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Pubblicazioni recenti - cardiorenal
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The effect of sodium-glucose cotransporter 2 inhibitors on biomarkers of inflammation: A systematic review and meta-analysis of randomized controlled trials.
Front Pharmacol2022 ;13():1045235. doi: 1045235.
Wang Dongmei, Liu Jieying, Zhong Ling, Li Shunhua, Zhou Liyuan, Zhang Qian, Li Ming, Xiao Xinhua,
Abstract
Inflammatory biomarkers may play vital roles in the pathophysiology of diabetes and diabetic cardiorenal complications. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have a potential cardiovascular and renal protective effect in type 2 diabetes. The aim of this meta-analysis was to quantify the effects of SGLT2 inhibitors on biomarkers of inflammation in randomized controlled trials (RCTs). PubMed, Cochrane Library, EMBASE, and Web of Science were searched for eligible RCTs of adults with type 2 diabetes (T2D) with no time limit (updated to 12 October 2022). The biomarkers selected included C-reactive protein (CRP), interleukin-6, tumor necrosis factor-alpha, leptin, adiponectin, ferritin, plasminogen activator inhibitor (PAI)-1, and vascular cell adhesion molecule-1. Data were analyzed using a random-effect model in Review Manager 5.4. Thirty-four studies with 6,261 patients (68.6% male) were eligible for this meta-analysis. The mean age of the participants was 62.57(±11.13) years old, and the median treatment duration length with follow-up was 24 weeks. Generally, the included trials were of good methodological quality. The meta-analysis revealed that ferritin levels were significantly reduced in SGLT2 inhibitor treatment groups placebo or standard diabetes therapies (SMD: -1.21; 95% CI: -1.91, -0.52,
Copyright © 2022 Wang, Liu, Zhong, Li, Zhou, Zhang, Li and Xiao.
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Blood volume and chronic kidney disease in heart failure - Can volume expansion help balance the Cardio-Renal Axis for better clinical outcomes?
Physiol Rep2022 Dec;10(23):e15526. doi: 10.14814/phy2.15526.
Miller Wayne L, Fudim Marat, Mullan Brian P,
Abstract
Intravascular volume is largely regulated by the kidneys but how differences in intravascular volume profiles interact with chronic kidney disease (CKD) to influence outcomes in chronic heart failure (HF) has not been explored. Our hypothesis was that a greater degree of volume expansion (VE) would moderate the impact of CKD on HF-related clinical outcomes. Quantitative blood volume (BV) data were available in 137 patients at the time of hospital discharge using a nuclear medicine radiolabeled albumin indicator-dilution technique. The study patients were stratified by the cohort median glomerular filtration rate (GFR, 44?ml/min/1.73?m ). An a priori cut-point of ?+25% above normal BV was then used to further stratify the two GFR subgroups and prospectively analyzed for 1-year HF-related mortality or 1st re-hospitalization. Persistent BV expansions ?+25% were present in 51% of the cohort. In the subgroup with GFR above the median (N = 68) greater or lesser BV expansion from +25% did not differentiate outcomes. However, in the subgroup with GFR below the median (N = 69), BV expansion-stratified risk (log-rank p = 0.022) with
© 2022 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.
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Eplerenone inhibits the macrophage-to-myofibroblast transition in rats with UUO-induced type 4 cardiorenal syndrome through the MR/CTGF pathway.
Int Immunopharmacol2022 Dec;113(Pt A):109396. doi: 10.1016/j.intimp.2022.109396.
