CardioRenal Medicine

Bypass of Coronary Artery in Renal Artery Stenosis Patients with HEart Chronic Total Occlusion might explain the 5-year Follow-up after Percutaneous Coronary Intervention:B-RASHEF Study
Zheng B
Renal artery stenosis (RAS) is associated with poor outcome in patients with ischemic heart disease. In this study, we investigated development of coronary collateral in RAS patients and possible association of RAS with 5-year outcome after CTO PCI.
A new clinical entity bridging the cardiovascular system and the kidney: The Chronic Cardiovascular-Kidney Disorder
Zoccali C
Background The complex relationship between heart and kidney dysfunction has been a subject of medical inquiry since the 19th century. The term "cardio-renal syndrome" (CRS) was introduced in the early 2000s and has since become a focal point of research. CRS is typically categorized into five subtypes based on the sequence of cardiovascular and kidney disease events. Summary The Cardiovascular-Kidney-Metabolic (CKM) syndrome, as defined by the American Heart Association (AHA), describes a set of interrelated metabolic risk factors and their effects on the kidneys and cardiovascular system. This syndrome emphasizes the complexity of managing patients with combined conditions and identifies several knowledge gaps, including disease mechanisms, clinical phenotype variability, and the impact of social determinants of health. The Chronic Cardiovascular-Kidney Disorder (CCKD) framework proposes a shift from the term "syndrome" to "disorder," focusing on concurrent cardiovascular and kidney problems regardless of their sequence. Key messages • The CCKD concept calls for simplification and conceptual clarity, arguing that understanding the bidirectional acceleration of disease progression between heart and kidney dysfunction can lead to more effective treatment strategies. • Both CKM and CCKD share common pathophysiological mechanisms and risk factors, including hypertension, diabetes, obesity, and dyslipidemia. Managing these conditions requires a comprehensive approach that addresses the underlying risk factors and pathophysiological mechanisms. • Future directions include embracing precision medicine, public health strategies, interdisciplinary care models, and ongoing research and innovation. Both frameworks underscore the need for comprehensive, interdisciplinary care models and innovative treatment strategies to address the complex interplay between cardiovascular and kidney diseases.
Recurrent Hospitalizations for Fluid Overload in Diabetes with Kidney Failure Treated with Dialysis
Phang CC, Ng LC, Abdul Kadir H, Liu P, Gan S, Choong LH, Tan CS, Bee YM and Lim CC
Background & Aims Diabetes Mellitus is the most common cause of end-stage kidney disease (ESKD) in Singapore. ESKD patients have high disease burden and are at increased risk of recurrent hospitalizations, including fluid overload. This study aimed to characterize the risk factors associated with readmissions for fluid overload that will identify high-risk hospitalizations for interventions to reduce readmissions. Methods Retrospective cohort study of all hospitalizations for fluid overload in adults with diabetes and ESKD on dialysis in SingHealth hospitals between 2018 and 2021. Fluid overload was defined by discharge codes for fluid overload, heart failure, pulmonary edema, and generalized edema until 30th December 2022. Multivariable Cox regression analysis using the Prentice, Williams and Peterson Total Time (PWP-TT) model was performed for the outcomes of readmissions for fluid overload within 30 days and 90 days of discharge. Results Among 3234 hospitalizations for fluid overload, readmission for fluid overload within 30-day and 90-day occurred in 585 (18.1%) and 967 (29.9%) hospitalizations, respectively. Ischemic heart disease, peripheral vascular disease and lower hemoglobin level were independently associated with readmissions for fluid overload within 30 and 90 days. Additionally, heart failure, hemodialysis (compared to peritoneal dialysis) and lack of statin at discharge were associated with increased 90-day readmission risk. Conclusion Modifiable (hemoglobin level, statin use) and non-modifiable factors (ischemic heart disease, peripheral vascular disease and heart failure) influenced the risk of readmission for fluid overload. These results may guide risk stratification and inform targeted interventions to reduce avoidable, unplanned readmissions for recurrent fluid overload among individuals with diabetes and ESKD.
Global trends and hotspots in the association between chronic kidney disease and cardiovascular diseases: a bibliometric analysis from 2010 to 2023
Chen B, Wang X, Pan D and Wang J
Introduction This study endeavors to evaluate the distribution patterns and research frontiers within the international literature on the association between chronic kidney disease and cardiovascular diseases in the medical field, through bibliometric analysis and visualized information. Methods The Web of Science Core Collection database was selected as the data source from 2010 to 2023, and articles related to the association between chronic kidney disease and cardiovascular diseases were retrieved. The article data was analyzed through CiteSpace for bibliometric mapping, involving the examination of keywords, references, country/region distributions, and institutional contributions to identify and understand the evolving research dynamics and frontiers in this interdisciplinary field. Results A total of 2936 publications on the association between chronic kidney disease and cardiovascular diseases were included. The country with the most publications was USA (n=904), and the institution with the most publications was University of Pennsylvania (n=116). The most frequent keywords were chronic kidney disease (n=2194), cardiovascular disease (n=1188), and mortality (n=604). The top 20 keywords and top ten references that burst during 2010 to 2023 were listed. Conclusion The association between chronic kidney disease and cardiovascular diseases has sparked extensive research, particularly in high-prevalence areas. From 2010 to 2023, publications on the association between chronic kidney disease and cardiovascular diseases show a linear increase. Current research hotspots and frontiers are mainly in cardiovascular-kidney-metabolic syndrome; innovative therapies and drug impact; gut microbiome; mendelian randomization analysis. Overall, our study offers a comprehensive scientometric analysis of the association between chronic kidney disease and cardiovascular diseases, providing valuable insights for both researchers and healthcare professionals in the field.
