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Pubblicazioni recenti - cardiorenal
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Serum and Urine Osmolality as Predictors of Adequate Diuresis in Acute Decompensated Heart Failure: A Prospective Cohort Study.
Cardiorenal Med2022 Jun;():. doi: 10.1159/000525730.
Lo Kevin Bryan, Salacup Grace, Pelayo Jerald, Putthapiban Prapaipan, Swamy Sowmya, Nakity Rasha, Naranjo-Tovar Mario, Rangaswami Janani,
Abstract
Background Determination of adequacy of decongestion remains a significant challenge in the management of acute heart failure (AHF). Methods This is a prospective single center cohort study of patients (>18 years old) admitted for AHF on intravenous diuretics, with BNP > 100 pg/mL or echocardiographic findings of reduced ejection fraction or diastolic dysfunction, and at least 1 clinical sign of volume overload. Patients with eGFR?45mL/minute or on dialysis, and with exposure to contrast dye or nephrotoxins were excluded. Serum and spot urine osmolality were obtained early morning simultaneously daily for 5 days or until discharge. ROC curves were used to analyze the optimal cut-offs for the osmolality values in the prediction of heart failure readmissions Results Of the total 100 patients, 62% were male and 59% were Black American. The mean age was 64.41±12.53 and 34% had preserved ejection fraction. Patients with 30-day readmission had higher serum osmolality(mOsm/kg) on admission (305 [299-310] vs 298 [294-303] p=0.044) and had higher drop in serum osmolality between admission and discharge (-7.5 [-9.0,-1.25] vs -1.0 [-4.0,4.0] ;p=0.044). Serum osmolality on admission of >299 mOsm/kg (sensitivity:83%, specificity:61%) and drop in serum osmolality between admission and discharge of >2 mOsm/kg (sensitivity:83%, specificity:65%) was associated with 30-day HF readmissions. No patients discharged with urine osmolality more than 500 mOsm/kg had 30-day readmissions but this was not statistically significant p=0.334 Conclusion Measurement of serum osmolality and urine osmolality may have some utility in AHF, but interpretation should consider baseline values and dynamic changes to account for individual differences in sodium and water handling.
The Author(s). Published by S. Karger AG, Basel.
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Evidence of chronic kidney injury in patients not meeting KDIGO criteria for chronic kidney disease.
Clin Kidney J2022 Jul;15(7):1217-1220. doi: 10.1093/ckj/sfac007.
Alvarez-Llamas Gloria, Santiago-Hernandez Aranzazu, Ruilope Luis M,
Abstract
Subjects not meeting KDIGO criteria for chronic kidney disease (CKD), i.e. normoalbuminuric (urinary albumin:creatinine ratio, UACR 60 mL/min/1.73 m, are considered at no increased cardiovascular or kidney risk associated with kidney disease, but the incidence of subclinical atherosclerosis, cardiovascular events and CKD progression is already increased in the high-normal UACR range (10-30 mg/g). Earlier intervention in this subclinical pre-CKD stage may diminish cardiorenal risk. However, tools to predict albuminuria development and to identify those subjects who will benefit most from intervention are limited. Recent data have identified urine molecular changes within the normoalbuminuria condition, consisting of an altered urinary peptidome, proteome and metabolome, which represent subclinical organ damage and processes such as inflammation, oxidative stress, tricarboxylic acids cycle deregulation, impaired fatty acids ?-oxidation or defective tubular reabsorption.
© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.
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Poricoic Acid A Inhibits the NF-B/MAPK Pathway to Alleviate Renal Fibrosis in Rats with Cardiorenal Syndrome.
Evid Based Complement Alternat Med2022 ;2022():8644353. doi: 10.1155/2022/8644353.
Chen Wenzhong, Fan Zhiwen, Huang Canhui, Liu Junying,
Abstract
Objective:
To explore the potential and mechanism of action of poricoic acid A (PAA) in treatment of cardiorenal injury and fibrosis due to cardiorenal syndrome (CRS).
Materials and Methods:
A CRS rat model was established by transabdominal subtotal nephrectomy (STNx). The experimental group was treated by gavage of PAA (10?mg/kg/day). After 8 weeks of treatment, echocardiography was utilized for detecting heart-related indexes in rats. HE and Masson staining were conducted to detect the degree of pathological damage and fibrosis in rat kidney tissue, respectively. In addition, serum blood urea nitrogen (BUN), serum creatinine (SCr), and 24-hour urine protein were measured biochemically. Also, the levels of inflammatory factors (IL-1, IL-6, and IL-10) in rat kidneys were measured using ELISA. Western blot was used to examine the expression of NF-B/MAPK pathway-related proteins.
