Cardiorenal Medicine最新文献

{"title":"Utilities of Sodium-Glucose Cotransporter-2 Inhibitor in the Intensive Care Units.","authors":"Jiong Cui, Kianoush Kashani","doi":"10.1159/crm/abtag018","DOIUrl":"https://doi.org/10.1159/crm/abtag018","url":null,"abstract":"<p><p>Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have become foundational therapies for heart failure and chronic kidney disease and are increasingly used in critically ill patients. Their established benefits for kidney and heart health, along with emerging evidence from acute-care settings, indicate growing interest in their potential role in intensive care medicine. However, whether these benefits can be translated to critically ill populations remains uncertain, and concerns regarding safety continue to influence clinical practice. Summary Clinical evidence supporting the use of SGLT2 inhibitors (SGLT2i) during acute illness is expanding. Benefits have been most consistently observed in acute heart failure, perioperative care, and renal outcomes, where randomized and observational studies suggest improved decongestion, reduced acute kidney injury, and favorable cardiorenal outcomes. These observations are supported by several biological effects of SGLT2i that extend beyond glucose lowering, including modulation of fluid balance, renal hemodynamics, metabolic adaptation, inflammation, and endothelial function-pathways that are central to the development of organ dysfunction during critical illness. However, important uncertainties remain regarding which critically ill patients are most likely to benefit, whether chronic therapy should be continued during acute illness, and how potential benefits should be balanced against safety concerns in the ICU. This review integrates current mechanistic and clinical evidence, examines the balance between potential benefits and risks, discusses practical management considerations, and highlights key research priorities to better define the role of SGLT2i in critical care medicine.   Key Messages - SGLT2 inhibitors show promise in critical care but are not established therapies. - Cardiorenal benefits must be balanced against metabolic and hemodynamic risks. - Future research should define the right patient, the right timing, and the right treatment strategy.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-sensitivity C-Reactive Protein as a Risk-Enhancing Biomarker in Patients with Chronic Kidney Disease and Atherosclerotic Cardiovascular Disease: A Narrative Review.","authors":"Ganesha Prakash N S, Tom Devasia, Ganesh Paramasivam, Indu Ramachandra Rao, Navaneeth Amin, Prasad N Shetty","doi":"10.1159/crm/abtag019","DOIUrl":"https://doi.org/10.1159/crm/abtag019","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) have a >10-fold higher risk of cardiovascular mortality than the general population, influenced by both traditional and non-traditional risk factors. Residual cardiovascular risk persists despite effective lipid lowering and antihypertensive treatment, suggesting that inflammation-driven mechanisms have been neglected. High-sensitivity C-reactive protein (hs-CRP) as a sensitive marker of systemic low-grade inflammation is a recognized risk-enhancing biomarker in atherosclerotic cardiovascular disease (ASCVD), but its precise role, optimal thresholds, and therapeutic relevance in concomitant CKD-ASCVD remain poorly synthesized.</p><p><strong>Summary: </strong>PubMed/MEDLINE, Scopus and EMBASE (January 1989-March 2026) were searched to consolidate evidence on hs-CRP in CKD-ASCVD from mechanistic, epidemiological, and clinical trials. Data supports a bidirectional cardiorenal axis: progressive CKD elevates hs-CRP by uremic toxin-induced interleukin-6 (IL-6), nuclear factor kappa-B (NF-κB) activation, atherosclerosis, while high hs-CRP aggravates renal deterioration by CD32b-Smad3-transforming growth factor beta 1 (TGF-β1) related tubulointerstistial fibrosis. hs-CRP >3 mg/L nearly doubles heart failure risk in CKD. Cumulative exposure increases the risk of developing CKD by 70% (hazard ratio [HR] 1.70) and cardiovascular mortality by up to three-fold. CKD-specific recalibration needed for standard thresholds (<1, 1-3, >3 mg/L). Novel anti-inflammatory agents, colchicine and ziltivekimab, reduce hs-CRP by 77-92% and lower cardiovascular events in general ASCVD populations, but advanced CKD evidence remains limited with outcome trials ongoing.</p><p><strong>Key messages: </strong>hs-CRP is a marker of a pathogenic bidirectional cardiorenal loop, independently associated with cardiovascular events, CKD progression, and death, beyond LDL-cholesterol and traditional risk factors. Serial hs-CRP monitoring as a continuous measure may be superior to threshold-based categorization, pending CKD-specific validation. IL-1β/IL-6 pathway inhibitors and colchicine are promising for residual inflammatory risk but hs-CRP itself is not validated as a direct therapeutic target.