Seminars in nephrology最新文献_第6页

Oral Anticoagulation Use in Individuals With Atrial Fibrillation and Chronic Kidney Disease: A Review 心房颤动和慢性肾病患者的口服抗凝药使用：综述。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-03-01 DOI: 10.1016/j.semnephrol.2024.151517

{"title":"Oral Anticoagulation Use in Individuals With Atrial Fibrillation and Chronic Kidney Disease: A Review","authors":"","doi":"10.1016/j.semnephrol.2024.151517","DOIUrl":"10.1016/j.semnephrol.2024.151517","url":null,"abstract":"<div><p>Atrial fibrillation (AF) is highly prevalent in patients with chronic kidney disease (CKD). It is associated with an increased risk of stroke, which increases as kidney function declines. In the general population and in those with a moderate degree of CKD (creatinine clearance 30-50 mL/min), the use of oral anticoagulation to decrease the risk of stroke has been the standard of care based on a favorable risk–benefit profile that had been established in seminal randomized controlled trials. However, evidence regarding the use of oral anticoagulants for stroke prevention is less clear in patients with severe CKD (creatinine clearance <30 mL/min) and those receiving maintenance dialysis, as these individuals were excluded from such large randomized controlled trials. Nevertheless, the direct oral anticoagulants have invariably usurped vitamin K antagonists as the preferred choice for oral anticoagulation among patients with AF across all strata of CKD based on their well-defined safety and efficacy and multiple pharmacokinetic benefits (e.g., less drug–drug interactions). This review summarizes the current literature on the role of oral anticoagulation in the management of AF among patients with CKD and highlights current deficiencies in the evidence base and how to overcome them.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"44 2","pages":"Article 151517"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0270929524000378/pdfft?md5=40cfca6fd75df660decc6c72f31b7fc5&pid=1-s2.0-S0270929524000378-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Kidney-Heart Interactions 肾与心脏的相互作用

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-03-01 DOI: 10.1016/j.semnephrol.2024.151511

引用次数: 0

Cardiac Devices and Kidney Disease 心脏设备与肾脏疾病。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-03-01 DOI: 10.1016/j.semnephrol.2024.151513

{"title":"Cardiac Devices and Kidney Disease","authors":"","doi":"10.1016/j.semnephrol.2024.151513","DOIUrl":"10.1016/j.semnephrol.2024.151513","url":null,"abstract":"<div><p><span><span><span>A growing variety of cardiac devices are available to monitor or support cardiovascular function. The entwined nature of cardiovascular disease and </span>kidney disease<span> makes the relationship of these devices with kidney disease a multifaceted question relating to the use of these devices in individuals with kidney disease and to the effects of the devices and device placement on kidney health. Cardiac devices can be categorized broadly into cardiac implantable electronic devices, structural devices, and circulatory assist devices. Cardiac implantable electronic devices include devices for monitoring and managing cardiac electrical activity and devices for </span></span>monitoring hemodynamics. Structural devices modify cardiac structure and include </span>valve prostheses<span>, valve repair clips, devices for treating atrial septal abnormalities, left atrial appendage closure devices, and interatrial shunt devices. Circulatory assist devices support the failing heart or support cardiac function during high-risk cardiac procedures. Evidence for the use of these devices in individuals with kidney disease, effects of the devices on kidney health and function, specific considerations with devices in kidney disease, and important knowledge gaps are surveyed in this article. With the growing prevalence of combined cardiorenal disease and the increasing variety of cardiac devices, kidney disease considerations are an important aspect of device therapy.</span></p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"44 2","pages":"Article 151513"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Contemporary Decongestive Strategies in Acute Heart Failure 急性心力衰竭的当代减充血策略。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-03-01 DOI: 10.1016/j.semnephrol.2024.151512