Results:
In this study, a CRS rat model was successfully established by STNx surgery. PAA treatment could significantly alleviate the damage of heart and kidney function in CRS rats and reduce the pathological damage of kidney tissue and renal fibrosis. Meanwhile, PAA could also inhibit the renal inflammatory response through downregulating IL-1 and IL-6 levels in the kidney tissue and upregulating IL-10 level. Further mechanism exploration showed that the NF-B/MAPK signaling pathway was significantly activated in CRS rats, while PAA treatment could markedly inhibit the NF-B/MAPK signaling pathway activity in CRS rats.
Conclusion:
PAA can obviously improve the pathological damage and fibrosis of renal tissue in CRS rats and maintain the function of the heart and kidney. The above functions of PAA may be achieved by inhibiting the NF-B/MAPK signaling pathway activity. Briefly speaking, PAA can serve as a potential drug for CRS treatment.
Copyright © 2022 Wenzhong Chen et al.
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SARS-CoV-2 spike protein antibody titers 6 months after SARS-CoV-2 mRNA vaccination among patients undergoing hemodialysis in Japan.
Clin Exp Nephrol2022 Jun;():. doi: 10.1007/s10157-022-02243-8.
Kanai Daisuke, Wakui Hiromichi, Haze Tatsuya, Azushima Kengo, Kinguchi Sho, Tsukamoto Shunichiro, Kanaoka Tomohiko, Urate Shingo, Toya Yoshiyuki, Hirawa Nobuhito, Kato Hideaki, Watanabe Fumimasa, Hanaoka Kanako, Hanaoka Masaaki, Mitsuhashi Hiroshi, Yamaguchi Satoshi, Ohnishi Toshimasa, Tamura Kouichi,
Abstract
BACKGROUND:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is shown to prevent severe illness and death in hemodialysis (HD) patients, but the immune response to vaccines is reduced in this population. This study compared SARS-CoV-2 spike protein antibody titers between HD patients and healthy controls in Japan for up to 6 months following vaccination.
METHODS:
A multi-institutional retrospective study at five clinics in Japan was conducted using 412 HD patients and 156 healthy controls who received two doses of the BNT162b2 (Pfizer-BioNTech) mRNA vaccine. Anti-SARS-CoV-2 spike protein S1 IgG antibody titers were measured at 1, 3, and 6 months after the second dose. The attenuation speed was calculated as slope (i.e., -?) using a linear mixed-effects model toward the log-transformed antibody titers.
RESULTS:
The HD group had significantly lower month 1 antibody titers (Ab-titer-1) than the controls, and these remained lower through month 6 (95% CI: 2617.1 (1296.7, 5240.8) vs. 7285.4 (4403.9, 11,000.0) AU/mL at Ab-titer-1, and 353.4 (178.4, 656.3) vs. 812.0 (498.3, 1342.7) AU/mL at Ab-titer-6 (p?0.001, respectively)). Lower log Ab-titer-1 levels in the HD group were significantly associated with a lower log Ab-titer-6 (0.90 [0.83, 0.97], p?0.001). The -? values in the HD patients and healthy controls were -4.7?±?1.1 and -4.7?±?1.4 (year), respectively.
CONCLUSION:
SARS-CoV-2 spike protein antibody titers were significantly lower in HD patients than in healthy controls at 1 (peak) and 6 months after the second vaccination. Low peak antibody titers contributed to low 6-month antibody titers.
© 2022. The Author(s), under exclusive licence to The Japanese Society of Nephrology.
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New Advances in Cardiorenal Syndrome-Ready for Prime Time?
J Clin Med2022 Jun;11(12):. doi: 3460.
Pliquett Rainer U,
Abstract
Cardiorenal Syndrome has become one pressing issue as far as hospitalizations are concerned [...].
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Natriuretic Peptide-Based Novel Therapeutics: Long Journeys of Drug Developments Optimized for Disease States.
Biology (Basel)2022 Jun;11(6):. doi: 859.
