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Pubblicazioni recenti - cardiorenal
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Effects of glucagon-like peptide-1 receptor agonists liraglutide and semaglutide on cardiovascular and renal outcomes across body mass index categories in type 2 diabetes: results of the LEADER and SUSTAIN 6 trials.
Diabetes Obes Metab2020 Aug;():. doi: 10.1111/dom.14160.
Verma Subodh, McGuire Darren K, Bain Stephen C, Bhatt Deepak L, Leiter Lawrence A, Mazer C David, Monk Fries Tea, Pratley Richard E, Rasmussen Søren, Vrazic Hrvoje, Zinman Bernard, Buse John B,
Abstract
Associations between body mass index (BMI) and the cardiovascular (CV) and kidney efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with type 2 diabetes (T2D) are uncertain; therefore, data analyzed separately from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial and the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN 6) were examined. These international, randomized, placebo-controlled trials investigated liraglutide and semaglutide (both subcutaneous) in patients with T2D and at high risk of CV events. In post hoc analyses, patients were categorized by baseline BMI (<25?kg/m , ?25-<30?kg/m , ?30-<35?kg/m , ?35?kg/m ), and CV and kidney outcomes with GLP-1RA versus placebo analyzed. All baseline BMI data from LEADER (n = 9331) and SUSTAIN 6 (n = 3290) were included (91% and 92% of patients with overweight or obesity, respectively). In SUSTAIN 6, nominally significant heterogeneity of semaglutide efficacy by baseline BMI was observed for CV death/myocardial infarction/stroke (major adverse CV events [MACE], primary outcome of both; p =?0.02); otherwise, there was no statistical heterogeneity for either GLP-1RA versus placebo across BMI categories for key CV and kidney outcomes. The lack of statistical heterogeneity from these cardiorenal outcomes implies that liraglutide and semaglutide may be beneficial for many patients and is likely not to depend on their baseline BMI, but further study is needed. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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Hypertension and related diseases in the era of COVID-19: a report from the Japanese Society of Hypertension Task Force on COVID-19.
Hypertens Res2020 Jul;():. doi: 10.1038/s41440-020-0515-0.
Shibata Shigeru, Arima Hisatomi, Asayama Kei, Hoshide Satoshi, Ichihara Atsuhiro, Ishimitsu Toshihiko, Kario Kazuomi, Kishi Takuya, Mogi Masaki, Nishiyama Akira, Ohishi Mitsuru, Ohkubo Takayoshi, Tamura Kouichi, Tanaka Masami, Yamamoto Eiichiro, Yamamoto Koichi, Itoh Hiroshi,
Abstract
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected more than seven million people worldwide, contributing to 0.4 million deaths as of June 2020. The fact that the virus uses angiotensin-converting enzyme (ACE)-2 as the cell entry receptor and that hypertension as well as cardiovascular disorders frequently coexist with COVID-19 have generated considerable discussion on the management of patients with hypertension. In addition, the COVID-19 pandemic necessitates the development of and adaptation to a "New Normal" lifestyle, which will have a profound impact not only on communicable diseases but also on noncommunicable diseases, including hypertension. Summarizing what is known and what requires further investigation in this field may help to address the challenges we face. In the present review, we critically evaluate the existing evidence for the epidemiological association between COVID-19 and hypertension. We also summarize the current knowledge regarding the pathophysiology of SARS-CoV-2 infection with an emphasis on ACE2, the cardiovascular system, and the kidney. Finally, we review evidence on the use of antihypertensive medication, namely, ACE inhibitors and angiotensin receptor blockers, in patients with COVID-19.
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Aerobic exercise alleviates oxidative stress-induced apoptosis in kidneys of myocardial infarction mice by inhibiting ALCAT1 and activating FNDC5/Irisin signaling pathway.
Free Radic Biol Med2020 Jul;():. doi: S0891-5849(20)31135-7.