Erratum
Sex Disparity in the In-Hospital Outcomes of Patients with Kidney Disease Admitted for Myocardial Infarction: Insights from a Large National Database
Rivera FB, Ruyeras JMM, Salva WFC, Balbin J, Tang S, Pine PLS, Tangco GA, Bantayan NRB, Amigo JAC, Ansay MFM, Matabang MA, Lerma EV, Ong K, Collado FM and Kazory A
There is limited evidence as to the effect of sex on the outcomes of patients admitted for ST-elevation myocardial infarction (STEMI) who have a concomitant diagnosis of chronic kidney disease (CKD) and end-stage renal disease (ESRD). We aimed to determine if there are differences in the outcomes between males and females in these patient populations.
Early Serum Biomarkers of Cardiovascular Disease in Elderly Patients with Chronic Kidney Disease
Zhang B and Liao R
The global population is aging. It is estimated that by 2050, the proportion of the elderly population will reach 16%. Various studies have suggested that elderly people have a greater incidence of CKD. These elderly patients are also susceptible to cardiovascular disease (CVD), which is the leading cause of death, resulting in poor prognosis in this population. However, CVD in such patients is often insidious and lacks early markers for effective evaluation. Fortunately, several studies have recently proposed biomarkers associated with this process.
Outcomes of Patients with Critical Limb Ischemia and Chronic Kidney Disease: A National Perspective
Rivera FB, Aparece JP, Marie Ruyeras JM, Menghrajani RH, Ybañez MJ, Candida Honorio EG, Albert Ramirez Damayo JI, Li G, Dwivedi A, Puentespina RA, Talili PJ, Cu JP, Alfonso Marañon Joson JJ, Baoy Bantayan NR, Lerma EV, Collado FM, Ong K, Vijayaraghavan K and Kazory A
Studies exploring the relationship between peripheral arterial disease (PAD), critical limb ischemia (CLI), and chronic kidney disease (CKD) and its effect on in-hospital outcomes are limited. We aimed to analyze the outcomes of patients with CKD and PAD who are admitted for CLI.
Usefulness of Antigen Carbohydrate 125 and N-Terminal Pro-B-Type Natriuretic Peptide for Assessing Congestion in Chronic Heart Failure: Insights from the CARDIOREN Registry
Gayán Ordás J, Nuñez J, Bascompte Claret R, Llacer P, Zegri-Reiriz I, de la Espriella R, Fort A, Rubio-Gracia J, Blazquez-Bermejo Z, Mendez A, Ponz I, Rodriguez Chaverri A, Caravaca-Pérez P, Recio Mayoral A, Jiménez Rubio C, Pomares A, José Soler M, Fluviá P, García Magallón B, Luis Górriz J, Manzano L, Husain-Syed F and Cobo Marcos M
A comprehensive assessment of congestion, including circulating biomarkers, is recommended in patients with acute heart failure. The circulating biomarkers natriuretic peptides (NPs) and carbohydrate antigen-125 (CA125) could be useful for congestion assessment in ambulatory chronic heart failure (CHF), but there is only limited information about their applicability in this context. Therefore, this study aimed to examine the association of plasma CA125 and NP levels with clinical and ultrasound congestion parameters in CHF.
Blood Volume Analysis and Cardiorenal Syndrome: From Bench to Bedside
Jefferies JL, Stavish CA, Silver MA, Butler J, Humes HD and Strobeck J
This review delves into the intricate landscape of cardiorenal syndrome (CRS) and highlights the pivotal role of blood volume analysis (BVA) in improving patient care and outcomes.
Prognostic Value of Shock Index Creatinine in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
Yang B, Wang C, Zhou T, Sun Y, Zheng S, Chen J, Luo S, Luo J and Li J
Shock index (SI) and its derivatives have been reported to have prognostic value in various cardiovascular diseases. This study aims to ascertain the utility of shock index creatinine (SIC) in predicting mid-term mortality among patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
Effect of Frail Phenotype on Cardiorenal Risk and Healthcare Utilization in Older Patients with Chronic Kidney Disease
Sun CY, Chao CT, Wu SH, Wu JL, Ling TC, Yang DC, Lin WR, Huang CH and Chang YT
Limited data have addressed frailty's role in cardiorenal risk among older adult patients with chronic kidney disease (CKD). We investigated whether frailty could predict major renal and cardiovascular events, healthcare utilization, and mortality in these patients.
