Cardiorenal Medicine最新文献

{"title":"Association of Persistent Organic Pollutants Polychlorinated Biphenyls and Dioxins with Cardiovascular-Kidney-Metabolic Syndrome and Its Prognosis: A Nationally Representative Study.","authors":"Wen Chen, Debin Chen, Yining Li, Yizhou Zhuang, Yaojie Wang, Youlan Chen, Yongju Ye, Qijun Zhang, Jianhui Zhao","doi":"10.1159/000551670","DOIUrl":"10.1159/000551670","url":null,"abstract":"<p><strong>Background: </strong>Persistent organic pollutants (POPs) may be risk factors for the development and progression of cardiovascular-kidney-metabolic (CKM) syndrome. This study aimed to evaluate the effects of polychlorinated biphenyls (PCBs) and dioxins on CKM syndrome, as well as the mediating role of inflammatory cells in these associations.</p><p><strong>Methods: </strong>Data on PCB- and dioxin-like compound exposure and CKM syndrome were obtained from the National Health and Nutrition Examination Survey 2005-2012. We applied multivariable logistic regression, weighted quantile sum regression, quantile g-computation, and subgroup analyses to assess the individual and combined health effects of PCBs and dioxin-like compounds on CKM syndrome. Mediation analyses evaluated the role of inflammatory cells in the relationship between these pollutants and CKM syndrome. Cox proportional hazards regression was performed to explore the impact of PCB and dioxin exposure on mortality risk among patients at different CKM syndrome stages.</p><p><strong>Results: </strong>Exposure to PCB138, PCB153, PCB180, 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin (hexa-CDDs), and 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin (hepta-CDDs) was associated with increased risk of advanced CKM syndrome by approximately 4%, 3%, 3%,3%, and 2%, respectively. In the mixture effect analysis, a combination of PCBs and dioxins was found to synergistically increase the risk of advanced CKM syndrome. Weighted quantile sum regression identified 1,2,3,4,6,7,8-heptachlorodibenzofuran (HXCDF) as the most significant contributor to this increased risk. Furthermore, white blood cells, lymphocytes, and neutrophils mediated the associations between PCBs, dioxin-like compounds, and advanced CKM syndrome, with mediation proportions ranging from 1.77% to 3.95%. Exposure to PCBs (except HXCDF) and dioxins was associated with increased mortality risk in CKM stage 0-2 patients, while exposure to hexa-CDDs was associated with increased all-cause mortality risk in CKM stage 3-4 patients.</p><p><strong>Conclusion: </strong>Exposure to PCBs and dioxin-like compounds increases the risk of advanced CKM syndrome and mortality across different CKM syndrome stages. Inflammatory cells play a mediating role in the relationship between these pollutants and advanced CKM syndrome.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"271-287"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688425","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":"Functional Mitral Regurgitation following Successful Living Donor Kidney Transplant: The VINTAGE Study.","authors":"Sumi Hidaka, Mizuki Yamano, Yasuhiro Mochida, Kazunari Tanabe, Shuzo Kobayashi","doi":"10.1159/000551778","DOIUrl":"10.1159/000551778","url":null,"abstract":"<p><strong>Introduction: </strong>Functional mitral regurgitation (FMR) is prevalent in CKD patients, but few studies have evaluated the effect of kidney transplant (KT) on FMR. This study aimed to clarify KT's effect on FMR.</p><p><strong>Methods: </strong>This study included 115 living-donor KT recipients (2012-2023). Primary outcome was change in FMR severity (5 categories: none to severe) based on echocardiographic findings before and 1 year post-KT. Aortic regurgitation (AR) severity and changes in left atrial diameter (LAD), left ventricular end-diastolic dimension (LVDd), ANP, and BNP levels were also assessed. Change in FMR and AR severity was assessed using Wilcoxon signed-rank tests. Multivariable logistic regression models were used to identify factors associated with the worsening of FMR and AR.</p><p><strong>Results: </strong>At baseline, 76.5% had trivial FMR; 22.6% had mild/moderate/severe FMR. One year post-KT, moderate/severe FMR disappeared. Overall, FMR improved in 19.1%, remained unchanged in 73.1%, and worsened in 7.8%. FMR severity distribution significantly changed (p = 0.004). Reductions in LAD/LVDd aligned with decreased ANP/BNP. Multivariable analysis identified acute ABMR as an independent factor for worsening FMR (OR = 4.02, 95% CI: 1.81-8.91, p < 0.001). No significant AR improvement was observed (p = 0.377). A history of arrhythmia (OR = 2.68, 95% CI: 1.28-5.64, p = 0.009) and stroke (OR = 2.27, 95% CI: 1.12-4.59, p = 0.023) were identified as an independent factor for worsening AR.