Wu Fangnan, Li Zhuo, Cai Mengxin, Xi Yue, Xu Zujie, Zhang Zezhou, Li Hangzhuo, Zhu Wanyu, Tian Zhenjun,
Abstract
Aerobic exercise involves in ameliorating kidney injury, but the underlying mechanisms are not fully clarified. In this study, we elucidated the potential mechanisms of aerobic exercise in ameliorating kidney injury following myocardial infarction (MI). In vivo, wildtype and alcat1 knockout mice were used to establish the MI model, and subjected to six-week moderate-intensity aerobic exercise. In vitro, Normal Rat Kidney (NRK) cells treated with HO and recombinant human Irisin (rhIrisin) were used for exploring potential mechanisms. Our results showed that Irisin expression was up-regulated by aerobic exercise in kidneys after MI, while ALCAT1 was reduced. In alcat1 knockout mice, we found that ALCAT1 involved in the progressions of oxidative stress and apoptosis in impaired kidney tissues of MI mice, but aerobic exercise reversed these changes. Furthermore, in vitro, we observed that Irisin inhibited both HO-treatment or overexpression of alcat1-induced oxidative stress and apoptosis in NRK cells, partially via AMPK-Sirt1-PGC-1? pathway. These findings reveal that aerobic exercise participates in alleviating the levels of oxidative stress and apoptosis in impaired kidney tissues following MI, partially via activating FNDC5/Irisin-AMPK-Sirt1-PGC-1? signaling pathway and inhibiting ALCAT1 expression.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Acute kidney injury in cardiogenic shock: A comprehensive review.
Catheter Cardiovasc Interv2020 Jul;():. doi: 10.1002/ccd.29141.
Sheikh Omar, Nguyen Tung, Bansal Shweta, Prasad Anand,
Abstract
Acute kidney injury (AKI) is an ominous predictor of mortality in cardiogenic shock. The present review examines the pathophysiology of AKI in cardiogenic shock (CS), summarizes the pertinent literature including the diagnostic criteria/definitions for AKI and possible role of biomarkers, and identifies risk factors and possible therapeutic interventions for AKI in CS. Our review finds that AKI is common in patients with CS and is associated with increased morbidity and mortality. Urinary biomarkers of renal tubular injury appear more sensitive for detection of AKI but have yet to be incorporated into daily practice. Emerging data would suggest vasopressor choices, mechanical circulatory support, and renal replacement therapy may have important therapeutic roles in the management of CS.
© 2020 Wiley Periodicals LLC.
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Early Spot Urinary Sodium and Diuretic Efficiency in Acute Heart Failure and Concomitant Renal Dysfunction.
Cardiorenal Med2020 Jul;():1-11. doi: 10.1159/000508178.
Miñana Gema, Llàcer Pau, Sanchis Ignacio, García-Blas Sergio, Bonanad Clara, Ventura Silvia, Sánchez Ruth, de la Espriella Rafael, Bodi Vicent, Fácila Lorenzo, Mollar Anna, Sanchís Juan, Bayés-Genís Antoni, Chorro Francisco J, Núñez Julio, ,
Abstract
OBJECTIVE:
In acute heart failure (AHF), early assessment of spot urinary sodium (UNa) has emerged as a useful biomarker for risk stratification and monitoring. The objective of this study was to investigate (a) whether early spot UNa predicts 24-h diuretic efficiency and (b) the clinical factors associated with early spot UNa in patients with AHF and concomitant renal dysfunction (RD).
METHODS:
This is a post hoc analysis of the IMPROVE-HF trial, in which 160 patients with AHF and RD (estimated glomerular filtrate rate [eGFR] <60 mL/min/1.73 m2) were included. Diuretic efficiency was calculated as the net fluid output produced per 40 mg of furosemide equivalents in 24 h. The association between early spot UNa and diuretic efficiency and clinical variables associated with UNa were evaluated using multivariate linear regression analysis. The contribution of the exposures in the predictability of the models was assessed with the coefficient of determination (R2).
RESULTS:
The mean age of the study population was 78 ± 8 years. The median (interquartile range) diuretic efficiency, early spot UNa, aminoterminal pro-brain natriuretic peptide, and eGFR were 747 (490-1,167) mL, 90 mmol/L (65-111), 7,765 pg/mL (3,526-15,369), and 33.7 ± 11.3 mL/min/1.73 m2, respectively. In a multivariate setting, lower UNa was significantly and nonlinearly associated with lower diuretic efficiency (p = 0.001), explaining the 44.4% of the model predictability. Natremia and surrogates of congestion emerged as the main factors related to UNa.
CONCLUSIONS:
In patients with AHF and RD at presentation, early spot UNa was inversely related to 24-h diuretic efficiency.