Han Yutong, Xian Yunqian, Gao Xiaomeng, Qiang Panpan, Hao Juan, Yang Fan, Shimosawa Tatsuo, Chang Yi, Xu Qingyou,
Abstract
Cardiovascular complications are the leading causes of death in patients with chronic kidney disease (CKD), accounting for approximately 50% of deaths. Despite significant advances in the understanding of cardiac disease due to CKD, the underlying mechanisms involved in many pathological changes have not been fully elucidated. In our previous study, we observed severe fibrosis in the contralateral kidney of a 6-month-old rat UUO model. In the present experiment, we also observed severe fibrosis in the hearts of rats subjected to UUO and the macrophage-to-myofibroblast transition (MMT). These effects were inhibited by the mineralocorticoid receptor (MR) blocker eplerenone. Notably, in vitro, aldosterone-activated MR induced the MMT and subsequently promoted the secretion of CTGF, the target of MR, from macrophages; these changes were inhibited by eplerenone. The CTGF also induced the MMT and both the aldosterone and CTGF-induced MMT could be alleviated by the CTGF blocker. In conclusion, our results suggest that targeting the MR/CTGF pathway to inhibit the MMT may be an effective therapeutic strategy for the treatment of cardiac fibrosis.
Copyright © 2022 Elsevier B.V. All rights reserved.
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The role of blood pressure control in the prevention of cardiorenal disease in patients with chronic kidney disease.
Nephrol Dial Transplant -
The repeatability, reproducibility, and influencing factors of intrarenal Doppler ultrasonography in dogs without heart disease.
Vet Radiol Ultrasound2022 Nov;():. doi: 10.1111/vru.13194.
Terukina Hiroki, Morita Tomoya, Yamasaki Masahiro,
Abstract
Renal impairment is concurrent with adverse outcomes such as heart disease in humans and dogs. Intrarenal Doppler ultrasonography (IRD) is used to assess intrarenal hemodynamics, and resistance index (RI) and venous impedance index (VII) are used to evaluate intrarenal hemodynamics in humans with heart failure. However, only a few studies have assessed the efficacy of IRD, especially VII, in dogs, and the methods differ between studies. Additionally, repeatability, reproducibility, and factors influencing IRD values have not been validated in dogs. This prospective, analytical study aimed to assess repeatability and reproducibility of IRD, and to clarify influencing factors of IRD in dogs without heart disease. We enrolled 78 dogs without heart disease. The RI and VII were highly reproducible, and the reference intervals for VII were 0.13-0.37. Differences in transducer (sector and convex) and posture (right lateral and supine decubitus position) had no effect on the IRD values. In contrast, RI and VII were higher in the renal vessels than in interlobar vessels. Age affected RI values (r = 0.39, P
© 2022 American College of Veterinary Radiology.
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Cardiorenal diseases in type 2 diabetes mellitus: clinical trials and real-world practice.
Nat Rev Endocrinol2022 Nov;():. doi: 10.1038/s41574-022-00776-2.
Lim Lee-Ling, Chow Elaine, Chan Juliana C N,
Abstract
Patients with type 2 diabetes mellitus (T2DM) can have multiple comorbidities and premature mortality due to atherosclerotic cardiovascular disease, hospitalization with heart failure and/or chronic kidney disease. Traditional drugs that lower glucose, such as metformin, or that treat high blood pressure and blood levels of lipids, such as renin-angiotensin-system inhibitors and statins, have organ-protective effects in patients with T2DM. Amongst patients with T2DM treated with these traditional drugs, randomized clinical trials have confirmed the additional cardiorenal benefits of sodium-glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide 1 receptor agonists (GLP1RA) and nonsteroidal mineralocorticoid receptor antagonists. The cardiorenal benefits of SGLT2i extended to patients with heart failure and/or chronic kidney disease without T2DM, whereas incretin-based therapy (such as GLP1RA) reduced cardiovascular events in patients with obesity and T2DM. However, considerable care gaps exist owing to insufficient detection, therapeutic inertia and poor adherence to these life-saving medications. In this Review, we discuss the complex interconnections of cardiorenal-metabolic diseases and strategies to implement evidence-based practice. Furthermore, we consider the need to conduct clinical trials combined with registers in specific patient segments to evaluate existing and emerging therapies to address unmet needs in T2DM.
© 2022. Springer Nature Limited.