</p><p><strong>Conclusion: </strong>KT is associated with an improvement in FMR among patients with kidney failure. This is likely due to LA/LV reverse remodeling from reduced volume/pressure overload. However, this benefit may diminish with graft dysfunction (e.g., acute rejection). Conversely, KT is not associated with an improvement in AR. Our findings highlight another important cardioprotective benefit of successful KT. Further prospective studies are needed to better understand this association.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"288-300"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590230","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":"Albuminuria and Acute Heart Failure: A New Biomarker for Congestion and Follow-Up?","authors":"Mario Galván-Ruiz, Patricia Nogueira-Salgueiro, Belén Rojas-Escrivá, María Del Val Groba-Marco, Miguel Fernández-de-Sanmamed-Girón, Jesús María González-Martín, Jonathan Déniz-Rosario, Daesub Chung-Kwon, Marco Antonio Suarez-Benítez, Elvira Martín-Bou, Sara Aladro-Escribano, Juan Carlos Quevedo-Reina, Ruth Martín-Alfaro, Casimira Domínguez-Cabrera, Eduardo Caballero-Dorta, Antonio García-Quintana, Alicia Conde-Martel","doi":"10.1159/000551740","DOIUrl":"10.1159/000551740","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated the trajectory of the urine albumin-to-creatinine ratio (UACR) in patients hospitalized with acute heart failure (HF) from pre-admission (baseline), through hospital admission, discharge and 2 weeks post-discharge. We also assessed its association with congestion-related biomarkers, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), CA 125, and the neutrophil-to-lymphocyte (N/L) ratio.</p><p><strong>Methods: </strong>Prospective, observational study including 99 consecutive patients admitted with acute HF. Blood and urine analyses were performed at admission, at discharge and 2 weeks post-discharge. Patients were stratified according to UACR at admission and the trajectories of UACR and biomarkers were evaluated. The clinical, analytical, and echocardiographic predictors of UACR were analysed.</p><p><strong>Results: </strong>Mean age was 70.8 ± 12.2 years, 57% were men. At admission, albuminuria was present in 65.7% of patients (45.5% microalbuminuria, 20.2% macroalbuminuria, respectively). A higher UACR at admission was associated with diabetes, lower eGFR, previous HF admission, higher clinical congestion score, mixed or right-sided congestive phenotype, higher NT-proBNP, and CA 125 levels. The UACR worsened from baseline to admission and improved at discharge, reflecting the congestion dynamics. NT-proBNP, CA 125, and N/L ratio showed similar patterns. Independent predictors of higher UACR at admission were diabetes, reduced renal function, higher aspartate aminotransferase (AST) and lower vitamin D levels. In the mixed linear regression analysis, lower eGFR, and higher AST levels remained independently associated with UACR trajectory. Admission UACR correlated with congestion score and predicted higher in-hospital mortality and early HF readmissions (<30 days).</p><p><strong>Conclusion: </strong>Albuminuria is common in acute HF and exhibits a dynamic change in relation to congestion. These findings suggest a potential role as a biomarker for congestion monitoring. However, given the study limitations, the results should be considered exploratory and warrant confirmation in larger prospective studies.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"258-270"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607939","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":"Pan-Immune-Inflammatory Value as a Systemic Inflammation Marker Associated with Cardiovascular-Kidney-Metabolic Syndrome: Evidence from a Cross-Sectional Study of 751 Patients.","authors":"Qing Li, Jiaqi Lu, Xinyi Dong, Fang Liu, Wei Nie, Zhifeng Dong","doi":"10.1159/000551234","DOIUrl":"10.1159/000551234","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Cardiovascular-kidney-metabolic (CKM) syndrome is associated with a high risk of renal insufficiency and cardiovascular events, with chronic inflammation being a critical factor in its pathogenesis. The pan-immune-inflammatory value (PIV), a novel systemic