© 2020 S. Karger AG, Basel.
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Chronic Kidney Disease in Adolescents after Surgery for Congenital Heart Disease.
Cardiorenal Med2020 Jul;():1-9. doi: 10.1159/000508177.
Bojan Mirela, Pieroni Laurence, Mirabile Cristian, Froissart Marc, Bonnet Damien,
Abstract
BACKGROUND:
The onset of chronic kidney disease (CKD) is an important prognostic factor in young adults with congenital heart disease (CHD). Although it is likely that CKD is manifest early in CHD patients, the prevalence among adolescents is still unknown. The National Kidney Foundation's Kidney Disease Improving Global Outcomes guidelines 2012 recommend new equations for the estimated glomerular filtration rate (eGFR) and highlight the importance of albuminuria for CKD screening. The objective of the present study was to estimate the prevalence of CKD in CHD adolescents.
METHODS:
This observational cross-sectional study included 115 patients aged 10-18 years attending the cardiologic outpatient clinic at our institution as a follow-up after cardiac surgery in infancy related to various CHDs. CKD assessment used the CKD criteria 2012, including eGFR equations based on serum creatinine and cystatin C, and measurement of albuminuria.
RESULTS:
No patient had an eGFR <60 mL min-1 1.73 m-2. However, 28.7% of all patients (95% CI 20.7-37.9) had eGFRbetween 60 and 89 mL min-1 1.73 m-2 when estimated by the bedside Schwartz creatinine-based equation,and 17.4% (95% CI 11.2-24.1) had eGFRbetween 60 and 89 mL min-1 1.73 m-2 when estimated by the Zappitelli equation, combining creatinine and cystatin C. Of all patients, 20.0% (95% CI 12.1-26.7) had orthostatic proteinuria, and none had persistent albuminuria.
CONCLUSIONS:
There was no evidence of CKD in the present population aged 10-18 years. The significance of an eGFR between 60 and 90 mL min-1 1.73 m-2 is not concordant for this age range and requires further investigations.
© 2020 S. Karger AG, Basel.
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Retrospective analysis of the renoprotective effects of long-term use of six types of sodium-glucose co-transporter 2 inhibitors in Japanese patients with type 2 diabetes mellitus and chronic kidney disease.
Diabetes Technol Ther2020 Jul;():. doi: 10.1089/dia.2020.0165.
Kobayashi Kazuo, Toyoda Masao, Hatori Nobuo, Saito Nobumichi, Kanaoka Tomohiko, Sakai Hiroyuki, Furuki Takayuki, Umezono Tomoya, Ito Shun, Suzuki Daisuke, Takeda Hiroshi, Minagawa Fuyuki, Degawa Hisakazu, Yamamoto Hareaki, Machimura Hideo, Chin Keiichi, Hishiki Toshimasa, Takihata Masahiro, Aoyama Kouta, Umezawa Shinichi, Minamisawa Kohsuke, Aoyama Togo, Hamada Yoshiro, Suzuki Yoshiro, Hayashi Masahiro, Hatori Yutaka, Sato Kazuyoshi, Miyakawa Masaaki, Tamura Kouichi, Kanamori Akira,
Abstract
AIM:
Sodium-glucose co-transporter 2 inhibitors (SGLT2is) provide renal protection in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to elucidate the renal effects of long-term use of six types of SGLT2i in Japanese patients with T2DM and chronic kidney disease (CKD).
MATERIALS AND METHODS:
The Kanagawa Physicians Association maintains a registry of patients who visit their 31 clinics. We retrieved the clinical data of patients with T2DM and CKD who were prescribed with SGLT2is for more than 1 year.
RESULTS:
A total of 763 patients with a median treatment duration of 33 months were included. The logarithmic value of the albumin-creatinine ratio (LNACR) decreased significantly from 1.60±0.65 to 1.51±0.67. The multiple linear regression analysis revealed that the LNACR at the initiation of treatment, change (?) in diastolic blood pressure, and ?HbA1c were independently correlated with ?LNACR (p<0.001). The decrease in the LNACR was significantly smaller in the patients with eGFR (mL/min/1.73 m2) of <60 (p<0.05). The eGFR decreased from 77.4±22.3 to 72.7±22.5 mL/min/1.73 m2 (p<0.001). The multiple linear regression analysis showed that the LNACR at the initiation of treatment, ?body weight at the previous survey, ?eGFR at the previous survey, and the eGFR at the initiation of treatment correlated independently with ?eGFR during the maintenance period (p<0.001). Greater changes in the eGFR during the maintenance period were observed in the patients with macroalbuminuria or eGFR of <60 (p<0.01).
