Cardiorenal Medicine最新文献

{"title":"Long-term impact of peritoneal dialysis ultrafiltration on cardiorenal patients.","authors":"Sara Núñez-Delgado, Maria Antonieta Azancot, Ana Belén Méndez Fernandez, Juan León-Román, Natalia Ramos Terrades, Néstor Toapanta, Ana Sánchez-Escuredo, Jordi Comas, María José Soler","doi":"10.1159/000546924","DOIUrl":"https://doi.org/10.1159/000546924","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) prevalence is increasing, and its prognosis worsens in the presence of other comorbidities. Up to 70% of patients develop cardio-renal syndrome (CRS), which is associated with diuretic resistance or kidney deterioration over time. Peritoneal dialysis (PD) for ultrafiltration (PD-UF) could be a potential therapeutic option in CRS, although its long-term outcomes have not been described.</p><p><strong>Methods: </strong>Retrospective registry study of the Catalan Renal Registry on patients with PD-UF indication between 2013-2022. Baseline clinical characteristics and follow-up until December/2022 was studied.</p><p><strong>Results: </strong>Of the 1874 incident patients on PD,198(10.6%) were PD-UF,73.2% of the patients were male and the mean age was70.7±9.3 years. Median eGFR at start was 22.6 [IQR14.8-32.8] ml/min·1.73m2 and 75.0% have an eGFR above 15 ml/min·1.73m2. Previous history of ischemic heart disease, arrhythmia or cardiac surgery was recorded, 57.6% of patients had ≥2 of these pathologies. The most common HF etiology was ischemic heart disease in 21.7% of patients. Median overall patient survival was 21 months [IQR17.3-24.3]. Technique survival at one year was 94.8%, and 27 patients were transferred to other renal replacement therapy (hemodialysis or kidney transplantation). In the cox multivariate analysis, age>75 years (HR 1.76[95%CI 1.20-2.59]), mild frailty (HR2.18[95%CI 1.17-2.59]), severe frailty (HR 17.62[95%CI 1.20-55.48]) and the burden of cardiac disease (2 categories HR 2.17[95%CI 1.05-4.47]; 3 categories HR 2.26 [95%CI 1.05-4.89]) were associated with poor overall survival. Technique survival was associated with eGFR (<30 ml/min·1.73m2 HR 5.64[95%CI 1.32-24.18]) and body mass index (<20 kg/m2 HR 6.53 [95%CI 1.06-40.12]) at baseline.</p><p><strong>Conclusion: </strong>PD-HF is a feasible option in patients with advanced HF and CRS. The complexity of this population increases with older age, frailty and higher cardiac burden.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-25"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367933","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":"Changes in renal venous flow and liberation from renal replacement therapy in patients with acute heart failure.","authors":"Faeq Husain-Syed, Lisa Vaughan, Pascal Bauer, Khodr Tello, Manuel J Richter, Henning Gall, Rafael De la Espriella, Marta Cobo Marcos, Julio Núñez, Janani Rangaswami, Gregorio Romero-González, Gökhan Yücel, Babak Yazdani, Mitchell H Rosner, Claudio Ronco, Birgit Assmus, Friedrich Grimminger, Hossein Ardeschir Ghofrani, Werner Seeger, Horst-Walter Birk, Kianoush B Kashani","doi":"10.1159/000546851","DOIUrl":"https://doi.org/10.1159/000546851","url":null,"abstract":"<p><p>Introduction In acute heart failure (AHF), the factors associated with successful renal replacement therapy (RRT) discontinuation are largely undefined. We hypothesized that improvements in Doppler-derived renal venous flow (RVF) waveforms may serve as indicators of recovering cardiorenal function associated with successful liberation from RRT. Methods We performed a post hoc analysis of a prospective cohort study involving inpatients with AHF undergoing serial renal Doppler evaluations. Patients who received acute RRT were retained for analysis, with Doppler assessments conducted both before RRT initiation and after discontinuation. Successful RRT discontinuation was defined as RRT cessation without relapse for at least 14 days. Logistic regression was used to evaluate the association between changes in RVF markers-including intra-renal venous flow (IRVF) and the renal venous stasis index (RVSI)-and RRT discontinuation, along with echocardiographic and clinical data from pre- to post-RRT Doppler measurements. Results 10/53 (19%) patients successfully discontinued RRT. Increases in the severity of IRVF patterns and RVSI were negatively associated with RRT discontinuation (IRVF per 1-pattern increase in severity: OR 0.01, 95% CI: <0.001-0.11; P<0.001; RVSI per 0.1-unit increase: OR 0.11, 95% CI: 0.03-0.48; P<0.001). Additionally, improvements in right ventricular function markers, such as the TAPSE/sPAP ratio (per 0.1 mm/mm Hg increase: OR 1.83, 95% CI: 1.03-3.32; P=0.049), were associated with higher odds of RRT discontinuation. Conclusions In AHF patients requiring acute RRT, improvements in RVF were associated with successful RRT discontinuation. Serial RVF assessment may offer a noninvasive means of capturing dynamic changes in cardiorenal syndrome physiology and renal recovery. Larger studies with more frequent and appropriately timed Doppler assessments are needed to determine whether RVF monitoring may guide RRT management in AHF.