inflammatory marker that synthesizes data from various immune cell counts, and its relationship with CKM have not yet been elucidated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 751 patients were recruited. The relationship between PIV and CKM was investigated. The trends in CKM prevalence across PIV quartiles were assessed using trend tests. To identify associations within specific subpopulations, subgroup analysis and interaction tests were performed. To construct a prediction model, feature selection was performed using least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression. A nomogram was constructed for visualization. Predictive performance was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis. The study was designed, executed, and reported in strict accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A fully completed STROBE checklist, with line-by-line cross-references to the corresponding sections of the manuscript, is provided as online supplementary Table 3 (for all online suppl. material, see &lt;ext-link ext-link-type=\"doi\" xlink:href=\"https://doi.org/10.1159/000551234\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"&gt;https://doi.org/10.1159/000551234&lt;/ext-link&gt;) to ensure maximal transparency and reproducibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median PIV was significantly higher in the CKM stage 4 group than in the stage 2-3 group (449.91 vs. 210.66, p &lt; 0.001). Subsequent to full adjustments, each 1-unit increase in PIV associated with a 26% higher odds of stage 4 CKM (OR = 1.26, 95% CI: 1.17-1.36, p &lt; 0.001), with a dose-response relationship (P for trend &lt; 0.001). Subgroup analysis demonstrated that the association was stronger among patients younger than 60 years compared with those aged ≥60 years (OR = 1.50 vs. 1.19), suggesting that PIV may have greater predictive value in younger individuals. Based on LASSO regression for feature selection, a multivariable CKM prediction model was developed, incorporating PIV as the principal independent predictor, and achieved an area under the curve of 0.797 (95% CI: 0.760-0.833). The model exhibited good discrimination and calibration performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study indicates that elevated PIV levels are independently associated with a higher likelihood of advanced (stage 4) CKM. The predictive model demonstrates that PIV, when combined with other readily available clinical variables, is strongly associated with CKM severity, suggesting that PIV may serve as a valuable marker for risk stratification in patients with CKM.&lt;/","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"159-178"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389572","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":"Multimodal Detection of Subclinical Cardiovascular Disease in Chronic Kidney Disease.","authors":"Inhae Baek, Purvi Parwani, Safwan Gaznabi, Dmitry Abramov, Anas Alani","doi":"10.1159/crm/abtag004","DOIUrl":"10.1159/crm/abtag004","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is the leading cause of mortality among individuals with chronic kidney disease (CKD) and is driven by chronic inflammation, oxidative stress, vascular calcification, accumulation of uremic toxins, ventricular remodeling, and microvascular dysfunction. Subclinical CVD is highly prevalent in CKD and often remains unrecognized until advanced stages, contributing to delayed intervention and increased mortality.</p><p><strong>Summary: </strong>Early detection of subclinical CVD in CKD is critical to prevent disease progression and reduce adverse outcomes. Advances in noninvasive imaging modalities - including echocardiography, coronary computed tomography angiography, coronary artery calcium (CAC) scoring, and cardiac magnetic resonance imaging - enable sensitive identification of early cardiac and vascular abnormalities. In parallel, circulating and urinary biomarkers such as C-reactive protein, high-sensitivity troponin (hsT), N-terminal pro-brain natriuretic peptide, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), fibroblast growth factor-23, and urine albumin-to-creatinine ratio provide insight into underlying pathophysiological mechanisms and support risk stratification and personalized management.</p><p><strong>Key messages: </strong>Subclinical CVD is common yet underdiagnosed in CKD, necessitating improved screening strategies. Integration of advanced imaging techniques with biomarker profiling offers a promising approach for early detection and individualized care. Continued innovation and implementation of these tools are essential to closing the cardiovascular mortality gap in this high-risk population.