CONCLUSIONS:
The study confirmed that the long-term use of six types of SGLT2i improved the ACR, although the eGFR gradually decreased during the treatment. The change in the ACR was significantly smaller in the patients with eGFR of <60 mL/min/1.73 m2 than in those with eGFR of >60 mL/min/1.73 m2. However, this was a retrospective observational study; further studies are needed to formulate final conclusions.
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Inhibition of apoptosis signal-regulating kinase 1 might be a novel therapeutic target in the treatment of cardiorenal syndrome.
Int J Cardiol -
Sodium acetate prevents nicotine-induced cardiorenal dysmetabolism through uric acid/creatine kinase-dependent pathway.
Life Sci2020 Jul;():118127. doi: S0024-3205(20)30878-X.
Michael O S, Dibia C L, Soetan O A, Adeyanju O A, Oyewole A L, Badmus O O, Adetunji C O, Soladoye A O,
Abstract
BACKGROUND:
Cigarette smoking or nicotine replacement therapy has been associated with cardiometabolic disorders (CMD). Hyperuricemia has been implicated in the pathogenesis of CMD and cardiorenal dysfunction. Gut microbiota-derived short chain fatty acids (SCFAs) have been reported to have beneficial glucoregulatory and cardiorenal protective effects. This study aimed at investigating the effect of acetate, a gut-derived SCFA, on nicotine-induced CMD and associated cardiorenal dysmetabolism.
MATERIALS AND METHOD:
Twenty-four male Wistar rats (n?=?6/group) were grouped as: vehicle (p.o.), nicotine-exposed (1.0?mg/kg; p.o.), and sodium acetate-treated (200?mg/kg; p.o.) with or without nicotine exposure daily for 6?weeks. Glucose regulation was evaluated by oral glucose tolerance test and homeostatic model assessment of insulin resistance. Cardiac and renal triacylglycerol (TG), lactate, nitric oxide (NO), uric acid (UA) levels, lactate dehydrogenase (LDH), creatine kinase (CK), adenosine deaminase (ADA), and xanthine oxidase (XO) activities were measured.
RESULTS:
The CMD were confirmed in the nicotine-exposed rats that exhibited lower body weight, insulin resistance, endothelial dysfunction, glucose intolerance, increased cardiac and renal TG, TG/HDL-cholesterol, UA, lactate, lipid peroxidation, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, LDH, CK, ADA and XO activities. Concurrent treatment with acetate prevented nicotine-induced glucometabolic and cardiorenal alterations.
CONCLUSION:
In summary, these results implied that nicotine exposure caused glucometabolic dysregulation and surplus lipid deposit in the heart and kidney through increased UA production and CK activity. Therefore, oral acetate administration prevents cardiorenal lipotoxicity and glucometabolic dysregulation via suppression of UA production and CK activity in nicotine-exposed rats.
Copyright © 2020. Published by Elsevier Inc.
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Short-and long-term administration of imeglimin counters cardiorenal dysfunction in a rat model of metabolic syndrome.
Endocrinol Diabetes Metab2020 Jul;3(3):e00128. doi: 10.1002/edm2.128.
Lachaux Marianne, Soulié Matthieu, Hamzaoui Mouad, Bailly Anaëlle, Nicol Lionel, Rémy-Jouet Isabelle, Renet Sylvanie, Vendeville Cathy, Gluais-Dagorn Pascale, Hallakou-Bozec Sophie, Monteil Christelle, Richard Vincent, Mulder Paul,
Abstract
Introduction:
Imeglimin, a glucose-lowering agent targeting mitochondrial bioenergetics, decreases reactive oxygen species (ROS) overproduction and improves glucose homeostasis. We investigated whether this is associated with protective effects on metabolic syndrome-related left ventricular (LV) and vascular dysfunctions.
Methods:
We used Zucker rats to assess the effects on LV function, LV tissue perfusion, LV oxidative stress and vascular function induced by imeglimin administered orally for 9 or 90 days at a dose of 150 mg/kg twice daily.