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Target weight optimization based on a modified VExUS protocol in hemodialysis: the VexHD prospective multi-center study.","authors":"Patricia Muñoz Ramos, Alberto Ortiz, Ana B Sanz, Martín Giorgi, Paloma Ruiz López-Alvarado, Irene Oñate, Verónica Ruth Mercado, José Carlos de la Flor Merino, Marco Vaca Gallardo, María Lina León-Machado, Virginia López de la Manzanara, Mohammad Manouchehri, Carlos Santos Alonso, Susana Carrasco, Miguel Ángel Navas Jiménez, Patricia de Sequera, Borja Quiroga","doi":"10.1159/crm/abtag011","DOIUrl":"https://doi.org/10.1159/crm/abtag011","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical examination has limitations in estimating fluid overload in hemodialysis patients. The aim of the present study is to evaluate the impact of target weight optimization using a modified Venous Excess Ultrasonography Score (VExUS) protocol on blood pressure control in euvolemic hemodialysis patients.</p><p><strong>Methods: </strong>We enrolled clinically euvolemic patients in hemodialysis from ten Spanish centers. Baseline clinical data, bioimpedance, and an extensive panel of cardiac, congestion, and inflammatory biomarkers were collected. Patients with congestion on modified VExUS protocol (excluding intrarenal vessels) underwent protocol‑driven ultrafiltration adjustments. Blood pressure, bioimpedance, and biomarkers were reassessed at study completion, and paired statistical analyses were performed.</p><p><strong>Results: </strong>Among the 72 clinically euvolemic patients included (60% male, mean age 69±18 years), 23 (32%) showed venous congestion on modified VExUS protocol and entered the intervention group and 49 were followed under routine care conditions (reference). Volume values obtained by bioimpedance spectroscopy were similar in the congestion intervention and non-congestion reference groups. After four weeks, the intervention group experienced a significant improvement in modified VExUS protocol parameters compared to baseline (2.1±0.5 vs 1.3±0.5; p<0.001) and a systolic blood pressure reduction compared with reference group participants (-14 [-37;4] vs 4 [-9;14] mmHg) (p=0.025). The reduction in systolic blood pressure was more notable in patients with higher baseline values. There were no differences in hemodialysis tolerance or biomarker changes between intervention and reference group participants.</p><p><strong>Conclusion: </strong>Modified VExUS protocol is a promising tool for evaluating volume overload and optimizing target weight. Its incorporation in the multiparametric assessment of target weight is associated with better blood pressure control.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finerenone in Reducing Proteinuria: Clinical Effects, Underlying Mechanisms, and Associated Cardiorenal Protection.","authors":"He Chen, Ling Xu, Dan Zhu","doi":"10.1159/crm/abtag001","DOIUrl":"https://doi.org/10.1159/crm/abtag001","url":null,"abstract":"<p><p>Proteinuria remains a cardinal surrogate of renal injury and cardiorenal risk, However, residual albuminuria is commonly observed after the treatment with renin-angiotensin-aldosterone system (RAAS) blockade or sodium-glucose cotransporter-2 inhibitors (SGLT2i). The non-steroidal, selective mineralocorticoid receptor antagonist(MRA) finerenone has recently been demonstrated to possess albuminuria-lowering and organ-protective effects, Nonetheless, its precise mechanisms of action and the full scope of its benefits within combination drug regimens require further elucidation. This review comprehensively synthesizes the clinical evidence for finerenone as an antiproteinuric agent in chronic kidney disease (CKD) and summarizes its potential mechanisms of action. Finerenone acts as an inverse agonist by binding to the mineralocorticoid receptor, thereby concurrently suppressing both genomic and non-genomic aldosterone signaling. This action inhibits pro-fibrotic, pro-inflammatory, and hemodynamic pathways that collectively contribute to damage of the glomerular filtration barrier, ultimately leading to the observed alleviation of proteinuria. Clinical studies have confirmed that finerenone reduces albuminuria, slows the progression of kidney failure, and decreases the risk of cardiovascular events, with a lower incidence of hyperkalemia compared to steroidal MRAs. Regarding combination therapies, the renal protective effects of finerenone are enhanced when used concomitantly with either RAAS blockers or SGLT2 inhibitors. However, its clinical benefits in non-diabetic CKD populations remain to be substantiated by large-scale studies. Furthermore, the mechanisms underlying its intrarenal hemodynamic protection require further elucidation, and the optimal combination strategies and the underlying mechanisms for the potential benefits of such regimens await validation through large-scale, randomized controlled trials.