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"513-524"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863740","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":"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":"10.1159/crm/abtag012","url":null,"abstract":"","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"536-540"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682701/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.1159/000552924","DOIUrl":"10.1159/000552924","url":null,"abstract":"<p><p>In the article \"Heart Failure and Comorbidities (Chronic Kidney Disease, Diabetes, Obesity) Management: A Multidisciplinary Approach\" [Cardiorenal Med. 2026;16(1):95-112; https://doi.org/10.1159/000550503] by Abramov et al., the authors noted there were errors in the citations in the published version.Under \"Adherence\" in the sentence \"The primary factors contributing to nonadherence include complicated medication regimes, undesirable side effects, polypharmacy, and financial burdens,\" citations 80 and 81 should be removed.In the section \"Provider-Level Barriers: Knowledge Gaps and Treatment Biases,\" the text \"Prior surveys have demonstrated that patients often do not receive optimal therapies despite physicians reporting to be adherent to the guidelines due to provider-related causes [92]\" should read \"Prior surveys have demonstrated that patients often do not receive optimal therapies despite physicians reporting to be adherent to the guidelines due to provider-related causes [124].\"These citation errors occurred during the revision and editing process following peer review. While restructuring sections and revising the manuscript to address reviewer comments, several citations were inadvertently misplaced or altered.To ensure accuracy, all references and corresponding in-text citations were subsequently rechecked against the original source material, all DOIs were verified, and citation numbering was confirmed against the final reference list.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":"16 1","pages":"311"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359682","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":"Intra-Dialytic Hypotension and the VExUS Assessment in Hospitalized Patients: A Prospective Cohort Study.","authors":"Rose Joyal, Josiane Proulx, Michel Gouin, Karel Huard, Lawrence Ledoux-Hutchinson, Sophie Gilbert, Emmanuel Charbonney, André Denault, William Beaubien-Souligny","doi":"10.1159/000551739","DOIUrl":"10.1159/000551739","url":null,"abstract":"<p><strong>Introduction: </strong>Predicting tolerance to fluid removal is particularly challenging in hospitalized, acutely ill patients. This study evaluated the association between the Venous Excess Ultrasound (VExUS) and IDHE in hospitalized patients.</p><p><strong>Methods: </strong>This single-center prospective cohort included hospitalized between 2022 and 2024 receiving hemodialysis. Ultrasound of the inferior vena cava (IVC), hepatic, portal, and femoral veins was performed. Patients were classified into four VExUS grades (0 to 3) based on IVC dimensions and venous Doppler waveforms. Follow-up at 3 months was conducted to evaluate outcomes across the different groups.</p><p><strong>Results: </strong>The cohort consisted of 93 patients. VExUS grading showed grade 0 in 52 patients (55.9%), grade 1 in 22 patients (23.7%), grade 2 in 11 patients (11.8%), and grade 3 in 8 patients (8.6%). The incidence of IDHE was tended to be higher in VExUS grade 0 (40.4%) and VExUS grade 3 (50.0%) patients compared with VExUS grade 1 (18.2%) or 2 (18.2%) (p = 0.145). The cumulative duration of hypotension (sBP <90 mm Hg) differed between VExUS groups (p = 0.03), with VExUS grade 3 patients experiencing longer median duration of hypotension compared to participants with a VExUS grade 1 (16.4 [0; 47.5] vs. 0 [0; 0] min, p = 0.04).</p><p><strong>Conclusion: </strong>Our findings showed a trend toward more frequent IDHE in both VExUS grade 0 and grade 3, with grade 3 patients experiencing a significantly longer cumulative duration of hypotension. High VExUS scores may identify patients at increased risk of hypotension due to impaired hemodynamic adaptability.