Cardiorenal Medicine最新文献

{"title":"Preventing Cardiovascular-Kidney-Metabolic Syndrome Progression: Pharmacologic Approaches and Pharmacists' Contributions.","authors":"Theresa Nguyen, Lisa Hong, Tomona Iso","doi":"10.1159/000552517","DOIUrl":"10.1159/000552517","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome is a condition reflecting the interactions among metabolic dysfunction, chronic kidney disease (CKD), and cardiovascular disease. It is driven by excess adipose tissue, insulin resistance, inflammation, and vascular and kidney dysfunction, which accelerates the development of hypertension, dyslipidemia, type 2 diabetes, and CKD. Early identification and intervention are critical to prevent progression to advanced cardiovascular and kidney disease; however, optimal interdisciplinary approaches to CKM management are not well established. This narrative review summarizes pharmacotherapeutic strategies to prevent CKM progression for individuals with CKM stages 1 and 2 and the expanding role of pharmacists.</p><p><strong>Summary: </strong>Obesity is a primary driver of CKM syndrome, and early assessment with weight-loss interventions is critical to reduce progression of CKM stages. Management emphasizes lifestyle modification, with pharmacotherapy increasingly used as an adjunct. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide/GLP-1 RAs promote substantial weight loss and provide cardiovascular benefits. Hypertension is an important modifiable risk factor as it contributes to kidney damage and adverse cardiovascular events. Management includes lifestyle modification and antihypertensive therapy with angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), calcium channel blockers, or thiazide diuretics. In patients with albuminuria and CKD, ACEis or ARBs should be prioritized due to their kidney-protective effects. Dyslipidemia contributes to endothelial dysfunction, atherosclerosis, and cardiovascular risk. Statins are first-line therapy, with ezetimibe or PCSK9 inhibitors considered when low-density lipoprotein cholesterol remains above goal despite maximally tolerated statin therapy. Type 2 diabetes and CKD substantially increase the risk of progression to advanced CKM stages. Sodium-glucose cotransporter 2 inhibitors and GLP-1 RAs provide additional cardiovascular and kidney-protective benefits, while ACEis or ARBs remain foundational therapy for slowing CKD progression and reducing CKM risk. Pharmacists play a critical role in early CKM management through medication optimization, patient education, access facilitation, and longitudinal follow-up. Pharmacist-led interventions have been shown to improve blood pressure, lipid levels, glycemic control, weight outcomes, and kidney parameters, supporting prevention of progression to advanced disease stages.</p><p><strong>Key messages: </strong>Pharmacotherapy optimization for cardiometabolic and kidney risk factors during CKM stages 1 and 2 is essential to prevent progression to late stage CKM. Although pharmacists are well positioned to participate in comprehensive CKM management, most previous interventions have focused on isolated d","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"347-356"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926430","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":"Integrated Ultrasound Approach to Fluid Assessment and Nutritional Status in Hemodialysis.","authors":"Jose C De La Flor, Avinash Chandu Nanwani, Celia Rodríguez Tudero, Elena Jiménez Mayor, Irwing R Benites Flores, Juan LLuncor Vásquez, Susan F Alcalde-Ruiz, Hugo J Espinoza-Rojas, Katia Hernández Torres, Patricia Muñoz-Ramos, Gregorio Romero-González, Jesús Angel Hernandez Vaquero","doi":"10.1159/000552121","DOIUrl":"10.1159/000552121","url":null,"abstract":"<p><strong>Introduction: </strong>Fluid overload is a major determinant of morbidity and mortality in maintenance hemodialysis (MHD) patients. This exploratory study describes the integration of lung ultrasound (LUS), modified Venous Excess Ultrasound Score (mVExUS), and bioimpedance analysis (BIA) for non-invasive fluid status assessment in MHD. Additionally, this study aimed to correlate congestion with malnutrition using echographic parameters (nutritional ultrasound [NUS]) in congestive and non-congestive patients.</p><p><strong>Methods: </strong>In this single-center retrospective observational cohort study, 47 adult patients on MHD underwent pre-dialysis evaluation with LUS, mVExUS, NUS, and BIA. Patients were classified as congestive if they had an mVExUS score ≥2, LUS with ≥3 B-lines in ≥3 thoracic zones and BIA with the ratio of extracellular water to total body water ECW/TBW ≥0.39. NUS was used to assess the quadriceps rectus femoris (QRF) and preperitoneal visceral fat (PPVF), measuring Y-axis, Y-axis/height, cross-sectional muscle area rectus femoris (CS-MARF), and supramuscular fat (SMF). Demographic, biochemical, functional, and dialysis-related parameters were collected. Frailty, sarcopenia and nutritional status were evaluated. Congestive patients were reassessed after 5 weeks.