{"title":"Contemporary Decongestive Strategies in Acute Heart Failure","authors":"","doi":"10.1016/j.semnephrol.2024.151512","DOIUrl":"10.1016/j.semnephrol.2024.151512","url":null,"abstract":"<div><p><span>Congestion is the primary driver of hospital admissions in patients with heart failure and the key determinant of their outcome. Although intravenous loop diuretics<span><span> remain the predominant agents used in the setting of acute heart failure, the therapeutic response is known to be variable, with a significant subset of patients discharged from the hospital with residual </span>hypervolemia. In this context, </span></span>urinary<span><span><span> sodium excretion has gained attention both as a marker of response to </span>loop diuretics<span><span> and as a marker of prognosis that may be a useful clinical tool to guide therapy. Several decongestive strategies have been explored to improve diuretic<span> responsiveness and removal of excess fluid. Sequential nephron blockade through combination </span></span>diuretic therapy<span><span> is one of the most used methods to enhance natriuresis<span><span> and counter diuretic resistance. In this article, I provide an overview of the contemporary decongestive approaches and discuss the clinical data on the use of add-on </span>diuretic therapy. I also discuss mechanical removal of excess fluid through </span></span>extracorporeal </span></span></span>ultrafiltration with a brief review of the results of landmark studies. Finally, I provide a short overview of the strategies that are currently under investigation and may prove helpful in this setting.</span></p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"44 2","pages":"Article 151512"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Challenges and Strategies in Implementing Novel Kidney Protective and Cardioprotective Therapies in Patients With Diabetes and Kidney Disease 对糖尿病肾病患者实施新型肾脏保护和心脏保护疗法的挑战与策略

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-03-01 DOI: 10.1016/j.semnephrol.2024.151520

{"title":"Challenges and Strategies in Implementing Novel Kidney Protective and Cardioprotective Therapies in Patients With Diabetes and Kidney Disease","authors":"","doi":"10.1016/j.semnephrol.2024.151520","DOIUrl":"10.1016/j.semnephrol.2024.151520","url":null,"abstract":"<div><p><span>Chronic kidney disease<span> (CKD) is highly prevalent, estimated to affect over 800 million people worldwide. Diabetes is a leading cause of kidney disease<span><span>. Both diabetes and CKD are associated with a high risk of cardiovascular disease and related morbidity and mortality. Over the last several years, there has been a shift in focus toward integrating kidney and cardiovascular care, particularly in diabetes. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists have rapidly become cornerstones of kidney and cardiovascular risk-focused care in diabetes and CKD. However, present-day use of these agents is low, and disparities in use by race, ethnicity, age, sex, and comorbidities are apparent. Challenges in implementation of kidney protective and cardioprotective therapies include low rates of diabetes and CKD screening, lack of provider comfort and subspecialty reliance, inconsistencies across professional society guidelines, high rates of drug discontinuation, and prohibitive costs. Effective implementation of kidney protective and cardioprotective therapies necessitates a multifaceted approach and active engagement of patients, pharmacists, </span>primary care<span> providers, subspecialty providers, and health care system leaders as key stakeholders. Implementation efforts should be practical and incorporate collaborative, multidisciplinary team-based approaches. Successful implementation of kidney protective and cardioprotective therapies has the potential to improve overall health outcomes and ameliorate </span></span></span></span>health care disparities.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"44 2","pages":"Article 151520"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New Insights on Cardiac Arrhythmias in Patients With Kidney Disease 肾病患者心律失常的新发现。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-03-01 DOI: 10.1016/j.semnephrol.2024.151518

引用次数: 0

Epidemiology and Management of Patients With Kidney Disease and Heart Failure With Preserved Ejection Fraction 肾病合并射血分数保留型心力衰竭患者的流行病学和管理。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-03-01 DOI: 10.1016/j.semnephrol.2024.151516