Ichiki Tomoko, Jinno Atsushi, Tsuji Yoshihisa,
Abstract
The field of natriuretic peptides (NPs) as an endocrine hormone has been developing since 1979. There are three peptides in humans: atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), which bind to the guanylyl cyclase-A (GC-A) receptor (also called natriuretic peptide receptor-A (NPR-A)), and C-type natriuretic peptide (CNP), which binds to the GC-B receptor (also called the NPR-B) and then synthesizes intracellular cGMP. GC-A receptor stimulation has natriuretic, vasodilatory, cardiorenal protective and anti-renin-angiotensin-aldosterone system actions, and GC-B receptor stimulation can suppress myocardial fibrosis and can activate bone growth before epiphyseal plate closure. These physiological effects are useful as therapeutics for some disease states, such as heart failure, hypertension, and dwarfism. To optimize the therapeutics for each disease state, we must consider drug metabolism, delivery systems, and target receptor(s). We review the cardiac NP system; new designer NPs, such as modified/combined NPs and modified peptides that can bind to not only NP receptors but receptors for other systems; and oral drugs that enhance endogenous NP activity. Finally, we discuss prospective drug discoveries and the development of novel NP therapeutics.
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Low Use of Guideline-recommended Cardiorenal Protective Antihyperglycemic Agents in Primary Care: A Cross-sectional Study of Persons With Type 2 Diabetes.
Can J Diabetes2022 Feb;():. doi: S1499-2671(22)00014-4.
Marasinghe Dewdunee H, Butalia Sonia, Garies Stephanie, Drummond Neil, Kim James W, Senior Peter A,
Abstract
OBJECTIVES:
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown cardiorenal benefits independent of their glucose-lowering effects among persons living with type 2 diabetes mellitus (T2DM). In this study we describe the proportion of persons with T2DM eligible to receive and currently receiving these agents based on their risk criteria for cardiorenal events.
METHODS:
This study was a cross-sectional analysis of primary care electronic medical records, in southern Alberta, of persons with T2DM who had at least 1 encounter with their primary care provider between December 31, 2018 to December 31, 2020. A descriptive and multivariate logistic regression analysis was conducted to examine clinical and demographic determinants of being prescribed one of the new treatments.
RESULTS:
Our study sample included 11,939 persons living with T2DM, among whom 66.3% had a cardiorenal indication for SGLT2i or GLP-1 RA use. In the secondary and primary prevention subsamples, 19.4% and 16.6% of persons were prescribed SGLT2i or GLP-1 RA, respectively, compared with 20.0% of those with no specific cardiorenal indication. Several person-level characteristics, such as age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.96 to 0.97), male sex (OR, 1.37; 95% CI, 1.21 to 1.55) and glycated hemoglobin (OR, 1.29; 95% CI, 1.24 to 1.34), were associated with being prescribed SGLT2i or GLP-1 RA.
CONCLUSIONS:
Low rates of SGLT2i or GLP-1 RA use and minimal differences between high-risk and no cardiorenal indication subsamples suggest the presence of barriers to prescribing these medications in a primary care setting. Action to highlight the indications for, and improve access to agents with, cardiorenal benefits will be required to achieve better outcomes for people with T2DM in primary care.
Copyright © 2022 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
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Prognostic significance of risk factors and biomarkers in patients hospitalized for cardiorenal syndromes: A pilot study.
Curr Med Chem2022 Jun;():. doi: 10.2174/0929867329666220622151106.
Theofilis Panagiotis, Vordoni Aikaterini, Nakas Nikos, Kotsakis Athanasios, Kranidis Athanasios, Makryniotou Ioanna, Kalaitzidis Rigas G,
Abstract
BACKGROUND:
Cardiorenal syndromes (CRS), involving the heart-kidney cross-talk and the activation of neurohumoral and inflammatory pathways, is an entity characterized by high morbidity and mortality.
OBJECTIVE:
To evaluate the prognostic role of risk factors and biomarkers in patients hospitalized for CRS.
METHODS:
In this observational cohort study, 100 consecutive patients hospitalized for CRS were enrolled. Socio-demographic characteristics, personal medical history, and prior medication use were recorded upon admission, and echocardiography was performed. Moreover, an array of blood markers were measured. The endpoint of interest was a composite of death or dialysis dependence at discharge.
RESULTS:
Patients were classified into two groups; Group 1 (N=52): discharged being dialysis-independent, Group 2 (N=48): death/dialysis dependence at discharge. No significant differences were detected in baseline characteristics between the two groups. Group 2 patients used renin-angiotensin-aldosterone system blockers (RAASb) less often and more frequently presented with oliguria/anuria. Group 2 patients had significantly lower hemoglobin, serum albumin, and 25-hydroxy-vitamin D [25(OH)D]. At the same time, serum phosphate, potassium, and parathyroid hormone (PTH) were significantly higher in Group 2 patients. In a multivariate regression analysis, lack of prior RAASb and lower 25(OH)D levels were independently associated with an increased risk of death or dialysis dependence at discharge. 25(OH)D/PTH ratio was the most accurate predictor of the composite endpoint (Sensitivity: 79.4%, Specificity: 70.4%).