</p><p><strong>Results: </strong>Eight patients (17%) met criteria for congestion. As expected by the predefined congestion criteria, patients classified as congestive showed higher mVExUS grades (p < 0.001), greater B-line burden (11.9 vs. 2.9), and higher ECW/TBW ratios (0.42 vs. 0.40; p = 0.004). After 5 weeks, congestive patients exhibited improvements in N-terminal pro-B-type natriuretic peptide (NT-proBNP), portal vein pulsatility index, and pulmonary congestion, without adverse hemodynamic events. The CS-MARF was 1.81 ± 0.11 cm2 in congestive versus 2.91 ± 0.78 cm2 in non-congestive (p = 0.0004).</p><p><strong>Conclusion: </strong>The integration of LUS, mVExUS, BIA and NUS provide a descriptive framework for multimodal assessment of fluid and nutritional status in MHD patients. These findings should be considered hypothesis-generating and require validation in prospective studies.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"301-310"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728413","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":"Divergent Role of Statin Use and Intensity in Patients Undergoing Transcatheter Aortic Valve Replacement.","authors":"Haitham Abu Khadija, Alena Kirzhner, Nizar Abu Hamdeh, Gera Gandelman, Omar Ayyad, Lilian Jofa, Amir Haim, Ramon Cohen, Alex Blatt, Adam Hassan, Ameer Mahamid, Duha Najajra, Muhammad Nasser, Yazan Hamdan, Tal Schiller, Mohammad Masu Apos D, Jacob George, Mohammad Alnees","doi":"10.1159/000551694","DOIUrl":"10.1159/000551694","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) and reduced glomerular filtration rate (GFR) are common complications following transcatheter aortic valve replacement (TAVR). Statins may exert renoprotective effects; however, the impact of statin intensity on renal outcomes remains uncertain. This study aimed to evaluate the association between preprocedural statin use and intensity with short-term renal outcomes after TAVR.</p><p><strong>Methods: </strong>We conducted a retrospective longitudinal cohort study including 810 consecutive patients undergoing TAVR at Kaplan Medical Center between January 2014 and August 2024. Patients were stratified by statin use (users vs. non-users) and statin intensity (high-intensity statins [HISs] vs. low-to-moderate-intensity statins). The primary outcome was 30-day change in estimated GFR (eGFR), categorized as improved, stable, or deteriorated. The secondary outcome was 30-day incidence of AKI. Multinomial logistic regression and Cox proportional hazards models were used, adjusted for baseline and procedural confounders.</p><p><strong>Results: </strong>Statin use was associated with an increased probability of GFR improvement (average marginal effect [AME], 20.7%; 95% CI, 12.3%-29.1%; p < 0.001) and a reduced risk of AKI (adjusted hazard ratio [HR], 0.53; 95% CI, 0.31-0.88; p = 0.015). In contrast, HIS therapy was associated with a higher risk of GFR deterioration (AME, 10.3%; 95% CI, 2.9%-17.8%; p = 0.006) and increased AKI incidence (adjusted HR, 2.85; 95% CI, 1.52-5.34; p = 0.001), particularly in the early postoperative period.</p><p><strong>Conclusion: </strong>Statin therapy is associated with improved short-term renal outcomes after TAVR. However, HISs may increase the risk of renal deterioration and AKI. These findings support individualized statin intensity strategies in the periprocedural period to balance cardiovascular benefit and renal safety.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"374-392"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175515","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 Cardiovascular-Kidney-Metabolic Syndrome and Depressive Symptoms in Middle-Aged and Older Chinese Adults: A Cross-Sectional and Longitudinal Analysis.","authors":"Wenjin Pei, Jinhao Shi, Chenyi Liu, Lu Chen, Yonghan Liu, Jialiang Hui, Siyuan Ma","doi":"10.1159/000552261","DOIUrl":"10.1159/000552261","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome and depressive disorder represent major public health burdens. While associations between depression and individual components of CKM syndrome have been established, the relationship between depression and CKM syndrome as an integrated clinical construct remains poorly understood.</p><p><strong>Methods: </strong>Data from the China Health and Retirement Longitudinal Study (CHARLS) were used, including 8,088 participants in cross-sectional analyses and 1,803 in longitudinal analyses. CKM syndrome was classified according to the American Heart Association (AHA) staging criteria, and depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The association between CKM stage and depressive symptoms was evaluated using ordinary least squares regression models with five levels of covariate adjustment. Subgroup analyses and interaction tests were conducted to investigate interaction effects across different populations.