Results:
Compared to untreated animals, 9- and 90-day imeglimin treatment decreased LV end-diastolic pressure and LV end-diastolic pressure-volume relation, increased LV tissue perfusion and decreased LV ROS production. Simultaneously, imeglimin restored acetylcholine-mediated coronary relaxation and mesenteric flow-mediated dilation. One hour after imeglimin administration, when glucose plasma levels were not yet modified, imeglimin reduced LV mitochondrial ROS production and improved LV function. Ninety-day imeglimin treatment reduced related LV and kidney fibrosis and improved kidney function.
Conclusion:
In a rat model, mimicking Human metabolic syndrome, imeglimin immediately countered metabolic syndrome-related cardiac diastolic and vascular dysfunction by reducing oxidative stress/increased NO bioavailability and improving myocardial perfusion and after 90-day treatment myocardial and kidney structure, effects that are, at least in part, independent from glucose control.
© 2020 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.
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Tubular effects of sodium-glucose cotransporter 2 inhibitors: intended and unintended consequences.
Curr Opin Nephrol Hypertens2020 Sep;29(5):523-530. doi: 10.1097/MNH.0000000000000632.
Dominguez Rieg Jessica A, Xue Jianxiang, Rieg Timo,
Abstract
PURPOSE OF REVIEW:
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are antihyperglycemic drugs that act by inhibiting renal sodium-glucose cotransport. Here we present new insights into 'off target', or indirect, effects of SGLT2 inhibitors.
RECENT FINDINGS:
SGLT2 inhibition causes an acute increase in urinary glucose excretion. In addition to lowering blood glucose, there are several other effects that contribute to the overall beneficial renal and cardiovascular effects. Reabsorption of about 66% of sodium is accomplished in the proximal tubule and dependent on the sodium-hydrogen exchanger isoform 3 (NHE3). SGLT2 colocalizes with NHE3, and high glucose levels reduce NHE3 activity. The proximal tubule is also responsible for the majority of phosphate (Pi) reabsorption. SGLT2 inhibition is associated with increases in plasma Pi, fibroblast growth factor 23 and parathyroid hormone levels in nondiabetics and type 2 diabetes mellitus. Studies in humans identified a urate-lowering effect by SGLT2 inhibition which is possibly mediated by urate transporter 1 (URAT1) and/or glucose transporter member 9 in the proximal tubule. Of note, magnesium levels were also found to increase under SGLT2 inhibition, an effect that was preserved in nondiabetic patients with hypomagnesemia.
SUMMARY:
Cardiorenal effects of SGLT2 inhibition might involve, in addition to direct effects on glucose homeostasis, effects on NHE3, phosphate, urate, and magnesium homeostasis.
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Value of Renal Vascular Doppler Sonography in Cardiorenal Syndrome Type 1.
J Ultrasound Med2020 Jul;():. doi: 10.1002/jum.15404.
Çakal Beytullah, Özcan Özgür Ula?, Omaygenç Mehmet Onur, Karaca ?brahim O?uz, K?z?l?rmak Filiz, Gunes Haci Murat, Boztosun Bilal,
Abstract
OBJECTIVES:
Worsening of renal function in a patient with acute decompensated heart failure is called cardiorenal syndrome (CRS) type 1. Recent studies have shown an association of persistent systemic venous congestion with renal dysfunction. This trial was set up to investigate the changes of renal Doppler parameters with diuretic therapy in patients with CRS type 1.
METHODS:
Cases of CRS type 1 were identified among patients hospitalized for decompensated heart failure. Serial measurements of the renal venous impedance index (VII) and arterial resistive index (ARI) were calculated by pulsed wave Doppler sonography.
RESULTS:
A total of 30 patients who had creatinine improvement with diuresis (group 1) and 34 patients without any improvement (group 2) were analyzed. Patients in group 1 had higher median VII and ARI (VII, 0.86 versus 0.66; P?
CONCLUSIONS:
Renal vascular Doppler parameters might offer guidance on the diagnostic and therapeutic strategies in prescribing decongestive therapy for decompensated heart failure.
© 2020 American Institute of Ultrasound in Medicine.
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Kidney disease and electrolytes in COVID-19: more than meets the eye.