CONCLUSION:
Lack of prior RAASb use, high PTH, low 25(OH)D levels, and low 25(OH)D/PTH ratio are associated with a poor prognosis in patients hospitalized for CRS.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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Prediction of acute kidney injury for acute type A aortic dissection patients underwent Sun's procedure by a perioperative nomogram.
Cardiorenal Med2022 Jun;():. doi: 10.1159/000524907.
Zhang Yuhui, Lan Yongrong, Chen Tongyun, Chen Qingliang, Guo Zhigang, Jiang Nan,
Abstract
INTRODUCTION:
Postoperative acute kidney injury (AKI) occurs in 20%-40% of acute type A aortic dissection (ATAAD) patients undergoing cardiac surgery. A predictive model could be developed to assess the probability of AKI in patients with ATAAD before and after cardiac surgery in a timely manner.
METHODS:
This retrospective study enrolled a total of 224 patients with ATAAD. Patients were subjected to total arch replacement using tetrafurcate graft with stented elephant trunk implantation according to Sun's procedure. Statistical comparison for the collected data was done with Student's t-test or Mann-Whitney U test (continuous variables) and chi-square test (categorical variables). The independent predictors were screened by multivariate logistic regression analysis, and then incorporated into a nomogram. The reliability of cardiac surgery-associated acute kidney injury (CSA-AKI) models was evaluated using the area under the receiver operating characteristic curve (AUC).
RESULTS:
This study enrolled 224 acute type A aortic dissection patients, including 53 patients with AKI and 171 patients without AKI. The incidence of ATAAD-induced AKI in the cohort was 23.66%. The screened predictors for AKI include iliac artery involvement, creatinine, D-dimer, autotransfusion, platelet-rich plasma reinfusion, nasal temperature, red blood cells, fresh frozen plasma, drainage, and mechanical ventilation. The calculated AUC values for model 1, model 2, model 3, and model 4 were 0.710, 0.777, 0.827, and 0.848, respectively. Model 4 was optimum for AKI risk scoring compared with model 1, model 2, and model 3.
CONCLUSIONS:
AKI prediction models were established for ATAAD patients using preoperative, intraoperative, and postoperative information. Particularly model 4 shows superiority in risk prediction for CSA-AKI.
The Author(s). Published by S. Karger AG, Basel.
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Body fluid regulation via chronic inhibition of sodium-glucose cotransporter-2 in patients with heart failure: a post hoc analysis of the CANDLE trial.
Clin Res Cardiol2022 Jun;():. doi: 10.1007/s00392-022-02049-4.
Fujiki Shinya, Tanaka Atsushi, Imai Takumi, Shimabukuro Michio, Uehara Hiroki, Nakamura Ikuko, Matsunaga Kazuo, Suzuki Makoto, Kashimura Takeshi, Minamino Tohru, Inomata Takayuki, Node Koichi, ,
Abstract
BACKGROUND:
In patients with chronic heart failure (CHF) and type 2 diabetes (T2D), sodium-glucose cotransporter-2 (SGLT2) inhibition improves cardiorenal outcomes, but details of the effects on distinct subsets of body fluid volume remain incomplete.
METHODS:
This was a post hoc analysis of patients with CHF and T2D in the CANDLE trial (UMIN000017669), an investigator-initiated, multi-center, randomized open-label trial that compared the effect of canagliflozin (100 mg, n?=?113) with glimepiride (starting dose: 0.5 mg, n?=?120) on changes in N-terminal pro-brain natriuretic peptide. The estimated plasma volume (ePV, calculated with the Straus formula) and estimated extracellular volume (eEV, determined by the body surface area) were compared between treatment groups at weeks 4, 12, and 24.
RESULTS:
Among 233 patients analyzed, 166 (71.2%) had an ejection fraction (EF)?>?50%. Reductions in ePV and eEV were observed only in the canagliflozin group until week 12 (change from baseline at week 12, ePV; - 7.63%; 95% confidence interval [CI], - 10.71 to - 4.55%, p?0.001, eEV; - 123.15 mL; 95% CI, - 190.38 to - 55.92 mL, p?0.001). While ePV stopped falling after week 12, eEV continued to fall until week 24 ([change from baseline at week 24] - [change from baseline at week 12], ePV; 1.01%; 95%CI, - 2.30-4.32%, p?=?0.549, eEV; - 125.15 mL; 95% CI, - 184.35 to - 65.95 mL, p?0.001).