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pressure-Strain Loop-Derived Myocardial Work in Hemodialysis versus Peritoneal Dialysis: A Cross-Sectional Echocardiographic Study.","authors":"Jue Lin, Lingxiang Ma, Mei Jin, Bing Li, Hanyin Huang, Xuning Huang, Meihua Chen","doi":"10.1159/crm/abtag002","DOIUrl":"https://doi.org/10.1159/crm/abtag002","url":null,"abstract":"<p><p>Objective Cardiovascular disease remains the leading cause of mortality in patients with end-stage renal disease (ESRD) patients. However, direct comparisons of myocardial performance between hemodialysis (HD) and peritoneal dialysis (PD) patients remain limited. This cross-sectional study aimed to assess and compare left ventricular (LV) myocardial work between ESRD patients undergoing HD and PD using noninvasive pressure-strain loop (PSL) analysis. Methods A total of 136 ESRD patients receiving maintenance dialysis, including 70 HD patients and 66 PD patients, together with 41 healthy controls, underwent echocardiographic PSL analysis. Myocardial work parameters, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were compared among groups. Results Compared with healthy controls, both dialysis groups showed significantly increased GWW and decreased GWE, indicating impaired myocardial work efficiency (all P <0.05). Despite comparable left ventricular ejection fraction and global longitudinal strain between the two dialysis groups, PD patients had significantly higher GCW than HD patients. Multivariable linear regression adjusting for potential confounders, including B-type natriuretic peptide and mean arterial pressure, showed that HD was independently associated with lower GCW. However, no significant differences were observed between HD and PD patients in GLS, GWI, or GWE. Given the modest effect size, borderline unadjusted statistical significance, and lack of correction for multiple comparisons, these findings should be considered hypothesis-generating and require confirmation in larger prospective studies. Conclusion Noninvasive PSL analysis may provide complementary information for characterizing myocardial work patterns in ESRD patients undergoing different dialysis modalities. PD was associated with higher GCW than HD, a difference not detected by conventional left ventricular ejection fraction or global longitudinal strain. Prospective multicenter studies are needed to confirm these associations and evaluate their prognostic significance.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Ventricular Free Wall Strain Is Associated with Low-Grade Albuminuria in HFpEF: A Cross-Sectional Cohort Study.","authors":"Andreas Kind, Daniela Zurkan, Alexandra Maria Chitroceanu, Fabian Spinka, Lucie Kretzler, Alaeddine Slama, Edwardo Reynolds, Diana Bachran, Kristina Franz, Bianca Materne, Theresa Keller, Alice Schneider, Alessio Alogna, Daniel Armando Morris, Michael Gotthardt, Frank Edelmann","doi":"10.1159/crm/abtag015","DOIUrl":"https://doi.org/10.1159/crm/abtag015","url":null,"abstract":"<p><p>Introduction Heart failure with preserved ejection fraction (HFpEF) presents a major health burden worldwide. Up to 40% of HFpEF patients present with elevated urine-albumin-creatinine-ratio levels (UACR). In this subgroup, the risk for adverse cardiovascular (CV) outcomes is increased. Prior studies suggest a correlation between albuminuria and incident heart failure and adverse outcomes even at levels below current clinical thresholds and in the presence of preserved renal function and may mark early cardio-renal and endothelial dysfunction. Whether right ventricular (RV) systolic function, as measured by RV free wall strain (RVFWS), relates to albuminuria in heart failure with preserved ejection fraction (HFpEF) has not been characterized. Methods Patients with HFpEF (LVEF ≥50%, HFA-PEFF score ≥5 or invasively elevated filling pressures) and patients of a CKD comparator cohort (CKD ≥G3 or >A1 and ≥1 CV risk factor, without diagnosed HF) were pooled from two cross-sectional cohort studies for this analysis. All patients underwent comprehensive assessment including albuminuria and RVFWS measurement. Albuminuria was categorized by KDIGO stage (A1/A2/A3). RVD was defined by RVFWS ≥ -20%, RV FAC <35% or TAPSE <17 mm. We examined the association between RVFWS and albuminuria using a multivariate linear model with a cohort interaction term and cohort-specific models. Model robustness was assessed by elastic-net regression, bootstrap internal validation, E-value and by adding NT-proBNP, neutrophile count, pulmonary artery systolic pressure and urinary α1-microglobulin individually in separate sensitivity models. Inter- and intra-observer reproducibility of RVFWS was quantified. Results In total, 119 HFpEF and 