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Cardioprotective effect of abscisic acid in a rat model of type 3 cardio-renal syndrome: Role of NOX-4, P-53, and HSP-70.
Biomed Pharmacother2022 Nov;157():114038. doi: 10.1016/j.biopha.2022.114038.
Adel Mohamed, Elmasry Ahlam, El-Nablaway Mohammad, Othman Gamal, Hamed Shereen, Khater Yomna, Ashour Rehab H, Hendawy Mahmoud, Rabei Mohammed R,
Abstract
Cardiorenal syndrome (CRS) is a complex heart and kidney pathophysiologic disorder that leads to a bidirectional interrelationship between them. Abscisic acid (ABA) is a phytohormone that is present in plants, and is known to regulate fundamental physiological functions. This study aimed to explore the efficacy of ABA in surgically induced-CRS type 3 rats. Rats were randomly and equally divided into four groups. Rats in Group 1 received saline (Sham group), Group 2 included control induced-CRS rats, Group 3 rats (CRS+ABA) included CRS rats treated with ABA and Group 4 (CRS + ABA + Verapamil + propofol) were CRS rats treated with Verapamil, propofol and ABA. The rats were treated with the drugs daily for four weeks. At the end of the study, relative heart weight corrected QT interval (QTc), mean blood pressure (MBP), kidney functions, oxidative stress, NADPH oxidase 4 (NOX4), protein 53 (P53), and heat shock proteins-70 (HSP-70) expression was assessed and recorded. ABA led to a significant shortening of the ventricular action potential duration indicated by QTc. Furthermore, it significantly lowered heart weight, MBP, serum creatinine, NOX-4, and P-53 expression and augmented HSP-70 expression. In contrast, adding calcium channel blockers (CCBs) to ABA mitigated this effect. The results suggested that ABA has a potential protective role in CRS-induced cardiac hypertrophy and arrhythmia that could be mediated through inhibition of P-53, NOX-4, and an increase in HSP-70 expression.
Copyright © 2022 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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Healthcare costs associated with comorbid cardiovascular and renal conditions among persons with diabetes, 2008-2019.
Diabetol Metab Syndr2022 Nov;14(1):179. doi: 10.1186/s13098-022-00957-z.
Shah Chintal H, Dave Chintan V,
Abstract
BACKGROUND:
There is paucity of data examining healthcare costs among persons with comorbid diabetes and cardiorenal conditions.
OBJECTIVE:
To elucidate the longitudinal trends and quantify the incremental healthcare costs associated with the following cardiorenal conditions: atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and kidney disease, among persons with diabetes.
METHODS:
Medical Expenditure Panel Survey data (2008-2019) were used to identify adults with diabetes and comorbid cardiorenal conditions. Overall, medical and pharmaceutical costs were ascertained (in 2019 US dollars). Analyses were adjusted for 14 variables using a two-part regression model.
RESULTS:
Among 32,519 adults with diabetes, the mean (standard error [SE]) annual healthcare costs were $13,829 ($213), with medical and prescription components contributing $9301 ($172) and $4528 ($98), respectively. Overall healthcare costs rose by 26.8% from $12,791 (2008-2009) to $16,215 (2018-2019) over the study period, driven by 42.5% and 20.3% increase in pharmaceutical and medical spending, respectively. Similar trends were observed for subgroup of persons with cardiorenal conditions. Compared to their counterparts without cardiorenal conditions and prior to adjustment, persons with ASCVD, HF and kidney disease incurred healthcare costs that were approximately 2.2, 3.3, and 2.7 times greater. After adjustment, comorbid ASCVD, HF and kidney disease were associated with annual excess spending of $8651 (95% CI $7729-$9573), $9373 (95% CI $9010-$9736), and $9995 (95% CI $8781-$11,209), respectively.
CONCLUSIONS:
Study results are generalizable to non-institutionalized US persons. Healthcare costs associated with the management of diabetes are high-especially among those with comorbid cardiorenal conditions, and have risen in recent years.