CONCLUSIONS:
Maintenance of a modest reduction in ePV and continuous removal of eEV via chronic SGLT2 inhibition suggests that favorable body fluid regulation contributes to the cardiorenal benefits of SGLT2 inhibitors in patients with CHF, irrespective of EF.
TRIAL REGISTRATION:
UMIN000017669.
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
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Amelioration of Hypertension by Oryeongsan through Improvements of Body Fluid and Sodium Balance: Roles of the Renin-Angiotensin System and Atrial Natriuretic Peptide System.
Evid Based Complement Alternat Med2022 ;2022():9159292. doi: 10.1155/2022/9159292.
Ahn You Mee, Kim Hye Yoom, Yoon Jung Joo, Kim Hyun Ju, Lee Yun Jung, Yun Young Gab, Shin Hyeun Kyoo, Cho Kyung Woo, Kang Dae Gill, Lee Ho Sub,
Abstract
Oryeongsan (Wulingsan in China and Goreisan in Japan), a formula composed of five herbal medicines, has long been used for the treatment of imbalance of the body fluid homeostasis in Asian countries. However, the mechanism by which Oryeongsan (ORS) improves the impaired body fluid and salt metabolism is not clearly defined. The present study was performed to define the role of the cardiorenal humoral system in the ORS-induced changes in blood pressure and renal function in hypertension. Experiments were performed in normotensive and two-kidney, one-clip hypertensive rats. Changes in the fluid and salt balance were measured in rats individually housed in metabolic cages. Changes in the systemic and local renin-angiotensin system (RAS) and cardiac natriuretic peptide hormone system (NPS) were evaluated. ORS water extract was administered by oral gavage (100?mg/kg daily) for 3 weeks. ORS induced diuresis and natriuresis along with an increase in glomerular filtration rate and downregulation of the Na/H exchanger 3 (NHE3) and aquaporin 2 expression in the renal cortex and medulla, respectively. Furthermore, treatment with ORS significantly decreased systolic blood pressure with contraction of body sodium and water accumulation in hypertensive rats. ORS-induced changes were accompanied by modulation of the RAS and NPS, downregulation of the systemic RAS and cardiorenal expression of angiotensin-converting enzyme (ACE) and angiotensin II subtype 1 (AT) receptor, and upregulation of the plasma ANP concentration and cardiorenal expression of ANP, ACE2, Mas receptor, and AT receptor. These findings indicate that ORS induces beneficial effects on the high blood pressure through modulation of the RAS and NPS of the cardiorenal system, suppression of the prohypertensive ACE-AT receptor pathway and NHE3, accentuation of the antihypertensive ACE2-Mas axis/AT receptor pathway in the kidney, suppression of the systemic RAS, and elevation of the plasma ANP levels and its synthesis in the heart. The present study provides a biological basis for the use of ORS in the treatment of impaired volume and pressure homeostasis.
Copyright © 2022 You Mee Ahn et al.
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Evidence for a Prehypertensive Water Dysregulation Affecting the Development of Hypertension: Results of Very Early Treatment of Vasopressin V1 and V2 Antagonism in Spontaneously Hypertensive Rats.
Front Cardiovasc Med2022 ;9():897244. doi: 10.3389/fcvm.2022.897244.