133 CKD patients were identified. In HFpEF, RVFWS was more impaired (-22.5% vs. -25.7%, p < 0.001) and RVD more prevalent (30% vs. 16%). Median UACR lay within the KDIGO A1 range in both cohorts. More impaired RVFWS was associated with higher UACR in HFpEF (adjusted UACR ratio 1.55 per 5% less-negative strain, 95% CI 1.17-2.04, p=0.002) but not in the CKD cohort (p=0.380), with a significant cohort interaction (p=0.002). The association persisted after adjustment in sensitivity models, and RVFWS was retained by penalized regression. Inter- and intra-observer agreement of RVFWS was moderate-to-good (ICC 0.71 and ICC 0.69, respectively). Discussion In ambulatory HFpEF patients with predominantly low-grade albuminuria, RVFWS is associated with UACR independently of clinical confounders, an association not observed in a CKD cohort with CV risk factors and not attenuated after adjustment for estimated PASP.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual Venous Doppler Abnormalities and Clinical Outcomes in Acute Heart Failure: Insights Beyond the Global VExUS Score.","authors":"Jose García Cantos, Paula Isabel Carmona, Raquel López-Vilella, María Jesús Montero Hernández, Miguel Angel Ródenas, María Victoria Johannessen López, Sergi Tormo, Víctor Donoso Trenado, Julia Martinez-Sole, Borja Guerrero Cervera, Maria Peris-Fernández, Amparo Soldevila, Ramón Devesa, Pilar Sánchez Pérez, Maria Casanova Aparicio, Luis Almenar-Bonet","doi":"10.1159/crm/abtag014","DOIUrl":"https://doi.org/10.1159/crm/abtag014","url":null,"abstract":"<p><strong>Background: </strong>Systemic venous congestion contributes to organ dysfunction and adverse outcomes in acute heart failure (AHF). The Venous Excess Ultrasound Score (VExUS) evaluates venous congestion, but its prognostic role and the relative contribution of its individual components in ward-admitted patients remains uncertain. We aimed to evaluate the association between global and individual VExUS-derived Doppler findings and clinical outcomes and to explore descriptive congestion patterns using unsupervised clustering.</p><p><strong>Methods: </strong>In this prospective observational study, 100 patients admitted with AHF were screened, and 80 with adequate ultrasound windows underwent standardized VExUS assessment within 24 hours of admission. Associations with 6-month all-cause mortality, readmissions, and renal deterioration were evaluated using multiplicity-adjusted statistical models. Hierarchical clustering was performed as an exploratory secondary analysis to characterize underlying profiles.</p><p><strong>Results: </strong>Individual VExUS components were significantly associated with mortality: hepatic venous flow abnormalities (OR 5.45, 95% CI 1.01-29.40; p=0.04), increased portal vein pulsatility (OR 26.1, 95% CI 1.74-389.59; p=0.01), and abnormal intrarenal venous flow (OR 6.0, 95% CI 1.01-35.62; p=0.049). Conversely, the aggregate global VExUS grade was not independently associated with mortality or other clinical outcomes. All multivariable models included a single doppler predictor adjusted for discharge creatinine. Exploratory hierarchical clustering delineated two descriptive groups with differing patterns of systemic congestion, renal function, and clinical presentation. The group with more severe systemic congestion exhibited lower estimated glomerular filtration rates and a higher proportion of observed deaths (71.4% vs 28.6% of total events; p=0.029).</p><p><strong>Conclusions: </strong>In this single-center cohort, selected individual venous Doppler abnormalities, rather than the aggregate VExUS grade, showed statistically significant associations with adverse outcomes; however, these associations were derived from models with very few events per variable and therefore should be regarded as hypothesis-generating rather than confirmatory. Exploratory clustering suggested the existence of distinct congestion patterns based on VExUS grade and clinical pattern. Larger multicenter studies with adequate event numbers are warranted to validate these exploratory findings and to determine whether they can meaningfully guide decongestive therapy.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-Kidney-Metabolic Syndrome: Is the Evidence Keeping Pace with the Concept?","authors":"Amir Kazory, Abhilash Koratala, Claudio Ronco","doi":"10.1159/crm/abtag012","DOIUrl":"https://doi.org/10.1159/crm/abtag012","url":null,"abstract":"","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of interventions for vascular calcification and stiffness in dialysis patients:a systematic review and network meta-analysis.","authors":"Yitao Li, Jun Wan, Yuanyou Tang, Juan Cao, Qi Peng","doi":"10.1159/crm/abtag010","DOIUrl":"https://doi.org/10.1159/crm/abtag010","url":null,"abstract":"<p><strong>Background: </strong>Vascular calcification (VC) and vascular stiffness (VS) significantly increase cardiovascular risks in renal dialysis (RD) patients. Currently, several interventions have been tried to alleviate VC and VS, but they all lack systematic comparison. This study integrated randomized controlled trials (RCTs) of seven interventions to provide evidence-based insights to inform clinical decision-making.