Clin Kidney J2020 Jun;13(3):274-280. doi: 10.1093/ckj/sfaa112.
Carriazo Sol, Kanbay Mehmet, Ortiz Alberto,
Abstract
COVID-19 is a global pandemic fuelled in some countries by government actions. The current issue of presents 15 articles on COVID-19 and kidney disease from three continents, providing a global perspective of the impact of severe acute respiratory syndrome coronavirus 2 on electrolytes and different kidney compartments (glomeruli, tubules and vascular compartments) and presenting clinically as a syndrome of inappropriate antidiuretic hormone secretion, acute kidney injury, acute kidney disease, collapsing glomerulopathy and thrombotic microangiopathy, among others, in the context of a brand-new cardiorenal syndrome. Kidney injury may need acute dialysis that may overwhelm haemodialysis (HD) and haemofiltration capabilities. In this regard, acute peritoneal dialysis (PD) may be lifesaving. Additionally, pre-existent chronic kidney disease increases the risk of more severe COVID-19 complications. The impact of COVID-19 on PD and HD patients is also discussed, with emphasis on preventive measures. Finally, current therapeutic approaches and potential future therapeutic approaches undergoing clinical trials, such as complement targeting by eculizumab, are also presented.
© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.
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Patient and Provider Characteristics Associated With Sodium-Glucose Cotransporter 2 Inhibitor Prescription in Patients With Diabetes and Proteinuric Chronic Kidney Disease.
Clin Diabetes2020 Jul;38(3):240-247. doi: 10.2337/cd19-0087.
McCoy Ian E, Han Jialin, Montez-Rath Maria E, Chertow Glenn M, Rhee Jinnie J,
Abstract
Despite accumulating evidence of cardiorenal benefits from sodium-glucose cotransporter 2 (SGLT2) inhibitors, prescription of agents in this drug class may be limited by concerns regarding adverse effects and interdisciplinary care coordination. To investigate these potential barriers, we performed a cross-sectional study of SGLT2 inhibitor prescriptions in 2017 in 3,779 adults with type 2 diabetes and proteinuric chronic kidney disease from a nationwide database. Only 173 (5%) of these patients received an SGLT2 inhibitor in 2017. Younger age, renin-angiotensin-aldosterone system inhibitor prescription, and higher estimated glomerular filtration rate were associated with SGLT2 inhibitor prescription. Primary care providers were responsible for the majority of the prescriptions. Continued efforts should be made to track and improve SGLT2 inhibitor use in indicated populations.
© 2020 by the American Diabetes Association.
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A brand-new cardiorenal syndrome in the COVID-19 setting.
Clin Kidney J2020 Jun;13(3):291-296. doi: 10.1093/ckj/sfaa082.
Apetrii Mugurel, Enache Stefana, Siriopol Dimitrie, Burlacu Alexandru, Kanbay Asiye, Kanbay Mehmet, Scripcariu Dragos, Covic Adrian,
Abstract
Coronaviruses are a major pathogen for adults, causing up to one-third of community-acquired respiratory tract infections in adults during epidemics. Although the pandemic outbreak of coronavirus disease-2019 (COVID-19) targets preferentially patient's lungs, recent data have documented that COVID-19 causes myocarditis, acute myocardial infarction, exacerbation of heart failure and acute kidney injury. Studies show that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), similar to its predecessor SARS-CoV, engages angiotensin-converting enzyme 2 (ACE2) as the entry receptor. ACE2 is also expressed in the heart, providing a link between coronaviruses and the cardiovascular system.
© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA.
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Association of clinic and ambulatory heart rate parameters with mortality in hypertension.
J Hypertens2020 Jul;():. doi: 10.1097/HJH.0000000000002565.
Böhm Michael, Schwantke Igor, Mahfoud Felix, Lauder Lucas, Wagenpfeil Stefan, de la Sierra Alejandro, Vinyoles Ernest, Gorostidi Manuel, Segura Julián, Ruilope Luis M,
Abstract
OBJECTIVES:
Resting heart rate (HR) taken in the office has been shown to be associated with cardiovascular outcomes in the general population, hypertension and heart failure. It is unknown whether 24-h oscillographic pulse rate measurement as an approximation of HR derived from ambulatory blood pressure monitoring (ABPM) associates with cardiovascular outcomes in hypertensive patients.