Verzicco Ignazio, Tedeschi Stefano, Graiani Gallia, Bongrani Alice, Carnevali Maria Luisa, Dancelli Simona, Zappa Jessica, Mattei Silvia, Bovino Achiropita, Cavazzini Stefania, Rocco Rossana, Calvi Anna, Palladini Barbara, Volpi Riccardo, Cannone Valentina, Coghi Pietro, Borghetti Alberico, Cabassi Aderville,
Abstract
In addition to long-term regulation of blood pressure (BP), in the kidney resides the initial trigger for hypertension development due to an altered capacity to excrete sodium and water. Betaine is one of the major organic osmolytes, and its betaine/gamma-aminobutyric acid transporter (BGT-1) expression in the renal medulla relates to interstitial tonicity and urinary osmolality and volume. This study investigated altered water and sodium balance as well as changes in antidiuretic hormone (ADH) activity in female spontaneously hypertensive (SHR) and normotensive Wistar Kyoto (WKY) rats from their 3-5 weeks of age (prehypertensive phase) to SHR's 28-30 weeks of age (established hypertension-organ damage). Young prehypertensive SHRs showed a reduced daily urine output, an elevated urine osmolarity, and higher immunostaining of tubule BGT-1, alpha-1-Na-K ATPase in the outer medulla vs. age-matched WKY. ADH circulating levels were not different between young prehypertensive SHR and WKY, but the urine aquaporin2 (AQP2)/creatinine ratio and labeling of AQP2 in the collecting duct were increased. At 28-30 weeks, hypertensive SHR with moderate renal failure did not show any difference in urinary osmolarity, urine AQP2/creatinine ratio, tubule BGT-1, and alpha-1-Na-K ATPase as compared with WKY. These results suggest an increased sensitivity to ADH in prehypertensive female SHR. On this basis, a second series of experiments were set to study the role of ADH V1 and V2 receptors in the development of hypertension, and a group of female prehypertensive SHRs were treated from the 25th to 49th day of age with either V1 (OPC21268) or V2 (OPC 41061) receptor antagonists to evaluate the BP time course. OPC 41061-treated SHRs had a delayed development of hypertension for 5 weeks without effect in OPC 21268-treated SHRs. In prehypertensive female SHR, an increased renal ADH sensitivity is crucial for the development of hypertension by favoring a positive water balance. Early treatment with selective V2 antagonism delays future hypertension development in young SHRs.
Copyright © 2022 Verzicco, Tedeschi, Graiani, Bongrani, Carnevali, Dancelli, Zappa, Mattei, Bovino, Cavazzini, Rocco, Calvi, Palladini, Volpi, Cannone, Coghi, Borghetti and Cabassi.
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Mission and 1-Year Outcomes of a Cardiorenal Subspecialty Consultation Service.
Kidney3602022 Apr;3(4):749-751. doi: 10.34067/KID.0000602022.
Bansal Nisha, Arora Nayan, Mariuma David, Jefferson Jonathan Ashley, O'Brien Kevin, Shankland Stuart,
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A Synergistic Association Between Inflammation, Malnutrition, and Mortality in Patients With Diabetics.
Front Nutr2022 ;9():872512. doi: 10.3389/fnut.2022.872512.
Wang Junjie, Chen Liling, Huang Zhidong, Lu Jin, Yang Yanfang, Zhao Xiaoli, Tu Jiabin, Pan Yuxiong, Bao Kunming, Chen Weihua, Xiu Jiaming, Liu Yong, Chen Longtian, Chen Shiqun, Chen Kaihong,
Abstract
Background:
Although inflammation is a known predictor for poor prognosis in patients with diabetics, few data report the synergistic association between inflammation, malnutrition, and mortality in patients with diabetics. We aim to explore whether malnutrition modifies the predictor of inflammation on prognosis.
Methods:
Nutritional status and inflammation were measured in 6,682 patients with diabetics undergoing coronary angiography or percutaneous coronary intervention between January 2007 to December 2018 from Cardiorenal Improvement Registry. Malnutrition was defined as Controlling Nutritional Status (CONUT) score, which was more than 1. High-sensitivity C-reactive protein (hs-CRP) exceeding the median was assessed as a high-risk inflammation. Cox regression models were used to estimate hazard ratios (HR) for mortality across combined hs-CRP and CONUT score categories.
Results:
During a median follow-up of 5.0 years (interquartile range: 3.0-7.6 years), 759 (11.36%) patients died. The mortality of the four groups (normal nutrition and low hs-CRP level; normal nutrition and high hs-CRP level; malnutrition and low hs-CRP level; and malnutrition and high hs-CRP level) were 7.29, 7.12, 10.71, and 17.31%, respectively. Compared with normal nutrition and low hs-CRP level, an isolated condition of either malnutrition or high hs-CRP level was not associated with any significant risk for all-cause mortality. However, concomitant presence of both high hs-CRP level and malnutrition condition was associated with a significantly increased risk of all-cause mortality (HR: 1.51; 95% CI: 1.20-1.89;
Conclusion:
The interplay of inflammation and malnutrition in patients with diabetics significantly amplifies the deleterious effects of each as distinct disease entities. A prospective randomized clinical trial is needed in the future to verify the results.
Copyright © 2022 Wang, Chen, Huang, Lu, Yang, Zhao, Tu, Pan, Bao, Chen, Xiu, Liu, Chen, Chen and Chen.
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Infectious Aortic Aneurysm in a Patient With Leriche Syndrome.
