigenetic modifications might induce further changes in target organs of the offspring, leading to modified gene expression and phenotypic outcomes without transmitting the original parental genetic alterations. This review presents clinical evidence supporting this hypothesis and discusses the potential underlying molecular mechanisms. Parental gene-offspring epigenome-offspring phenotype interactions have been observed in neurocognitive disorders as well as cardio-renal diseases.
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"Asian" Heart Failure.
Circulation2024 Jul;150(3):177-179. doi: 10.1161/CIRCULATIONAHA.123.068576.
Yoo Sang Gune K, Lam Carolyn S P, Sweitzer Nancy K,
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Periostin predicts all-cause mortality in male but not female end-stage renal disease patients on hemodialysis.
Cardiorenal Med2024 Jul;():. doi: 10.1159/000539765.
Li Xitong, Liu Yvonne, Hocher Johann-Georg, Chu Chang, Reichetzeder Christoph, Kalk Philipp, Szakallova Angelika, Chen Xin, Krämer Bernhard K, Tepel Martin, Hocher Berthold,
Abstract
BACKGROUND:
Periostin is a matricellular protein. Elevated serum concentrations of periostin have been reported in patients with various cardiovascular diseases, including heart failure. Patients with end-stage renal disease have a substantially increased risk for cardiovascular diseases. However, there is a lack of clinical studies to clarify the prognostic significance of systemic periostin on all-cause mortality in patients with end-stage renal disease on hemodialysis.
METHODS:
313 stable end-stage renal disease patients were recruited and followed for five years concerning all-cause mortality. At baseline, we collected blood samples and clinical data. Serum periostin concentrations were measured using a certified ELISA.
RESULTS:
The optimal cut-off value for serum periostin regarding all-cause mortality, calculated through ROC analysis, was 777.5 pmol/l. Kaplan-Meier survival analysis using this cut-off value demonstrated that higher periostin concentrations are linked to higher all-cause mortality (log-rank test: P = 0.002). Subgroup analysis revealed that serum periostin concentrations only affected all-cause mortality in male but not in female patients (P = 0.002 in male patients and P = 0.474 in female patients). Multivariate Cox regression analyses, adjusted for confounding factors, likewise showed that elevated serum periostin concentrations were positively associated with all-cause mortality in male (P = 0.028) but not in female patients on hemodialysis (P = 0.313).
CONCLUSION:
Baseline serum periostin is an independent risk factor for all-cause mortality in male patients with chronic renal disease on hemodialysis.
The Author(s). Published by S. Karger AG, Basel.
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GLP-1 receptor agonists' impact on cardio-renal outcomes and mortality in T2D with acute kidney disease.
Nat Commun2024 Jul;15(1):5912. doi: 5912.
Pan Heng-Chih, Chen Jui-Yi, Chen Hsing-Yu, Yeh Fang-Yu, Sun Chiao-Yin, Huang Thomas Tao-Min, Wu Vin-Cent,
Abstract
Previous studies have explored the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in reducing cardiovascular events in type 2 diabetes. Here we show that GLP-1 RAs are associated with lower risks of mortality, major cardiovascular events (MACEs), and major adverse kidney events (MAKEs) in type 2 diabetes patients with acute kidney disease (AKD). Utilizing global data from the TriNetX database (2002/09/01-2022/12/01) and propensity score matching, we compare 7511 GLP-1 RAs users to non-users among 165,860 AKD patients. The most common causes of AKI are sepsis (55.2%) and cardiorenal syndrome (34.2%). After a median follow-up of 2.3 years, GLP-1 RAs users exhibit reduced risks of mortality (adjusted hazard ratio [aHR]: 0.57), MACEs (aHR: 0.88), and MAKEs (aHR: 0.73). External validation in a multicenter dataset of 1245 type 2 diabetes patients with AKD supports the favorable outcomes. These results emphasize the potential of GLP-1 RAs in individualized treatment for this population.
© 2024. The Author(s).
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Cardiorenal syndrome: Plasmonic biosensors.
Clin Chim Acta2024 Jul;562():119870. doi: 10.1016/j.cca.2024.119870.
Rezabakhsh Aysa, Fathi Farzaneh, Habtemariam Solomon, Ahmadian Elham,
Abstract
Cardiorenal syndrome (CRS) is defined as a broad spectrum of conditions encompassing both the heart and kidneys in which acute or chronic heart disorder may induce acute or chronic tubular injury in the kidneys and vice versa. Early diagnosis allows timely intervention and attenuates disease progression. Two well-established biomarkers, neutrophil gelatinase-associated lipocalin (NGAL) and brain (B-type) natriuretic peptide (BNP), are reflective of impaired cardiac and kidney function associated with poor prognosis in various cardiac disorders, including heart failure and coronary artery disease. Given the ongoing contribution of CRS to the high morbidity and mortality post-MI, early risk stratification and preventive measures are highly significant. In this review, we examine Surface Plasmon Resonance (SPR) optical biosensors for detection of these biomarkers and discuss potential implications of this highly sensitive and specific technology in CRS detection, treatment and outcomes.
Copyright © 2024 Elsevier B.V. All rights reserved.
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