</p><p><strong>Results: </strong>Higher CKM stages were significantly associated with increased depressive symptom severity. In the cross-sectional analysis (2011), mean CES-D-10 scores were 8.6 ± 6.4, 8.6 ± 6.3, 8.1 ± 6.2, and 10.7 ± 6.9 for the total population and CKM stages 0-1, 2-3, and 4, respectively. Scores in stage 4 exceeded the threshold for severe depressive symptoms and were significantly higher than those in other stages (p < 0.001). Subgroup analyses further confirmed the robustness of these findings. In longitudinal analyses, progression in CKM stage over a 4-year period was independently associated with an increase in CES-D-10 scores in the fully adjusted model (β = 0.31, 95% CI: 0.07-0.54).</p><p><strong>Conclusions: </strong>CKM syndrome is significantly associated with depressive symptoms, especially in stage 4. There is a positive relationship between CKM progression and depressive symptom severity, highlighting the need for integrated physical and mental health care for CKM patients.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"424-433"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374769","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":"Indexed Neutrophil Gelatinase-Associated Lipocalin: Improving Prediction and Ruling Out of Contrast-Induced Nephropathy.","authors":"Shafik Khoury, Shir Frydman, Moran Gvili Perlman, Shmuel Banai, Haytham Abu Katash, Yacov Shacham","doi":"10.1159/000550837","DOIUrl":"10.1159/000550837","url":null,"abstract":"<p><strong>Background: </strong>The risk for contrast-induced acute kidney injury (CI-AKI) following cardiac procedures involving contrast administration is particularly high among chronic kidney disease (CKD) patients. Neutrophil gelatinase-associated lipocalin (NGAL) has been widely studied as an early marker for renal injury. However, CKD could impact NGAL levels and alter their predictive performance. This study aimed to evaluate a novel baseline \"indexed NGAL\" (I-NGAL), calculated by adjusting NGAL to the estimated glomerular filtration rate (eGFR), for the prediction of CI-AKI in CKD patients undergoing elective transcatheter aortic valve replacement (TAVR).</p><p><strong>Methods: </strong>A total of 134 CKD patients undergoing elective TAVR were included. Serum NGAL levels were drawn at hospital admission. Patients were followed for the occurrence of CI-AKI. Receiver-operator characteristic methods were used to identify optimal sensitivity and specificity for I-NGAL. Univariate and multivariate binary logistic regression models were used to assess I-NGAL predictive performance.</p><p><strong>Results: </strong>Overall, 35/134 patients (26%) developed CI-AKI following TAVR; both NGAL and I-NGAL were significantly higher among patients having CI-AKI. I-NGAL results had a higher predictive ability than unindexed NGAL results (AUC of 0.83 vs. 0.78, p < 0.001). The optimal I-NGAL cutoff for prediction of CI-AKI was 4, with a sensitivity of 71%, a specificity of 77%, and a negative predictive value of 88%. In a multivariate logistic regression model, I-NGAL was independently associated with CI-AKI (OR 1.22, 95% CI: 1.05-1.41; p = 0.007). I-NGAL level >4 was also independently associated with CI-AKI (OR 8.13, 95% CI 3-21.8, p < 0.001).</p><p><strong>Conclusion: </strong>Among CKD patients undergoing elective TAVR, adjusting baseline NGAL values according to eGFR yields an I-NGAL that serves as an improved tool for predicting and ruling out CI-AKI, regardless of baseline renal function.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"80-86"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13008385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112012","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 Percutaneous Coronary Intervention and Long-Term Clinical Outcomes in Patients with Chronic Kidney Disease and Acute Myocardial Infarction.","authors":"Jing Zhou, Junjuan Li, Yan Xu, Ru Wang, Liufu Cui, Qing Yang, Shouling Wu, Xin Zhou","doi":"10.1159/000553263","DOIUrl":"10.1159/000553263","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic kidney disease (CKD) are at a high risk of adverse outcomes after acute myocardial infarction (AMI); however, evidence on long-term outcomes after percutaneous coronary intervention (PCI) in this population remains limited.</p><p><strong>Methods: </strong>This prospective cohort study, nested within the Kailuan Study, included patients with CKD who experienced AMI between 2006 and 2020. Participants were classified into PCI and non-PCI groups based on documented PCI receipt and were matched 1:2 on age and sex (452 PCI; 745 non-PCI). Follow-up began at the time of AMI diagnosis or PCI and continued until December 31, 2023. The primary outcome was all-cause mortality, with secondary outcomes being new-onset heart failure and CKD progression. Time-segmented Cox models were used for all-cause mortality, and standard Cox models were used for secondary outcomes.</p><p><strong>Results: </strong>During follow-up, PCI receipt was associated with a lower risk of all-cause mortality compared with no PCI. The association was stronger during the first 5 years of follow-up (hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.24-0.47) and was attenuated thereafter (HR, 0.73; 95% CI, 0.51-1.04). No significant associations were observed between PCI receipt and either new-onset heart failure (HR, 1.06; 95% CI, 0.72-1.57) or CKD progression (HR, 1.11; 95% CI, 0.72-1.71).