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-22"},"PeriodicalIF":2.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265317","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":"Systematic review on the management of diuretic resistance in acute heart failure across the spectrum of kidney disease.","authors":"Pedro Marques, Mackenzie Blydt-Hansen, Tomoko Takano, João Pedro Ferreira, Michael A Tsoukas, Abhinav Sharma, Thomas A Mavrakanas","doi":"10.1159/000546520","DOIUrl":"https://doi.org/10.1159/000546520","url":null,"abstract":"<p><strong>Background/aims: </strong>Diuretic resistance is commonly reported in acute heart failure (AHF), especially in patients presenting with impaired kidney function. Effective treatment strategies for promoting decongestion in this population remain unclear.</p><p><strong>Methods: </strong>A systematic review using Medline/Cochrane databases was performed from inception to January 2024 identifying randomized clinical trials (RCTs) including patients with diuretic resistance or at risk of diuretic resistance based on the presence of kidney dysfunction at study enrollment. Trials testing different pharmacological or invasive modalities compared to standard of care, placebo or an active comparator were considered. Data on decongestion related outcomes, safety outcomes and clinical outcomes up to 90 days were collected.</p><p><strong>Results: </strong>Among the 22 RCTs included, 6 trials involved 529 patients with established diuretic resistance, while 16 trials enrolled 1913 patients at risk of diuretic resistance. Diuretic resistance was differently defined across studies and most trials focused on interventions targeting different sites of action along the renal tubules. The different treatment strategies demonstrated efficacy in promoting decongestion while being associated with mild increase in creatinine and cystatin C. The use of appropriately high doses of intravenous loop diuretics was able to promote decongestion across the spectrum of kidney dysfunction. The presence of baseline kidney dysfunction did not identify a population resistant to standard decongestive strategies.</p><p><strong>Conclusions: </strong>Diuretic resistance is not accurately defined in AHF but is uncommon in patients treated with appropriately high doses of intravenous loop diuretics. The main therapeutic goal during the acute setting should focus on promoting decongestion instead of overemphasizing on mild changes in kidney related biomarkers.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-30"},"PeriodicalIF":2.4,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172677","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":"Cardiopulmonary Exercise Testing in Patients with Chronic Kidney Disease.","authors":"Nolan W Groninger, Drake E Dillman, Hunter Stafford, Monique Campos, Andrew R Coggan, Kenneth Lim","doi":"10.1159/000546201","DOIUrl":"https://doi.org/10.1159/000546201","url":null,"abstract":"<p><p>Cardiopulmonary exercise testing (CPET) is an emerging tool in nephrology that has garnished significant interest among clinicians and investigators. The power of CPET technology lies in its ability to accurately assess cardiovascular functional capacity using an integrative approach, to identify multi-organ reserve capacities and interrogate pathophysiological mechanisms underpinning impaired exercise tolerance in patients with Chronic Kidney Disease (CKD). These capabilities provide rationale for accumulating studies exploring the use of this existing technology for new applications in nephrology and to solve current clinical practice barriers. For example, it has the potential to help transform diagnostic approaches to cardiovascular complications in patients with CKD, to offer superior cardiovascular risk stratification and to provide a solution to current limitations of traditional resting endpoints in cardiorenal clinical trial design. This article reviews the foundational principles, methodologic and operational implementation of CPET in patients with CKD and those on dialysis.