METHODS:
We evaluated ABPM recordings from 56?901 patients with complete 3373?421 HR measures entering the final analysis from the Spanish Blood Pressure Monitoring Registry for a median follow-up time of 5.1 years. We explored the association of office HR, mean 24-h HR, mean day HR, mean night HR as well as day-night HR differences, morning mean HR, morning HR surge and night peak HR to all-cause death, cardiovascular death and noncardiovascular death. Data were analyzed by Cox regression analysis, analysis of variance and chi-square test.
RESULTS:
The Spanish ABPM Registry recorded data in 223 primary care centers in Spain from 2004 until 31 December 2014 at the end of recruitment. Office HR was 3.5?bpm higher than mean 24-h HR, office mean HR versus mean night was 10.4?bpm higher and mean day versus mean night HR 9.3?bpm higher, while there were no relevant difference between office and mean day HR. Office mean, 24-h day and night HR more than 90?bpm were associated with an increased risk for all-cause and noncardiovascular death, whereas for cardiovascular death only mean night HR was predictive. The strongest association to all-cause death was observed with mean night HR [hazard ratio 3.80 (2.87-5.03)], mean 24-h HR [2.85 (2.30-3.54)] and mean day HR [2.22 (1.83-2.70)]. Day-night dipping of more than 8?bpm was associated with a 20% lesser risk on all-cause, cardiovascular and noncardiovascular death. Results were robust after adjusting for relevant risk indicators.
CONCLUSION:
HR parameters derived from ABPM provide important information, in particular association with death by mean night HR, mean 24-h HR and reduced day-night HR dipping less than 8?bpm superior to office HR.
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Sodium-glucose cotransporter 2 inhibitors at the intersection of cardiovascular, renal and metabolic care: an integrated and multidisciplinary approach to patient-centered care.
Curr Opin Cardiol2020 Jul;():. doi: 10.1097/HCO.0000000000000774.
Verma Subodh, Klug Eric, Mareev Viacheslav Y, Kobalava Zhanna D, Connelly Kim A, Arici Mustafa, Berwanger Otávio, Santoso Anwar, Mehta Roopa, Meglis Gus, Kosiborod Mikhail N,
Abstract
PURPOSE OF REVIEW:
The management of individuals who live with type 2 diabetes requires an integrated and multifaceted approach.
RECENT FINDINGS:
Sodium-glucose cotransporter 2 inhibitors effectively prevent and treat cardiorenal complications in the presence of type 2 diabetes. They also reduce death and disease progression in those with established heart failure (with reduced ejection fraction) in the absence of diabetes.
CONCLUSION:
Close collaborations between primary care physicians, cardiovascular specialists, endocrinologists and nephrologists are necessary to optimize cardiovascular, renal and metabolic risk reduction in their shared patients.
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Physical exercise and epicardial adipose tissue: A systematic review and meta-analysis of randomized controlled trials.
Obes Rev2020 Jul;():. doi: 10.1111/obr.13103.
Saco-Ledo Gonzalo, Valenzuela Pedro L, Castillo-García Adrián, Arenas Joaquín, León-Sanz Miguel, Ruilope Luis M, Lucia Alejandro,
Abstract
We performed a meta-analysis of the effects of exercise on epicardial adipose tissue (EAT). A systematic search was conducted in PubMed and Scopus (since inception to 1 February 2020) of randomized controlled trials assessing the effects of exercise interventions alone (with no concomitant weight loss intervention) on EAT. The standardized mean difference (Hedges' g) and 95% confidence interval between interventions were computed using a random effects model. Ten studies (including 521 participants who had, on average, overweight/obesity) met all inclusion criteria. Interventions were supervised and lasted 2 to 16 weeks (?3 sessions·per week). Exercise significantly reduced EAT (g = 0.82 [0.57-1.07]) irrespective of the duration of the intervention or the EAT imaging assessment method. Exercise benefits were separately confirmed for endurance (six studies, n = 287; g = 0.83 [0.52-1.15]) but not for resistance exercise training (due to insufficient data for quantitative synthesis). It was not possible to compare the effect of high-intensity interval training (HIIT) versus moderate-intensity continuous training (two studies, one reporting higher benefits with HIIT and the other no differences). Physical exercise interventions-particularly endurance training, with further evidence needed for other exercise modalities-appear as an effective strategy for reducing EAT in individuals with overweight/obesity, which supports their implementation for cardiovascular risk reduction.