Clin Nucl Med2022 Jun;():. doi: 10.1097/RLU.0000000000004319.
Norikane Takashi, Yamamoto Yuka, Takami Yasukage, Tani Ryosuke, Nishiyama Yoshihiro,
Abstract
ABSTRACT:
Leriche syndrome is a relatively rare atherosclerotic occlusive disease characterized by total occlusion of the abdominal aorta and/or both iliac arteries. The typical clinical manifestations of Leriche syndrome include intermittent claudication, fatigue, and leg pain. We present the case of a 56-year-old man with Leriche syndrome accompanied by an infectious abdominal aortic aneurysm. 18F-FDG PET angiography/CT and 18F-FDG PET/CT provided important information about the thrombus and infected sites.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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Non-steroidal mineralocorticoid receptor antagonists in cardiorenal disease.
Eur Heart J2022 Jun;():. doi: ehac299.
Pandey Arjun K, Bhatt Deepak L, Cosentino Francesco, Marx Nikolaus, Rotstein Ori, Pitt Bertram, Pandey Ambirash, Butler Javed, Verma Subodh,
Abstract
Despite existing treatments, patients with heart failure and chronic kidney disease (CKD) remain at high risk for adverse outcomes and progression to end-stage disease. Steroidal mineralocorticoid receptor antagonists (MRAs) such as spironolactone and eplerenone reduce mortality but remain under-prescribed due to the perceived risk of hyperkalaemia and hormonal side effects. The discovery of non-steroidal MRAs represents a major new dimension in cardiorenal disease therapy. Non-steroidal MRAs have high affinity and specificity for the mineralocorticoid receptor (MR) and differ from both steroidal agents and each other with respect to important physiochemical, pharmacodynamic, and pharmacokinetic parameters. Similar to their steroidal counterparts, they have beneficial anti-inflammatory, anti-remodelling, and anti-fibrotic properties in the kidneys, heart, and vasculature. There are several non-steroidal MRAs under development and clinical assessment; of these, only esaxerenone and finerenone are approved for treatment globally. In Japan, esaxerenone is approved for essential hypertension and has been studied in diabetic nephropathy. Compared with steroidal MRAs, finerenone more potently inhibits MR co-regulator recruitment and fibrosis and distributes more evenly between the heart and kidneys. The landmark Phase III trials FIGARO-DKD and FIDELIO-DKD demonstrated that finerenone-reduced major kidney and cardiovascular events on top of maximally tolerated renin-angiotensin-aldosterone system inhibition in patients with CKD associated with Type 2 diabetes. Non-steroidal MRAs are currently under evaluation in heart failure and for synergistic treatment with sodium-glucose contransporter 2 inhibitors. These ground-breaking agents could become an important therapy across the spectrum of cardiorenal disease.
© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Sex-specific effects of daily tadalafil on diabetic heart kinetics in RECOGITO, a randomized, double-blind, placebo-controlled trial.
Sci Transl Med2022 Jun;14(649):eabl8503. doi: 10.1126/scitranslmed.abl8503.
Pofi Riccardo, Giannetta Elisa, Feola Tiziana, Galea Nicola, Barbagallo Federica, Campolo Federica, Badagliacca Roberto, Barbano Biagio, Ciolina Federica, Defeudis Giuseppe, Filardi Tiziana, Sesti Franz, Minnetti Marianna, Vizza Carmine D, Pasqualetti Patrizio, Caboni Pierluigi, Carbone Iacopo, Francone Marco, Catalano Carlo, Pozzilli Paolo, Lenzi Andrea, Venneri Mary Anna, Gianfrilli Daniele, Isidori Andrea M,
Abstract
Cyclic GMP-phosphodiesterase type 5 (PDE5) inhibition has been shown to counteract maladaptive cardiac changes triggered by diabetes in some but not all studies. We performed a single-center, 20-week, double-blind, randomized, placebo-controlled trial (NCT01803828) to assess sex differences in cardiac remodeling after PDE5 inhibition in patients with diabetic cardiomyopathy. A total of 122 men and women (45 to 80 years) with long-duration (>3 years) and well-controlled type 2 diabetes mellitus (T2DM; HbA1c
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Review of SGLT2i for the Treatment of Renal Complications: Experience in Patients with and Without T2D.
Diabetes Ther2022 Jun;():. doi: 10.1007/s13300-022-01276-2.
