Cardiorenal Medicine

INTRODUCTION: Heart failure (HF) progression according to changes in the serum chloride concentration ([sCl-]) was recently proposed as the 'chloride theory' for HF pathophysiology. The present study examined the association of neurohormones and renal Cl avidity to determine their contribution to acute HF and their involvement to the 'chloride theory'. METHODS: Data from 29 patients with acute HF (48% men; 80.3±12 years) were analyzed. Blood and urine samples were obtained before decongestive therapy...

INTRODUCTION: Albuminuria is prevalent in patients with chronic heart failure and is a risk factor for disease progression. However, its clinical meaning in acute heart failure remains elusive. This study analyzed the trajectory of urine albumin to creatinine ratio (UACR) between admission and discharge and its association with decongestion. METHODS: In this prospective observational study, 63 patients were enrolled. UACR, B-type natriuretic peptide (BNP), and clinical congestion score (CCS) were obtained at admission and discharge...

Background A systemic inflammatory response is triggered in patients undergoing cardiothoracic surgery with cardiopulmonary bypass. This response is particularly evident in pediatric patients, especially if of low weight and after undergoing long cardio-pulmonary by-pass (CPB), and can severely impair surgical result. Objectives Adsorptive blood purification techniques have been proposed to limit this systemic inflammatory response. To test its efficacy, we added the hemoadsorption filter Jafron HA 380 to CPB in a very compromised pediatric patient who underwent heart transplantation...

BACKGROUND: There is a marked increase in the global prevalence of obesity over the last decades with an estimated 1.9 billion adults living with overweight or obesity. This is associated with a sharp rise in prevalence of cardiorenal metabolic diseases such as type 2 diabetes mellitus, chronic kidney disease, and heart failure. With recent evidence of the efficacy of sodium glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists on cardiorenal protection and weight reduction, it is reasonable to investigate common causative pathways for cardiorenal metabolic diseases...

BACKGROUND: The maladaptive neurohormonal activation, an integral mechanism in the pathophysiology of heart failure (HF) and cardiorenal syndrome, has a profound impact on renal sodium handling. Congestion is the primary reason for hospitalization of patients with HF and the main target of therapy. As sodium is the main determinant of extracellular volume, the goal is to enhance urinary sodium excretion in order to address excess fluid. The interventions to increase natriuresis have conventionally focused on distal nephron as the primary segment that counterbalances the effects of loop diuretics...

INTRODUCTION: Mounting evidence in the literature describes a reverse association, whereby obesity may have a protective effect on mortality - the "obesity paradox." Due to the significant overlap between elements of cardiorenal metabolic disease, we examined the effects of obesity on outcomes in a cohort of patients with non-dialysis chronic kidney disease (ND-CKD) by grouping patients according to their level of cardiometabolic co-morbidity to reduce the risk of bias. METHODS: This study was undertaken on all patients with a documented body mass index (BMI) in the Salford Kidney Study database from October 2002 until December 2016...

INTRODUCTION: Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) improve outcomes but are underutilized in patients with chronic kidney disease (CKD). Little is known about reasons for discontinuation and lack of reinitiating these medications. We aimed to explore clinicians' and patients' experiences and perceptions of ACEI/ARB use in CKD. METHODS: A multi-profession sample of health care clinicians and patients with documented ACEI/ARB associated side effects in the past 6 months...

INTRODUCTION: In cardiorenal syndrome type 1 (CRS1) vascular congestion is central to the pathophysiology of heart failure and thus a key target for management. The Venous Evaluation by Ultrasound System (VExUS) could guide decongestion effectively and thereby improve outcomes. METHODS: In this randomized clinical trial, patients with CRS1 (i.e., increase in creatinine ≥0.3 mg/dL) were randomized to guide decongestion with VExUS compared to usual clinical evaluation...

INTRODUCTION: QTc interval prolongation is increasingly frequent as CKD advances and predicts death in dialysis. However, predictors and mortality-risk in predialysis CKD are understudied. FGF23 induces left ventricular hypertrophy (LVH) which is associated with QTc interval prolongation and death, suggesting a possible pathway from FGF23 to death that entails LVH and QTc prolongation. We looked for links between FGF23 and prolonged QTc intervals mediated by LVH, and for deaths associated with QTc prolongation in a prospective observational cohort of patients with predialysis CKD...

INTRODUCTION: Due to the cardiotoxicity of cancer treatment and traditional risk factors for cardiovascular disease (CVD) such as obesity, diabetes, dyslipidemia, and hypertension, cancer patients are at higher risk of developing CVD. However, limited research exists on the correlation between chronic kidney disease (CKD) and CVD risk in cancer patients. METHODS: This cross-sectional study selected cancer patients aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) conducted from 2015 to 2020...