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-21"},"PeriodicalIF":2.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141270","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":"Early Versus Late Acute Kidney Injury in Patients Undergoing Primary Percutaneous Coronary Intervention.","authors":"Inbal Greenberg, Yacov Shacham, Maayan Konigstein, Shmuel Banai, Jeremy Ben-Shoshan","doi":"10.1159/000546496","DOIUrl":"https://doi.org/10.1159/000546496","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) frequently complicates ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) and is associated with increased short- and long-term mortality. However, the impact of the AKI onset time following PCI on patient outcomes remains uncertain. This study aimed to investigate the timing of post-PCI AKI development and its prognostic significance in STEMI patients.</p><p><strong>Methods: </strong>This retrospective cohort study included 2,912 STEMI patients who underwent successful PCI upon admission. The timing of AKI was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using routine blood tests conducted during hospitalization. The primary endpoint was all-cause mortality.</p><p><strong>Results: </strong>Among 2,912 STEMI patients studied, 222 (7.6%) developed AKI. AKI was classified as early if it occurred within 1.5 days (n=108, 48.6%) or late if it occurred after 1.5 days (n=114, 51.4%). Early AKI was associated with a significantly higher incidence of cardiogenic shock at presentation, lower post-PCI left ventricular ejection fraction, and increased 30-day mortality compared to late AKI. In multivariate Cox regression analysis, early AKI emerged as an independent predictor of long-term mortality (adjusted HR 1.8, 95% CI 1.1-2.8, p=0.015). Additionally, multivariate logistic regression analysis identified cardiogenic shock as a significant predictor of early AKI (adjusted OR 2.3, 95% CI 1.1-4.9, p=0.03).</p><p><strong>Conclusion: </strong>In STEMI patients, early AKI-compared to late AKI-is associated with higher short- and long-term mortality and occurs more frequently in those presenting with cardiogenic shock.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-19"},"PeriodicalIF":2.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093017","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":"Kidney Recovery After Acute Kidney Injury; A comprehensive Review.","authors":"Mehrbod Vakhshoori, Amir Abdipour, Jasjot Bhullar, Melin Narayan, Sergio Infante, Sayna Norouzi, Roy O Mathew","doi":"10.1159/000546156","DOIUrl":"https://doi.org/10.1159/000546156","url":null,"abstract":"<p><p>Acute Kidney Injury (AKI) is a common and critical condition associated with significant morbidity and mortality across various patient populations. The recovery process following AKI is complex and involves a multitude of biological, clinical, and environmental factors. Despite considerable research, there remains substantial debate regarding the exact role and significance of these factors, as well as how they interact with one another. This systematic review aims to examine the currently available evidence on the key factors influencing AKI recovery. We hope to offer a clearer understanding of the complex dynamics in AKI recovery, including where current evidence remains inconclusive or contradictory. This review will provide valuable insights for clinicians and researchers aiming to improve treatment strategies and patient outcomes in AKI recovery.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-19"},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092041","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":"Biomarkers associated with worsening renal function and progression in chronic kidney disease among patients hospitalized for acute heart failure.","authors":"Marcus Andreas Ohlsson, John Molvin, Hannes Holm Isholth, Zainu Nezami, Agne Laucyte-Cibulskiene, Anders Christensson, Amra Jujic, Martin Magnusson","doi":"10.1159/000546236","DOIUrl":"https://doi.org/10.1159/000546236","url":null,"abstract":"<p><strong>Introduction: </strong>Worsening renal function (WRF) is associated with poor prognosis in patients with heart failure (HF). Osteopontin (OPN) and Matrix extracellular phosphoglycoprotein (MEPE) are expressed in the kidneys and are involved in bone mineralization processes. Higher OPN levels have been associated with a higher risk for adverse outcomes in patients with chronic kidney disease (CKD), and MEPE has been shown to promote renal phosphate excretion. Here, we explored if MEPE and OPN are associated with WRF and CKD in patients admitted for acute HF.