</p><p><strong>Conclusion: </strong>In patients with CKD and AMI, PCI was associated with lower all-cause mortality during the first 5 years of follow-up, with no significant differences in new-onset heart failure or CKD progression.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"461-473"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315905","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":"Predicting Stroke Incidence Using Estimated Glucose Disposal Rate Index in the Population with Cardiovascular-Kidney-Metabolic Syndrome Stage 0-3 in the Chinese Middle-Aged and Elderly Population.","authors":"Qian Lu, Jiaxin Shao, Jijie Jin, Fei Wang, Zhenyang Cao, Qianrong Zheng, Shengzhang Chen, Jianghua Zhou, Hao Zhou, Changxi Chen","doi":"10.1159/000549744","DOIUrl":"10.1159/000549744","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a leading cause of death and disability worldwide. Although individuals in cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 have not yet experienced overt clinical events such as stroke, mounting evidence suggests that these stages often involve subclinical metabolic and vascular injury. Insulin resistance (IR), a hallmark of CKM syndrome, contributes to cerebrovascular injury via mechanisms such as inflammation, oxidative stress, and endothelial dysfunction. The estimated glucose disposal rate (eGDR), a noninvasive index of IR, has shown cardiovascular prognostic value, yet its utility in predicting stroke across early CKM stages remains unclear.</p><p><strong>Methods: </strong>This study analyzed 4,065 participants from the China Health and Retirement Longitudinal Study (CHARLS) classified as CKM stages 0-3. The eGDR was computed using waist circumference, HbA1c, and hypertension status. K-means clustering identified four longitudinal eGDR changes. Restricted cubic spline (RCS) models were used to determine stage-specific eGDR thresholds for stroke prediction. Cox regression assessed associations between baseline, cumulative, and dynamic eGDR with stroke incidence, while subgroup analyses also employed.</p><p><strong>Results: </strong>During follow-up, 383 incident stroke cases were observed. Lower baseline and cumulative eGDR levels were independently associated with higher stroke risk. Participants with persistently low or sharply declining eGDR group exhibited more than double the stroke risk compared to those with stable high eGDR. The RCS analysis confirmed a linear inverse association between cumulative eGDR and stroke in CKM stages 2-3 and identified optimal thresholds that maximized sensitivity and specificity. Notably, stage 2 presented the lowest threshold (7.41), potentially reflecting a critical tipping point where metabolic burden exceeds vascular compensation.</p><p><strong>Conclusion: </strong>eGDR is a clinically relevant predictor of stroke in asymptomatic individuals with CKM syndrome. The application of stage-specific thresholds enhances the precision of early risk stratification and highlights the need for tailored surveillance strategies. These findings suggest the potential value of eGDR monitoring as a practical tool for early risk stratification in metabolically at-risk populations.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"1-13"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647322","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":"The Role of Inflammation and High-Sensitivity C-Reactive Protein in Atherosclerotic Cardiovascular Disease and Chronic Kidney Disease: The FLAME-ASCVD Survey among Nephrologists.","authors":"Vlado Perkovic, David Cherney, Edmundo Erazo-Tapia, Sofia Gerward, Sandra Waechter, Manisha Sahay, Nikolaus Marx","doi":"10.1159/000550094","DOIUrl":"10.1159/000550094","url":null,"abstract":"<p><strong>Background: </strong>Systemic inflammation (SI) contributes to increased cardiovascular risk in patients with atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD). We assessed clinical perceptions toward SI and usage of high-sensitivity C-reactive protein (hsCRP) among nephrologists.</p><p><strong>Methods: </strong>FLAME-ASCVD Nephro was an online survey of nephrologists from 10 countries who treat ≥20 patients with ASCVD and CKD a month and were practicing for ≥3 years. Results were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Of 513 nephrologists who responded, 300 completed and were included in the survey; the mean age was 46 years and the mean time in practice was 16 years. Hypertension (89%), overweight/obesity (81%), and CKD (80%) were the ASCVD risk factors most often discussed with patients (SI was ninth). The most common unmet needs (ranked 1-3) for patients with ASCVD and CKD were \"lack of effective SI treatment options\" (44%), \"limited awareness of the role of SI in ASCVD\" (35%), and \"higher risk of CV events\" (33%). Seventy-four percent of nephrologists wanted to learn more about the role of SI in ASCVD and 71% test for and use SI results when determining management approaches. Seventy percent of nephrologists considered hsCRP testing in patients with ASCVD and CKD (aided), and proven clinical efficacy of hsCRP was the top reason (37%); out-of-pocket cost (30%) was the most common reason for not considering hsCRP testing.