© 2022. The Author(s).
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The Use of Information and Communication Technology-Based Self-management System DialBeticsLite in Treating Abdominal Obesity in Japanese Office Workers: Prospective Single-Arm Pilot Intervention Study.
JMIR Diabetes2022 Nov;7(4):e40366. doi: 10.2196/40366.
Kawai Yuki, Waki Kayo, Yamaguchi Satoko, Shibuta Tomomi, Miyake Kana, Kimura Shigeko, Toyooka Tsuguyoshi, Nakajima Ryo, Uneda Kazushi, Wakui Hiromichi, Tamura Kouichi, Nangaku Masaomi, Ohe Kazuhiko,
Abstract
BACKGROUND:
Making lifestyle changes is an essential element of abdominal obesity (AO) reduction. To support lifestyle modification and self-management, we developed an information and communication technology-based self-management system-DialBeticsLite-with a fully automated dietary evaluation function for the treatment of AO.
OBJECTIVE:
The objective of this study was to evaluate the preliminary efficacy and feasibility of DialBeticsLite among Japanese office workers with AO.
METHODS:
A 2- to 3-month prospective single-arm pilot intervention study was designed to assess the effects of the intervention using DialBeticsLite. The information and communication technology system was composed of 4 modules: data transmission (body weight, blood pressure, blood glucose, and pedometer count); data evaluation; exercise input; and food recording and dietary evaluation. Eligible participants were workers who were aged ?20 years and with AO (waist circumference ?85 cm for men and ?90 cm for women). Physical parameters, blood tests, nutritional intake, and self-care behavior were compared at baseline and after the intervention.
RESULTS:
A total of 48 participants provided completed data for analysis, which yielded a study retention rate of 100%. The average age was 46.8 (SD 6.8) years, and 92% (44/48) of participants were male. The overall average measurement rate of DialBeticsLite, calculated by dividing the number of days with at least one measurement by the number of days of the intervention, was 98.6% (SD 3.4%). In total, 85% (41/48) of the participants reported that their participation in the study helped them to improve their lifestyle. BMI, waist circumference, and visceral fat area decreased significantly after the intervention (P<.001 in addition the daily calorie intake reduced significantly there was a significant improvement self-care behavior terms of exercise and diet>
CONCLUSIONS:
Using DialBeticsLite was shown to be a feasible and potentially effective method for reducing AO by providing users with a motivational framework to evaluate their lifestyle behaviors.
©Yuki Kawai, Kayo Waki, Satoko Yamaguchi, Tomomi Shibuta, Kana Miyake, Shigeko Kimura, Tsuguyoshi Toyooka, Ryo Nakajima, Kazushi Uneda, Hiromichi Wakui, Kouichi Tamura, Masaomi Nangaku, Kazuhiko Ohe. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 28.11.2022.
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Considerations for Choosing First-Line Urate-Lowering Treatment in Older Patients with Comorbid Conditions.
Drugs Aging2022 Nov;():. doi: 10.1007/s40266-022-00986-3.
Kang Eun Ha,
Abstract
Gout is the most common inflammatory arthritis in adults. The prevalence of gout increases with age. Urate-lowering treatment (ULT) among older patients is often challenging in that patients frequently suffer insufficient effectiveness or adverse events due to comorbidities, concurrent medications, and altered pharmacokinetics. The large-scale randomized controlled trials (RCTs) directly investigating gout patients regarding cardiovascular (CV) safety have only recently been introduced; CARES and FAST compared the CV safety of the two xanthine oxidase inhibitors (XOis), febuxostat versus allopurinol, in patients with gout. Based on the CARES trial that showed CV concerns with febuxostat, the current international guidelines recommend allopurinol as first-line ULT in gout, while preserving other agents as a second-line treatment, despite a higher potency of febuxostat. XOis would be more suitable than uricosurics to treat older patients with gout due to the high prevalence of chronic kidney disease (CKD) in older patients. However, allopurinol alone might not achieve the target serum uric acid levels below 6 mg/dL and CKD might confer an increased risk of allopurinol induced cutaneous adverse reactions in older patients. Furthermore, as well as the later analysis of CARES participants who were lost to follow-up, data from the FAST trial and real-world studies suggest non-inferior CV safety for febuxostat compared to allopurinol even in the presence of CV diseases. Thus, febuxostat use in older patients with renal impairment may be more positively considered. The combination therapy of a novel uricosuric, verinurad, plus febuxostat reduced albuminuria in hyperuricemic patients with type 2 diabetes and CKD in a phase 2a trial, and further RCTs are awaited. Finally, the sodium-glucose cotransporter-2 inhibitor class of oral hypoglycemic agents, known to exert beneficial CV and renal effects independent of glycemic control, have shown a uricosuric effect and could be used as adjunctive therapy in older patients with cardiorenal comorbidities.
© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
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An Untargeted Metabolomics Approach on Carfilzomib-Induced Nephrotoxicity.
Molecules2022 Nov;27(22):. doi: 7929.
Barla Ioanna, Efentakis Panagiotis, Lamprou Sofia, Gavriatopoulou Maria, Dimopoulos Meletios-Athanasios, Terpos Evangelos, Andreadou Ioanna, Thomaidis Nikolaos, Gikas Evangelos,
Abstract
BACKGROUND:
Carfilzomib (Cfz) is an anti-cancer drug related to cardiorenal adverse events, with cardiovascular and renal complications limiting its clinical use. Despite the important progress concerning the discovery of the underlying causes of Cfz-induced nephrotoxicity, the molecular/biochemical background is still not well clarified. Furthermore, the number of metabolomics-based studies concerning Cfz-induced nephrotoxicity is limited.
METHODS:
A metabolomics UPLC-HRMS-DIA methodology was applied to three bio-sample types i.e., plasma, kidney, and urine, obtained from two groups of mice, namely (i) Cfz (8 mg Cfz/ kg) and (ii) Control (0.9% NaCl) ( = 6 per group). Statistical analysis, involving univariate and multivariate tools, was applied for biomarker detection. Furthermore, a sub-study was developed, aiming to estimate metabolites' correlation among bio-samples, and to enlighten potential mechanisms.
RESULTS:
Cfz mostly affects the kidneys and urine metabolome. Fifty-four statistically important metabolites were discovered, and some of them have already been related to renal diseases. Furthermore, the correlations between bio-samples revealed patterns of metabolome alterations due to Cfz.
CONCLUSIONS:
Cfz causes metabolite retention in kidney and dysregulates (up and down) several metabolites associated with the occurrence of inflammation and oxidative stress.
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sFlt-1 in Chronic Kidney Disease: Friend or Foe?
Int J Mol Sci2022 Nov;23(22):. doi: 14187.
Matsui Masaru, Onoue Kenji, Saito Yoshihiko,
Abstract
Placental growth factor (PlGF) and its receptor, fms-like tyrosine kinase-1 (Flt-1), are important regulators involved in angiogenesis, atherogenesis, and inflammation. This review article focuses on the function of PlGF/Flt-1 signaling and its regulation by soluble Flt-1 (sFlt-1) in chronic kidney disease (CKD). Elevation of circulating sFlt-1 and downregulation of sFlt-1 in the vascular endothelium by uremic toxins and oxidative stress both exacerbate heart failure and atherosclerosis. Circulating sFlt-1 is inconsistent with sFlt-1 synthesis, because levels of matrix-bound sFlt-1 are much higher than those of circulating sFlt-1, as verified by a heparin loading test, and are drastically reduced in CKD.
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Sodium-Glucose Cotransporter-2 Inhibitors-Miracle Drugs for the Treatment of Chronic Kidney Disease Irrespective of the Diabetes Status: Lessons from the Dedicated Kidney Disease-Focused CREDENCE and DAPA-CKD Trials.
Int J Mol Sci2022 Nov;23(22):. doi: 13749.