</p><p><strong>Methods: </strong>A systematic search was conducted for all RCTs on drug treatments for vascular stiffness or calcification in patients receiving renal dialysis published between January 2001 and October 2025 in four databases: PubMed, Web of Science, Embase, and The Cochrane Library. Analyses were conducted in accordance with the PRISMA NMA guidelines and registered in PROSPERO (CRD420251060534). Risk assessment was performed using the Cochrane Risk of Bias 2.0 tool. Bayesian network meta-analysis was then conducted using R software and Stata 15.0.</p><p><strong>Results: </strong>Sodium thiosulfate (STS) showed the highest SUCRA ranking for improving pulse wave velocity (PWV) (SUCRA = 89.4%), but no statistically significant difference was observed between STS and standard care (MD -1.3, 95% CrI -2.8, 0.2). No statistically significant differences were observed across all interventions for PWV improvement. Etidronic acid (EA) ranked first in SUCRA for reducing coronary artery calcification (CAC) volume score (SUCRA = 84.57%), but the difference versus most interventions did not reach statistical significance (MD -1300, 95% CrI -3800, 1100). Sodium thiosulfate (STS) showed statistically significant reduction in CAC volume score compared with standard care, 300 mg SNF472, and 600 mg SNF472 (MD -188.27, 95% CrI -221.68, -154.52; MD -192.55, 95% CrI -245.83, -139.54; MD -182.39, 95% CrI -237.91, -126.55). For coronary artery and aortic Agatston scores, standard care showed superior SUCRA rankings, but EA exhibited statistically significant difference compared with cinacalcet (aortic Agatston score: MD -1175.11, 95% CrI -2220.92, -125.45), indicating partial comparative efficacy among drugs.</p><p><strong>Conclusion: </strong>This study suggests that SUCRA rankings indicate STS has a potential comprehensive advantage in improving vascular stiffness and delaying calcification progression, making it a reasonable exploratory choice for dialysis patients with concurrent VC and VS. While EA ranks highest in SUCRA for reducing CAC volume score, it has limited impact on VS and requires caution regarding long-term safety. Given the limited sample size, network sparsity for some outcomes, and mostly non-significant between-group comparisons, large-scale, head-to-head RCTs are needed to further validate these findings.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver-Kidney-Heart Axis in MASLD: Molecular and Cellular Pathways of Renal Injury Associated with Metabolic Hepatic Steatosis. A Narrative Review.","authors":"Jorge Rico Fontalvo, Rodrigo Daza Arnedo, Gregorio Romero-González, Avinash Chandu Nanwani, Alyi A Arellano-Cabeza, Luisa Rodríguez Roseo, Maria Ximena Cardona, Javier Jiménez Quintero, Homero Puello Galarcio, Tomas Rodríguez Yánez, Jose C De La Flor","doi":"10.1159/crm/abtag007","DOIUrl":"https://doi.org/10.1159/crm/abtag007","url":null,"abstract":"<p><strong>Background: </strong>Steatotic liver disease associated with metabolic dysfunction (MASLD) has become the most common chronic liver disease worldwide. The impact of this condition is not limited to liver dysfunction; its relationship with chronic kidney disease (CKD) is significant, as it shares pathophysiological mechanisms and an increased risk of adverse cardiovascular outcomes. In this context, the coexistence of MASLD and CKD does not appear to be solely due to shared risk factors, but rather to convergent biological mechanisms that promote liver injury, as well as glomerular and tubular damage, including insulin resistance, inflammation, lipotoxicity, oxidative stress, neurohormonal activation, and fibrotic progression.</p><p><strong>Summary: </strong>A detailed search was conducted in databases such as ScienceDirect, PubMed, Sage Journals, Nature, and SpringerLink to evaluate literature related to the pathophysiological mechanisms of renal dysfunction in patients with MASLD. This review analyzes the relationship between MASLD and CKD from a clinical perspective, with an emphasis on shared pathophysiological axes.</p><p><strong>Key messages: </strong>MASLD and CKD represent much more than the coexistence of two prevalent diseases; they should be understood as the expression of systemic metabolic dysfunction, in which insulin resistance, chronic low-grade inflammation, lipotoxicity, oxidative stress, neurohormonal activation, and fibrotic progression converge.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1"},"PeriodicalIF":3.2,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}