</p><p><strong>Conclusion: </strong>Lack of effective treatment options for SI remains the most common unmet need for patients with ASCVD and CKD. Further medical education is needed to raise awareness among nephrologists about the role of SI and hsCRP testing.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"14-24"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773550","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":"Potential Mechanisms of Sodium-Glucose Cotransporter 2 Inhibitors in Regulating Cardiac and Renal Fibrosis.","authors":"Wei Huang, Tianxiang Guan, Ziyou Yan, Yuanwu Cui, Shanrong Bi, Mingxia Wu, Dongkai Yuan","doi":"10.1159/000551330","DOIUrl":"10.1159/000551330","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of agents initially developed for glycemic control in type 2 diabetes mellitus. Beyond their glucose-lowering effects, accumulating clinical evidence has demonstrated significant cardiorenal protective benefits in patients with chronic kidney disease (CKD), irrespective of diabetic status. Cardiac and renal fibrosis are central pathological processes contributing to CKD progression and cardiovascular dysfunction. However, the mechanisms underlying the anti-fibrotic effects of SGLT2 inhibitors remain incompletely understood.</p><p><strong>Summary: </strong>This review summarizes current experimental and clinical evidence regarding the role of SGLT2 inhibitors in modulating cardiac and renal fibrosis. We discuss their potential mechanisms, including hemodynamic regulation, metabolic reprogramming, attenuation of oxidative stress and inflammation, inhibition of pro-fibrotic signaling pathways, and modulation of cellular crosstalk within the cardiorenal axis. Emerging insights from molecular and translational studies are integrated to clarify how SGLT2 inhibitors may exert anti-fibrotic effects beyond glycemic control.</p><p><strong>Key messages: </strong>SGLT2 inhibitors confer cardiorenal protection that extends beyond glucose lowering and involves multifaceted anti-fibrotic mechanisms. Understanding these molecular and cellular pathways may provide new therapeutic perspectives for targeting fibrosis in CKD and cardiovascular disease.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"220-236"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13258248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940387","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":"Clinical Outcomes of Ticagrelor versus Clopidogrel in Patients with Chronic Kidney Disease and Acute Myocardial Infarction: A Real-World Cohort Study.","authors":"Wei-Chiao Sun, Hsin-Fu Lee, Chihung Lin, Shu-Chun Huang, Jia-Jin Chen, Wen-Yu Ho, Chieh-Li Yen, Ching-Chung Hsiao","doi":"10.1159/000550521","DOIUrl":"10.1159/000550521","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) is a major risk factor for cardiovascular morbidity and mortality, particularly in patients with acute myocardial infarction (AMI). Dual antiplatelet therapy is essential for secondary prevention in AMI, but the optimal P2Y12 inhibitor in CKD patients remains unclear. While ticagrelor has demonstrated superior cardiovascular outcomes compared to clopidogrel in the general population, its safety and efficacy in advanced CKD are not well established.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from the Chang Gung Research Database (CGRD) to compare ticagrelor and clopidogrel in CKD stage III-V patients hospitalized with AMI between 2001 and 2020. Inverse probability of treatment weighting was applied to balance baseline characteristics. Clinical outcomes, including recurrent AMI, ischemic stroke, cardiovascular death, major bleeding events, and all-cause mortality, were evaluated using Cox proportional hazards models and competing risk analysis.</p><p><strong>Results: </strong>Among 3,461 patients (ticagrelor: 704, clopidogrel: 2,757), ticagrelor was associated with a significantly lower risk of all-cause mortality (HR 0.694, 95% CI 0.539-0.894, p = 0.047), with no significant differences in recurrent AMI, ischemic stroke, cardiovascular death, or major bleeding events.</p><p><strong>Conclusions: </strong>In CKD patients with AMI, ticagrelor was associated with reduced all-cause mortality compared to clopidogrel, without an increased risk of major bleeding. These findings highlight the need for further prospective studies to confirm ticagrelor's benefits and inform optimal antiplatelet strategies in this high-risk population.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"58-67"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028326","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}