Gohda Tomohito, Murakoshi Maki,
Abstract
Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease worldwide. In Japan, the proportion of new patients requiring dialysis due to DKD has remained unchanged over the past five years. Early diagnosis and treatment are extremely important for the prevention of DKD progression. Albuminuria is the most promising biomarker currently available for diagnosing DKD and predicting its prognosis at an early stage; however, it has relatively poor specificity and sensitivity for DKD. Measuring the serum levels of tumor necrosis factor receptors (TNFRs; TNFR1 and TNFR2) is an alternative for predicting the prognosis of patients with CKD, irrespective of their diabetes status. Cardiorenal risk factor management and renin-angiotensin system inhibitor usage are effective in slowing the DKD progression, although the residual risk remains high in patients with DKD. Recently, two classes of antihyperglycemic agents, sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists, in addition to nonsteroidal selective mineralocorticoid receptor antagonists, which are less potent blood pressure-lowering and potassium-sparing agents, have emerged as cardiorenal disease-modifying therapies for preventing the DKD progression. This review focused on the SGLT2 inhibitor-based therapeutic strategies that have demonstrated cardiorenal benefits in patients with type 2 diabetes.
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Meta-analysis assessing the effectiveness of SGLT2i+GLP1RA combination therapy versus monotherapy on cardiovascular and cerebrovascular outcomes in diabetic patients.
Front Physiol2022 ;13():1028486. doi: 1028486.
Du Lixin, Qin Jiao, Wang Dengchuan, Zhao Yunhui, Xu Ning, Wu Chaowen, Yuan Jianpeng,
Abstract
Relevant meta-analyses have confirmed the cardiovascular and renal benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) among patients with type 2 diabetes (T2D) and/or cardiorenal disease. However, it is not established whether the combination therapy of SGLT2i and GLP1RA will yield an additive benefit on cardiorenal endpoints. Lopez and colleagues recently did a cohort study (Lopez et al., Am. J. Cardiol., 2022, 181, 87-93) and aimed to address this issue. However, their findings are not consistent with those of previous studies. To confirm Lopez et al.'s findings (Lopez et al., Am. J. Cardiol., 2022, 181, 87-93) and address the aforementioned inconsistencies, we conducted a meta-analysis based on relevant studies. Our meta-analysis identified that SGLT2i + GLP1RA combination therapy was significantly associated with the reduced risks of cardiovascular/cerebrovascular atherosclerotic, heart failure-associated, and death outcomes compared with SGLT2i/GLP1RA monotherapy. These might support this combination therapy used for better reducing cardiovascular and death events in T2D patients, especially in those with high or very high cardiovascular risk. This is a commentary on a previous article (Lopez et al.'s study (Lopez et al., Am. J. Cardiol., 2022, 181, 87-93)) published outside of Frontiers. Therefore, we submitted this manuscript as an Opinion article, as suggested in the Author Guidelines.
Copyright © 2022 Du, Qin, Wang, Zhao, Xu, Wu and Yuan.
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Sodium-Glucose Co-transporter-2 Inhibitors Induced Diabetic Ketoacidosis in Patients Undergoing Bariatric Surgery: a Systematic Review of Case Reports and Case Series.
Obes Surg2022 Nov;():. doi: 10.1007/s11695-022-06368-3.
Gokhare Viswanath Nakul, Sharma Mitesh, Bandlamudi Nanda, Idris Iskandar, Singhal Rishi, Mahawar Kamal, Madhok Brijesh,
Abstract
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are glucose-lowering agents being increasingly used for cardio-renal protection in patients with or without type 2 diabetes (T2DM). This systematic review identified the clinical risk factors and outcomes of diabetic ketoacidosis (DKA) in patients undergoing bariatric and metabolic surgery (BMS) on SGLT2i. We found 12 studies with a total of 16 patients (10 females; mean age of 51 years). Apart from one patient, all patients developed DKA in the post-operative period presenting at a median of 5 days after surgery. Most of the patients were euglycaemic on presentation with DKA. Patients undergoing BMS on SGLT2i are at increased risk of developing DKA that can mimic post-operative surgical complications causing diagnostic dilemmas, especially with the euglycaemic variant, and delaying treatment.