</p><p><strong>Methods: </strong>WRF was defined as an increase in plasma creatinine of >26.5 mmol/L or 50% higher than admission concentration within 48 hours of admission. OPN and MEPE were analyzed in 315 HF patients at baseline, and in 120 patients at 6-month follow-up. Associations between MEPE and OPN, and a) WRF, b) CKD stage 3-5, and c) markers of kidney function were explored. Further, OPN and MEPE at baseline and at 6 month follow-up (delta (Δ) values) were related to CKD progression.</p><p><strong>Results: </strong>The study population had a mean age of 75 (±12) years and 31% were women. Higher levels of MEPE and OPN were associated with WRF (n=30; OR 2.80 (1.49-5.25); p=0.001, and OR 1.84; (1.05-3.23); p=0.034, respectively)). On admission, both MEPE and OPN were associated with CKD stage 3-5 (OR 5.27; (2.76-10.07); p<0.001, and OR 3.26; (1.90-5.60); p<0.001, respectively)). At 6-month follow-up, progression in CKD stage was associated with ΔMEPE and ΔOPN (HR 2.53; (1.48-4.31); p<0.001, and HR 2.66; (1.51-4.71); p<0.001)).</p><p><strong>Conclusion: </strong>Here, MEPE and OPN are for the first time shown to be independently associated with WRF and subsequent deterioration in CKD in a HF cohort. The mechanisms of these associations are currently largely unknown and need to be investigated further.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-13"},"PeriodicalIF":2.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980686","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":"Cardiorenal benefits of SGLT2 inhibitors in patients with chronic kidney disease and concomitant hypertension.","authors":"Mi Wang, Li Zuo","doi":"10.1159/000545622","DOIUrl":"https://doi.org/10.1159/000545622","url":null,"abstract":"<p><strong>Background: </strong>Uncontrolled hypertension is both a driver of chronic kidney disease (CKD), and a complication of the disease, as well as a risk factor for cardiovascular disease (CVD). Therefore, renal protective agents with anti-hypertensive properties are desirable for management of cardiorenal syndrome in CKD. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are emerging as a new class of renal protective agents, with robust efficacy in delaying progression of CKD and reducing cardiovascular events. Here, we present an overview of SGLT2 inhibitors and discuss the alternative mechanisms contributing to the anti-hypertensive and cardiorenal benefits of SGLT2 inhibitors, with a focus on people with CKD and concomitant hypertension. We also explore the role of SGLT2 as a central node in the pathways underlying these mechanisms.</p><p><strong>Summary: </strong>Beyond its well-known renal benefit, SGLT2 inhibitors have shown blood pressure (BP)-lowering effects in people with CKD, with an average reduction of 3-5 mmHg in systolic BP. Clinical evidence has shown that SGLT2 inhibitors confer cardiorenal protective effects to patients with CKD regardless of diabetes status, and these benefits appear to extend to individuals with hypertensive CKD. The anti-hypertensive effects of SGLT2 inhibitors were also demonstrated in patients with CKD and hypertension. While osmotic diuresis is thought to be a predominant mechanism underlying the anti-hypertensive effects of SGLT2 inhibitors in the CKD population, we believe that the underlying mechanisms are likely to be multifactorial, with alternative pathways also involved, particularly in hypertension-associated CKD.</p><p><strong>Key messages: </strong>Given the rising incidence of hypertension and CKD, the BP-lowering and cardioprotective effects of SGLT2 inhibitors could provide additional value in using this drug class for management of patients with CKD who have hypertension. Further subgroup analyses or larger studies on this specific population will provide more insights into the role of SGLT2 inhibitors in improving cardiorenal outcomes in this setting.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-23"},"PeriodicalIF":2.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983452","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":"Cardiorenal Disease and Heart Failure with Preserved Ejection Fraction: Two Sides of the Same Coin.","authors":"Gonzalo Núñez-Marín, Enrique Santas","doi":"10.1159/000543390","DOIUrl":"10.1159/000543390","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) have a strong pathophysiological interrelationship, and their combination worsens prognosis.