INTRODUCTION: The combined clinical impact of muscle mass, muscle function and adipose mass on hospitalisation events, especially those that have exact causes, such as cardiovascular diseases (CVDs), had been rarely studied in patients on haemodialysis (HD). This study aimed to determine the influence of lean tissue index (LTI), fat tissue index (FTI) and hand grip strength (HGS) on the risk of CVD-related hospitalisation in patients undergoing chronic HD. METHODS: This multi-centre observational study enrolled a total of 2,041 clinically stable patients aged >18 years and who had undergone HD for at least three months at 17 HD units in 2019...

BACKGROUND: Limited data are available on the long-term impact of mild renal dysfunction (eGFR 60-89 ml/min/1.73m2) in patients with three-vessel coronary disease (3VD). METHODS: A total of 5,272 patients with 3VD undergoing revascularization were included and were categorized into 3 groups: normal renal function (eGFR ≥90 ml/min/1.73m2, n=2352), mild renal dysfunction (eGFR 60-89, n=2501) and moderate renal dysfunction (eGFR 30-59, n=419). Primary endpoint was all-cause death...

INTRODUCTION: Increased left atrial (LA) size is a risk factor for cardiovascular events and all-cause mortality. It is closely related to left ventricular hypertrophy and chronic volume overload, both of which are common in hemodialysis. Calcimimetic treatment with Etelcalcetide (ETL) previously showed an inhibitory effect on left ventricular mass index (LVMI) progression in this population. METHODS: This is a post-hoc analysis of the EtECAR-HD trial, where 62 patients were randomized to ETL or alfacalcidol (ALFA) for one year...

INTRODUCTION: Sacubitril/valsartan (S/V) reduces all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF), but it may decline their estimated glomerular filtration rates (eGFR). In addition to eGFR, this clinical study aimed to develop a blood urea nitrogen (BUN)-based index to evaluate the status of renal perfusion and then identify predictors of all-cause death or heart transplant in patients with HFrEF receiving S/V. METHODS: From the recruited 291 patients with HFrEF who were prescribed S/V from March 2017 to March 2019, we collected demographic, drug history, laboratory, echocardiographic, and clinical data from one year before S/V initiation until December 2020...

Introduction Chronic kidney disease (CKD) is a growing public health problem, with significant burden of cardiovascular disease and mortality. The risk of cardiovascular disease in CKD is elevated beyond that predicted by traditional cardiovascular risk factors, suggesting that other factors may account for this increased risk. Through metabolic profiling, this study aimed to investigate the associations between serum metabolites associated with prevalent cardiovascular disease in Asian patients with CKD to provide insights into the complex interactions between metabolism, cardiovascular disease in CKD...

Introduction- Acute kidney injury (AKI) is a common and serious complication in critically ill patients, particularly those with ST elevation myocardial infarction (STEMI). Mechanical ventilation (MV) is often needed when respiratory deterioration occurs and was continuously associated with higher risk for AKI. Whether MV is an independent predictor for AKI in STEMI patients has not been evaluated before. We aimed to determine a potential association between MV and the occurrence of AKI in STEMI patients. Methods- A single center retrospective cohort in a tertiary referral hospital...

INTRODUCTION: Patients with end-stage renal disease receiving hemodialysis (HD) have a high morbidity and mortality rate associated with pulmonary hypertension (PH). A nomogram was developed to predict all-cause mortality in HD patients with PH. In this study, we aimed to validate the usefulness of this nomogram. METHODS: A total of 274 HD patients with PH were hospitalized at the Affiliated Hospital of Xuzhou Medical University between January 2014 and June 2019 and followed up for 3 years...

BBACKGROUND: Impaired relaxation is the earliest manifestation of ischemic cascade. Risk factors and renal function abnormalities are associated with coronary disease and diastolic dysfunction as well. We aimed to study the association of noninvasive assessment of LV filling pressures and renal function with mortality in high risk patients undergoing coronary angiography. PATIENTS AND METHODS: An observational prospective study of consecutive 564 patients undergoing coronary angiography...

INTRODUCTION: Although maintenance hemodialysis (MHD) in end-stage renal disease (ESRD) appears to induce some risk factors and strengthen cardiac function, the morbidity of ESRD patients receiving hemodialysis remains high. This study aimed to identify left ventricular (LV) structural and functional abnormalities in ESRD patients on MHD using three-dimensional speckle-tracking imaging (3D-STI). METHODS: Eighty-five ESRD patients with normal LV ejection fraction (LVEF >50%) participated in this study, including 55 MHD patients comprising the chronic kidney disease (CKD) V-D group and 30 nondialysis patients comprising the CKD V-ND group...

INTRODUCTION: Spot urinary sodium emerged as a useful parameter for assessing decongestion in patients with congestive heart failure (CHF). Growing evidence endorses the therapeutic role of continuous ambulatory peritoneal dialysis (CAPD) in patients with refractory CHF and kidney disease. We aimed to examine the long-term trajectory of urinary, peritoneal, and total (urinary plus peritoneal) sodium removal in a cohort of patients with refractory CHF enrolled in a CAPD program. Additionally, we explored whether sodium removal was associated with the risk of long-term mortality and episodes of worsening heart failure (WHF)...