© 2022. Crown.
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Type 5 Cardiorenal Syndrome: An Underdiagnosed and Underrecognized Disease Process of the American Mother.
J Clin Med Res2022 Oct;14(10):395-399. doi: 10.14740/jocmr4792.
Ilagan Justin, Sahani Harshini, Saleh Arif Bin, Tavakolian Kameron, Mararenko Anton, Udongwo Ndausung, Douedi Steven, Upadhyaya Vandan, Patel Swapnil, Mushtaq Arman, Sealove Brett, Gonzalez David, Asif Arif,
Abstract
Cardiorenal syndrome (CRS) continues to be an area of concern due to the changing understanding of identification, pathophysiology and optimal management. Originally thought that diuretics were always the answer, recent literature has shed lights on the five major CRS subphenotypes, and while conceptual in their classifications, different strategies may be utilized to manage each type. The effect of CRS in pregnant women is largely under discussed and underappreciated as its own entity. Trials involving possible management, specifically utilizing serelaxin, a recombinant form of relaxin, have shown promising results but more data are needed to begin implementing it on a large scale.
Copyright 2022, Ilagan et al.
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Acute and chronic cardiovascular consequences of acute kidney injury: a systematic review and meta-analysis.
Cardiorenal Med2022 Nov;():. doi: 10.1159/000527198.
De Clercq Lorenz, Ailliet Tim, Schaubroeck Hannah, Hoste Eric A J,
Abstract
INTRODUCTION? We examined whether patients with acute kidney injury (AKI) have a higher risk of developing atrial fibrillation (AF), heart failure (HF), acute coronary syndrome (ACS) and major adverse cardiac events (MACE) in the short- and long-term compared to patients without AKI, and if that risk is related to the severity of AKI. Furthermore, we investigated the influence of a cardiac event following AKI on the risk of all-cause mortality, length of stay in the intensive care unit and in the hospital. METHODS: We included English and Dutch retrospective and prospective cohort studies on adults (?15 years) with AKI. Studies lacking epidemiological data, studies not using the consensus definitions (RIFLE, AKIN, KDIGO), animal studies and studies on children were excluded. Studies were identified using the PubMed and Embase search engines. The last search was performed on the first of August 2021. For assessment of method quality, NOS (Newcastle-Ottawa Scale) for assessing risk of bias was used for cohort studies and heterogeneity was determined by the I²-statistic. Statistical analysis was performed using the Cochrane Review Manager (RevMan 5.3). The risk ratio (RR) and 95% confidence interval (CI) were calculated using the Mantel-Haenszel test. Results were presented a summary caterpillar plot. RESULTS? We evaluated 14 studies comprising 736 210 patients. AKI was defined according to the RIFLE consensus in 1 article, to the AKIN criteria in 7 and to the KDIGO guidelines in 6. Of the 14 included studies, 4 were prospective and 10 were retrospective. In comparison to patients without AKI, we found that patients with AKI had a 94% increased risk of developing AF in the short term (RR: 1.94, 95% CI 1.35 to 2.79; P = 0.0004). In the long-term, patients with AKI stage 1 had a 59% increased risk of developing HF and a 77% risk of developing ACS. (RR: 1.59, 95% CI 1.07 to 2.34, P = 0.02 and RR: 1.77, 95% CI 1.68 to 1.88, P
The Author(s). Published by S. Karger AG, Basel.
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Cardiovascular and kidney outcomes of combination therapy with sodium-glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists in patients with type 2 diabetes and chronic kidney disease: A systematic review and network meta-analysis.
Diabetes Res Clin Pract2022 Nov;194():110161. doi: 10.1016/j.diabres.2022.110161.