© 2020 World Obesity Federation.
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Prevalence of anemia in patients with chronic kidney disease in Japan: A nationwide, cross-sectional cohort study using data from the Japan Chronic Kidney Disease Database (J-CKD-DB).
PLoS One2020 ;15(7):e0236132. doi: 10.1371/journal.pone.0236132.
Sofue Tadashi, Nakagawa Naoki, Kanda Eiichiro, Nagasu Hajime, Matsushita Kunihiro, Nangaku Masaomi, Maruyama Shoichi, Wada Takashi, Terada Yoshio, Yamagata Kunihiro, Narita Ichiei, Yanagita Motoko, Sugiyama Hitoshi, Shigematsu Takashi, Ito Takafumi, Tamura Kouichi, Isaka Yoshitaka, Okada Hirokazu, Tsuruya Kazuhiko, Yokoyama Hitoshi, Nakashima Naoki, Kataoka Hiromi, Ohe Kazuhiko, Okada Mihoko, Kashihara Naoki,
Abstract
BACKGROUND:
The Japan Chronic Kidney Disease Database (J-CKD-DB) is a nationwide clinical database of patients with chronic kidney disease (CKD) based on electronic health records. The objective of this study was to assess the prevalence of anemia and the utilization rate of erythropoiesis-stimulating agents (ESAs) in Japanese patients with CKD.
METHODS:
In total, 31,082 adult outpatients with estimated glomerular filtration rates of 5-60 ml/min/1.73 m2 in seven university hospitals were included this analysis. The proportions of patients with CKD stages G3b, G4, and G5 were 23.5%, 7.6%, and 3.1%, respectively.
RESULTS:
The mean (standard deviation) hemoglobin level of male patients was 13.6 (1.9) g/dl, which was significantly higher than the mean hemoglobin level of female patients (12.4 (1.6) g/dl). The mean (standard deviation) hemoglobin levels were 11.4 (2.1) g/dl in patients with CKD stage G4 and 11.2 (1.8) g/dl in patients with CKD stage G5. The prevalences of anemia were 40.1% in patients with CKD stage G4 and 60.3% in patients with CKD stage G5. Logistic regression analysis showed that diagnoses of CKD stage G3b (adjusted odds ratio [95% confidence interval]: 2.32 [2.09-2.58]), G4 (5.50 [4.80-6.31]), and G5 (9.75 [8.13-11.7]) were associated with increased prevalence of anemia. The utilization rates of ESAs were 7.9% in patients with CKD stage G4 and 22.4% in patients with CKD stage G5.
CONCLUSIONS:
We determined the prevalence of anemia and utilization rate of ESAs in Japanese patients with CKD using data from a nationwide cohort study.
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Apela improves cardiac and renal function in mice with acute myocardial infarction.
J Cell Mol Med2020 Jul;():. doi: 10.1111/jcmm.15651.
Pan Yang, Li Quanyi, Yan Hong, Huang Jin, Wang Zhi,
Abstract
Apela was recently identified as a new ligand of the apelin peptide jejunum (APJ) receptor. The purpose of this study was to investigate the role of apela in post-myocardial infarction (post-MI) recovery from cardiorenal damage. A murine MI model was established, and apela was then infused subcutaneously for two weeks. Echocardiographs were performed before and after infarction at the indicated times. Renal function was evaluated by serum and urine biochemistry. Immunohistochemistry of heart and kidney tissue was performed by in situ terminal deoxynucleotidyl transferase-mediated dUPT nick end-labelling reaction. Compared to the control group (MI/vehicle), the average value of the left ventricular ejection fraction in apela-treated mice increased by 32% and 39% at 2- and 4-week post-MI, respectively. The mean levels of serum blood urea nitrogen?creatinine, N-terminal pro-brain natriuretic peptide and 24-hour urine protein were significantly decreased at 4-week post-MI in apela-treated mice relative to that of control animals. At the cellular level, we found that apela treatment significantly reduced myocardial fibrosis and cellular apoptosis in heart and kidney tissue. These data suggest that apela improves cardiac and renal function in mice with acute MI. The peptide may be potential therapeutic agent for heart failure.
© 2020 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd.
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