Hypertension in Cardiovascular and Kidney Disease: Recent Trends - Treating Two Diseases as One
De Pascalis A, Tomassetti A, Vetrano D, Tringali E, Di Lullo L, Napoli M, La Manna G and Cianciolo G
Hypertension and chronic kidney disease (CKD) are closely interlinked pathophysiologic states, such that high blood pressure (BP) is an independent risk factor for disease progression in both adult and pediatric patients with kidney disorders and progressive decline in kidney function can conversely lead to worsening BP control.
The Art of Ultrafiltration, from Pump to Peritoneum
Belal A and Kazory A
Heart failure remains a significant public health burden given its prevalence, morbidity, mortality as well its untoward financial consequences.
Galectin-3 and Soluble CD146 Identify Cardiorenal Injuries in Severe Burn Patients: A Biomarker-Based Approach
Boutin L, Soussi S, Garcia Lavello A, Masson Fron E, Deniau B, Legrand M, Blot-Chabaud M, Figueroa SM, Chadjichristos CE, Azibani F and Dépret F
Acute kidney injury (AKI) and myocardial injury (MI) are severe conditions in patients with severe burn injury, and combination of both is even worst and is called the cardiorenal syndrome (CRS). Identifying a distinct cardiorenal phenotype could significantly enhance the management of these patients. Galectin-3 (Gal3) and soluble CD146 (sCD146) are biomarkers for renal and cardiac injuries. This study aims to assess the occurrence and reliability of these biomarkers in recognizing CRS in individuals who have been severely burn.
Cardiorenal Syndrome and Inflammation: A Forgotten Frontier Resolved by Sorbents?
Ramírez-Guerrero G, Ronco C and Reis T
Cardiorenal syndrome (CRS) describes the maladaptive relationship between heart and kidney dysfunction, with different pathways perpetuating the pathophysiology. Inflammation is one of these mechanisms. It contributes to the final nonhemodynamic pathways of organ dysfunction in the heart-kidney cross-talk. It may be a mediator and amplifier of this pathological communication, playing a vital role in both acute and chronic cardiorenal dysfunction. Current therapeutic strategies are not satisfactory in mitigating the inflammatory pathway in CRS. Hemoadsorption overcomes this limitation, and the soluble mediators of inflammation are potentially amenable to removal by hemoadsorption. This perspective article describes the inflammatory mechanisms in CRS and the rationality of using hemoadsorption in this scenario.
Efficacy of Modern Therapies for Heart Failure with Reduced Ejection Fraction in Specific Population Subgroups: A Systematic Review and Network Meta-Analysis
Lavalle C, Mariani MV, Severino P, Palombi M, Trivigno S, D'Amato A, Silvetti G, Pierucci N, Di Lullo L, Chimenti C, Summaria F, Ronco C, Badagliacca R, Miraldi F and Vizza CD
The efficacy and safety of emerging therapies for heart failure with reduced ejection fraction (HFrEF) have never been compared in specific subgroups of patients.
Predictive Value of Serum Soluble ST2 in Adult Patients Undergoing Cardiac Surgery for Acute Kidney Injury
Chen Z, Li J, Liu X, Liu X, Zhu J, Tang X, Deng Y and Chen C
Cardiac surgery is related to an increased risk of postoperative acute kidney injury (AKI). Serum soluble ST2 (sST2) is highly predictive of several cardiovascular diseases and may also be involved in renal injury. This study explored the relationship between serum sST2 levels measured at intensive care unit (ICU) admission and the development of AKI after cardiac surgery.
Polishing the Core: Refining Venous Excess Ultrasound for Venous Congestion Assessment
Passos RDH, Teixeira PGZ, Pellegrino CM, Galindo VB, Almeida RS, Midega TD and Flato UAP
Sodium-Glucose Cotransporter-2 Inhibitors Use in Patients with Reduced Kidney Function Hospitalized for Fluid Overload and Heart Failure: An Observational Study
Tan SY, Galang LD, Leong EW, Huang Z, Chin Z, Sia WJ, Kang ML, Tan CS, Abdullah HRB and Lim C
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended in kidney disease and heart failure to reduce adverse clinical outcomes, but utilization can vary. To understand potential gaps in clinical practice and identify opportunities for improvement, we aimed to describe the prevalence and factors associated with SGLT2i prescription in patients with reduced kidney function hospitalized for fluid overload and/or heart failure.
Telomere Length Is Associated with Increased Risk of Cardiovascular Events in Patients with End-Stage Kidney Disease on Hemodialysis
Vostatek R, Hohensinner P, Schmaldienst S, Lorenz M, Klauser-Braun R, Pabinger I, Säemann M, Ay C and Königsbrügge O
Patients with chronic kidney disease, especially those with end-stage kidney disease (ESKD) on hemodialysis (HD), are at increased risk for cardiovascular disease (CVD), including myocardial infarction and ischemic stroke. A shortening in telomere length, as a parameter for accelerated vascular aging, is an established biomarker for CVD in the general population. We aimed to elucidate the role of telomere length in ESKD patient on HD and its association with cardiovascular outcomes.