Tsukamoto Shunichiro, Morita Ryutaro, Yamada Takayuki, Urate Shingo, Azushima Kengo, Uneda Kazushi, Kobayashi Ryu, Kanaoka Tomohiko, Wakui Hiromichi, Tamura Kouichi,
Abstract
AIMS:
Both sodium-glucose cotransporter-2 (SGLT-2) inhibitors and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce cardiovascular (CV) event in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). However, little evidence pertains to the benefits of their combined use.
METHODS:
We systematically searched the PubMed, MEDLINE, EMBASE, and Cochrane Library databases through July 2022. We selected randomized controlled trials comparing SGLT-2 inhibitors, MRAs, or SGLT-2 inhibitor + MRA combination therapy, with placebo in patients with T2D and CKD. We performed a network meta-analysis to indirectly compare the treatments. The primary outcome was a composite of CV events.
RESULTS:
Eight studies were selected with 36,186 patients. The primary outcome was significantly improved in the combination therapy group compared with the other groups (RR [95% CI]; vs SGLT-2 inhibitors, 0.76 [0.60; 0.96]; vs MRAs, 0.66 [0.53; 0.82]; vs placebo, 0.58 [0.47; 0.73]). Additionally, the combination therapy was associated with a considerable reduction in the risk of hyperkalemia (RR vs MRA, 0.43 [0.23; 0.79]).
CONCLUSION:
Combination of SGLT-2 inhibitors and MRAs potentially reduced CV events compared with SGLT-2 inhibitors or MRAs alone. This combination may be a candidate treatment strategy for patients with T2D and CKD.
Copyright © 2022 Elsevier B.V. All rights reserved.
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Recent Developments in the Evaluation and Management of Cardiorenal Syndrome: A Comprehensive Review.
Curr Probl Cardiol2022 Nov;():101509. doi: 10.1016/j.cpcardiol.2022.101509.
Kim Jitae A, Wu Lingling, Rodriguez Mario, Lentine Krista, Virk Hafeez Ul Hassan, Hachem Karim El, Lerma Edgar V, Kiernan Michael S, Rangaswami Janani, Krittanawong Chayakrit,
Abstract
Cardiorenal syndrome (CRS) is increasingly recognized diagnostic entity associated with high morbidity and mortality among acutely ill heart failure (HF) patients with acute and/ or chronic kidney diseases (CKD). While traditionally viewed as a state of decline in glomerular filtration rate (GFR) due to decreased renal perfusion, mainly due to therapeutic interventions to relieve congestive in HF, Recent insights into the underlying pathophysiologic mechanisms of CRS led to a broader definition and further classification of CRS into five distinct types. In this comprehensive review, we discuss the classification of CRS, highlighting the underlying common pathogenetic pathways of heart failure and kidney injury, including increased congestion, neurohormonal dysregulation, oxidative stress as well as inflammation, and cytokine storm that are particularly evident in COVID-19 patients with multiorgan failure and also in those with other disorders including sepsis, systemic lupus erythematosus and amyloidosis. In this review we also present the recent advances in the diagnostic strategies of CRS including cardiac and renal biomarkers as well as advanced cardiac and renal imaging techniques that are available to aid in the diagnosis as well as in the prognostication of this disorder. Finally, we discuss the various therapeutic options available to-date, including fluid optimization, hemofiltration, renal replacement therapy as well as the role of SGLT2 inhibitors in light of recent data from RCTs. It is important to note that, CRS population are either excluded or underrepresented, at best, in major RCTs and therefore, therapeutic recommendations are largely extrapolated from FH and CKD clinical trials.
Copyright © 2022. Published by Elsevier Inc.
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How slimming regulatory T cells limit atherosclerosis: Mechanistic insights into T cell lipid metabolism.
Atherosclerosis2022 Dec;362():23-25. doi: 10.1016/j.atherosclerosis.2022.11.002.
van der Vorst Emiel P C, Döring Yvonne,
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