</p><p><strong>Summary: </strong>This article briefly reviews the bidirectional epidemiological burden and the pathophysiological interplay between HFpEF and CKD. It also discusses some of the controversial aspects regarding the diagnosis and screening of HFpEF in CKD patients and focuses on the most effective therapeutic approaches to improve symptoms and prognosis in this high-risk population.</p><p><strong>Key messages: </strong>Due to its prevalence and prognostic significance, HFpEF screening should be considered in patients with CKD, with careful use of traditional diagnostic tools in this population. Optimal medical therapy has seen major recent advances in patients with both HFpEF and CKD. SGLT2 inhibitors, finerenone, and semaglutide have consistently demonstrated cardio- and renoprotective effects in both conditions.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"108-121"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Arterial Stiffness, Carbamylation, and Mortality in Patients Undergoing Coronary Angiography with No or Mild Chronic Kidney Disease.","authors":"Clara Daschner, Marcus E Kleber, Ksenija Stach, Goekhan Yuecel, Faeq Husain-Syed, Niklas Ayasse, Anders H Berg, Winfried März, Bernhard K Krämer, Babak Yazdani","doi":"10.1159/000543143","DOIUrl":"10.1159/000543143","url":null,"abstract":"<p><strong>Introduction: </strong>The processes of atherosclerosis, inflammation, and carbamylation are closely linked in cardiovascular (CV) disease, but the potential of carbamylation burden as a CV mortality predictor is unclear, especially in patients with no or mild chronic kidney disease (CKD). This study aimed to investigate whether elevated carbamylated albumin (C-Alb), as a surrogate marker for carbamylation burden, is associated with mortality and arterial stiffness/atherosclerotic burden in patients with no or mild CKD, using pulse pressure (PP) as a marker for arterial stiffness.</p><p><strong>Methods: </strong>We measured C-Alb in 3,193 participants of the Ludwigshafen Risk and Cardiovascular Health study who had been referred for coronary angiography and followed up for 10 years.</p><p><strong>Results: </strong>The mean age was 62.7 years, and 30.4% were female. Mean blood pressure was 141/81 mm Hg, and mean C-Alb was 5.54 mmol/mol. Increase in C-Alb levels was associated with older age; female sex; increased PP, high-sensitivity C-reactive protein, and interleukin-6 levels; and increased incidence of coronary artery disease (CAD), peripheral artery disease (PAD), and carotid stenosis. In contrast, BMI, diastolic blood pressure (DBP), albumin, and the proportion of active smokers decreased with increasing C-Alb levels. In particular, C-Alb showed a highly significant correlation with CAD severity: Friesinger (Pearson correlation coefficient [r] = 0.082, p < 0.001) and Gensini score (r = 0.066, p < 0.001). The area under the curve (AUC) for all-cause mortality prediction by the European Society of Cardiology Heart Score (ESC-HS) significantly improved from 0.719 to 0.735, and the AUC for CV mortality prediction based on C-Alb increased from 0.726 to 0.750 in patients without previously known CV disease. C-Alb correlated directly and significantly with PP (r = 0.062, p < 0.001), which was consistently the strongest predictor of mortality across all C-Alb tertiles. The hazard ratios (HRs) for all-cause mortality per 10 mm Hg increase (or 1,000 mm Hg/min increase for double product [DP]) in the 1st tertile of C-Alb were 1.18, 1.13, 1.11, and 1.11 for PP, mean arterial pressure (MAP), systolic blood pressure (SBP), and DP, respectively, but the HR for DBP did not reach significance. In the 3rd tertile of C-Alb, the HRs were 1.13, 1.05, and 1.09, for PP, SBP, and DP, respectively, but the HR for MAP did not reach significance.</p><p><strong>Conclusion: </strong>C-Alb may be a valuable biomarker for assessing CV risk and improving mortality prediction even in patients with no or mild CKD. The findings support the notion of a crosslink between carbamylation, inflammation, atherosclerosis, and mortality. While these results are promising, further research is needed to fully elucidate the role of C-Alb in CV disease progression and risk stratification.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"83-97"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}