{"title":"Epidemiology and Management of Patients With Kidney Disease and Heart Failure With Preserved Ejection Fraction","authors":"","doi":"10.1016/j.semnephrol.2024.151516","DOIUrl":"10.1016/j.semnephrol.2024.151516","url":null,"abstract":"<div><p>Heart failure with preserved ejection fraction (HFpEF) comprises approximately one-half of all diagnoses of heart failure. There is significant overlap of this clinical syndrome with chronic kidney disease (CKD), with many shared comorbid conditions. The presence of CKD in patients with HFpEF is one of the most powerful risk factors for adverse clinical outcomes, including death and heart failure hospitalization. The pathophysiology linking HFpEF and CKD remains unclear, but it is postulated to consist of numerous bidirectional pathways, including endothelial dysfunction, inflammation, obesity, insulin resistance, and impaired sodium handling. The diagnosis of HFpEF requires certain criteria to be satisfied, including signs and symptoms consistent with volume overload caused by structural or functional cardiac abnormalities and evidence of increased cardiac filling pressures. There are numerous overlapping metabolic clinical syndromes in patients with HFpEF and CKD that can serve as targets for intervention. With an increasing number of therapies available for HFpEF and CKD as well as for obesity and diabetes, improved recognition and diagnosis are paramount for appropriate management and improved clinical outcomes in patients with both HFpEF and CKD.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"44 2","pages":"Article 151516"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Paving a Path to Equity in Cardiorenal Care 为实现心肾护理公平铺平道路。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-03-01 DOI: 10.1016/j.semnephrol.2024.151519

{"title":"Paving a Path to Equity in Cardiorenal Care","authors":"","doi":"10.1016/j.semnephrol.2024.151519","DOIUrl":"10.1016/j.semnephrol.2024.151519","url":null,"abstract":"<div><p>Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"44 2","pages":"Article 151519"},"PeriodicalIF":2.8,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epidemiology of Cancer in Kidney Transplant Recipients 肾移植受者的癌症流行病学。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-01-01 DOI: 10.1016/j.semnephrol.2024.151494

David Massicotte-Azarniouch MD, MSc , J. Ariana Noel MD, MSc , Greg A. Knoll MD, MSc

{"title":"Epidemiology of Cancer in Kidney Transplant Recipients","authors":"David Massicotte-Azarniouch MD, MSc , J. Ariana Noel MD, MSc , Greg A. Knoll MD, MSc","doi":"10.1016/j.semnephrol.2024.151494","DOIUrl":"10.1016/j.semnephrol.2024.151494","url":null,"abstract":"<div><p>Kidney transplantation is the ideal treatment modality for patients with end-stage kidney disease, with excellent outcomes post-transplant compared with dialysis. However, kidney transplant recipients are at increased risk of infections and cancer because of the need for immunosuppression. Kidney transplant recipients have approximately two to three times greater risk of developing cancer than the general population, and cancer is a major contributor to morbidity and mortality. Most of the increased risk is driven by viral-mediated cancers such as post-transplant lymphoproliferative disorder, anogenital cancers, and Kaposi sarcoma. Nonmelanoma skin cancer is the most frequent type of cancer in kidney transplant recipients, likely due to an interaction between ultraviolet radiation exposure and decreased immune surveillance. Occurrence of the more common types of solid organ cancers seen in the general population, such as breast, prostate, lung, and colorectal cancers, is not, or is only mildly, increased post-transplant. Clinical care and future research should focus on prevention and on improving outcomes for important immunosuppression-related malignancies, and treatment options for other cancers occurring in the transplant setting.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":"44 1","pages":"Article 151494"},"PeriodicalIF":2.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0270929524000111/pdfft?md5=99b92dccff332e7ea4e7c242ea388063&pid=1-s2.0-S0270929524000111-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Systemic Amyloidosis and Kidney Transplantation: An Update 系统性淀粉样变性与肾移植：最新进展。

IF 2.8 3区医学

Seminars in nephrology Pub Date : 2024-01-01 DOI: 10.1016/j.semnephrol.2024.151496

Shankara K. Anand MS , Vaishali Sanchorawala MD , Ashish Verma MBBS

引用次数: 0