González-Albarrán Olga, Morales Cristóbal, Pérez-Maraver Manuel, Aparicio-Sánchez José Juan, Simó Rafael,
Abstract
The management of type 2 diabetes (T2D) involves decreasing plasma glucose levels and reducing cardiovascular and microvascular complications. Diabetic kidney disease (DKD), defined as presence of albuminuria, impaired glomerular filtration, or both, is an insidious microvascular complication of diabetes that generates a substantial personal and clinical burden. The progressive reduction in renal function and increased albuminuria results in an increase of cardiovascular events. Thus, patients with DKD require exhaustive control of the associated cardiovascular risk factors. People with diabetes and renal impairment have fewer options of antidiabetic drugs because of contraindications, adverse effects, or altered pharmacokinetics. Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) reduce blood glucose concentrations by blocking the uptake of sodium and glucose in the proximal tubule and promoting glycosuria, and these agents now have an important role in the management of T2D. The results of several cardiovascular outcomes trials suggested that SGLT2i are associated with improvements in renal endpoints in addition to their reduction in cardiovascular events and mortality, which represents a major advance in the care of this population. The dedicated kidney outcomes trials have confirmed the renoprotective action of SGLT2i across different glomerular filtration and albuminuria values, even in patients with non-diabetic chronic kidney disease. Notably, this improvement in kidney function may indirectly benefit cardiac function through multifaceted interorgan cross talk, which can break the cardiorenal vicious circle linked to T2D. In this article, we briefly review the different mechanisms of action that may explain the renal beneficial effects of SGLT2i and disclose the results of the key renal outcome trials and the subsequent update of related clinical guidelines.
© 2022. The Author(s).
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Prevention of Cardiorenal Complications with Sodium-Glucose Cotransporter Type 2 Inhibitors: A Narrative Review.
Diabetes Ther2022 Jun;():. doi: 10.1007/s13300-022-01277-1.
Botana Manuel, Escalada Javier, Merchante Ángel, Reyes Rebeca, Rozas Pedro,
Abstract
Heart failure (HF) and chronic kidney disease (CKD) are the most frequent first cardiorenal conditions in patients with type 2 diabetes (T2D), which can be exacerbated by other comorbidities, such as hypertension, dyslipidemia, and obesity. To improve their clinical outcomes, patients with T2D need to achieve and maintain glycemic targets, as well as prevent cardiorenal disease onset and progression. Several clinical trials evaluating the sodium-glucose cotransporter type 2 inhibitors (SGLT2i) dapagliflozin, empagliflozin, canagliflozin, and ertugliflozin have shown consistent risk reduction in major adverse cardiovascular events and/or hospitalization for HF, together with lower risk of kidney disease progression. The benefits associated with SGLT2i in T2D are distinct from other antihyperglycemic drugs since they have been proposed to exert pleiotropic metabolic and direct effects on the kidney and the heart. In this review, we summarize and discuss the evidence regarding the mechanisms of action, the efficacy and safety profiles, and the clinical guidelines on the use of the therapeutic class of SGLT2i, highlighting their role in cardiorenal prevention beyond glycemic control.
© 2022. The Author(s).
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Benefits of SGLT2i for the Treatment of Heart Failure Irrespective of Diabetes Diagnosis: A State-of-the-Art Review.
Diabetes Ther2022 Jun;():. doi: 10.1007/s13300-022-01278-0.
Delgado Elías, Jódar Esteban, Mezquita-Raya Pedro, Moreno-Pérez Óscar,
Abstract
Morbidity and mortality associated with heart failure (HF) has remained high despite advances in therapy. Furthermore, HF-associated risk in patients with type 2 diabetes mellitus (T2D) is even higher than in patients without T2D owing to the strong reciprocal relationship between conditions. However, until recently, no therapy to treat patients with diabetes also reduced cardiovascular risks related to HF. Recent clinical studies (DAPA-HF, EMPEROR-Reduced and EMPEROR-Preserved, SOLOIST-WHF trial) and meta-analysis have demonstrated that sodium-glucose cotransporter-2 inhibitors (SGLT2i) are among the first antidiabetic drugs capable of reducing cardiovascular risks related to HF and improving the prognosis of patients with and without diabetes. Their pleiotropic mechanisms of action place them at the intersection of hemodynamic, metabolic, and neurohumoral pathways, with clear advantages for treating these patients independent of its glucose-lowering effect. Moreover, the benefits of SGLT2i were consistent across the cardiorenal continuum in different populations and clinical settings, which has led to different guidelines introducing SGLT2i as a first-line treatment for HF.
© 2022. The Author(s).
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