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"248-257"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615918","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":"Chronic Kidney Disease, Circulating Ceramides, and Coronary Microvascular Dysfunction: Insights from the CRUISE-MET Study.","authors":"Qiang Chen, Xuexi Li, Yingying Xie, Yike Li, Zhaoxue Sheng, Wuqiang Che, Shuoyan An, Sunjing Fu, Lining He, Cui Fang, Wenjun Dong, Jingang Zheng, Yanxiang Gao","doi":"10.1159/000552268","DOIUrl":"10.1159/000552268","url":null,"abstract":"<p><strong>Introduction: </strong>Ceramides and chronic kidney disease (CKD) independently associate with coronary microvascular dysfunction (CMD), but their combined association remains unestablished, warranting investigation.</p><p><strong>Methods: </strong>This cross-sectional analysis included coronary artery disease (CAD) patients from the CRUISE-MET trial (NCT06383208) who underwent coronary angiography and ceramide profiling measurement. The microvascular resistance was assessed in all patients using the angiography-derived microcirculatory resistance (AMR). CKD was classified based on both estimated glomerular filtration rate and urine albumin-to-creatinine ratio. The combined associations and statistical mediation of ceramides and renal dysfunction on CMD was examined, with sensitivity analyses to ensure the robustness.</p><p><strong>Results: </strong>In this analysis of 794 CAD patients, CKD patients demonstrated significantly higher AMR values (2.56 ± 0.51 vs. 2.46 ± 0.48, p = 0.003) and CMD prevalence (57.1% vs. 41.7%, p < 0.001). Three ceramide species - Cer(18:1/16:0), Cer(18:1/18:0), and Cer(18:1/24:1) - showed strong positive correlations with AMR (all p < 0.05). LASSO regression identified 14 factors associated with CMD, with E/e', CKD, and Cer(18:1/16:0) emerging as top correlates. Cer(18:1/16:0) demonstrated superior predictive performance (area under the curve [AUC] = 0.609, 95% CI: 0.570-0.648, p < 0.001), with its addition to baseline models significantly improving reclassification (δAUC = 0.03, p = 0.010; cNRI>0 = 0.23, p < 0.001; integrated discrimination improvement = 0.03, p < 0.001). Notably, patients with concurrent CKD and elevated Cer(18:1/16:0) exhibited significantly higher odds of CMD (OR = 3.74, 95% CI: 2.39-5.84). Statistical mediation analysis suggested that Cer(18:1/16:0) mediated 13.8% of the association between CKD and CMD.</p><p><strong>Conclusion: </strong>Ceramides, particularly Cer(18:1/16:0), partially mediated the statistical association between CKD and CMD. These findings highlight the potential role of sphingolipid metabolism in cardiorenal pathophysiology.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"321-333"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811565","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":"Therapeutic Advances in Diabetic Kidney Disease: 30 Years of Evidence and the Rise of the \"Fantastic Four\" in Nephrology.","authors":"Faeq Husain-Syed, Goekhan Yuecel, Clara Daschner, Jan Jochims, Babak Yazdani","doi":"10.1159/000550423","DOIUrl":"10.1159/000550423","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) remains the leading cause of chronic kidney disease and kidney failure worldwide. Over the past 3 decades, management has evolved from strict glycemic and blood pressure control to targeted therapies that modify disease progression.</p><p><strong>Summary: </strong>The DCCT/EDIC (1993) confirmed the impact of intensive glycemic and multifactorial risk factor management. But the early 1990s established the foundation of nephroprotective therapy with the Captopril Trial (1993) in type 1 diabetes and subsequent IRMA-1 (2001), IDNT (2001), and the RENAAL (2001) studies established renin-angiotensin-system blockade as the first disease-specific therapy. More than a decade later, sodium-glucose cotransporter-2 (SGLT2) inhibitors transformed care, with EMPA-REG OUTCOME (2015) and CANVAS (2017) studies first demonstrating kidney benefits as secondary outcomes, which were confirmed in subsequent dedicated kidney trials: CREDENCE (2019), DAPA-CKD (2020), and EMPA-KIDNEY (2022) studies, demonstrating consistent reductions in kidney failure and cardiovascular mortality. Finerenone further advanced outcomes in FIDELIO-DKD (2020) and FIGARO-DKD (2021), and combination therapy with SGLT2 inhibition showed additive benefit in the CONFIDENCE (2025) study. Most recently, the FLOW (2024) trial confirmed glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as promising fourth pillar of nephroprotective therapies.</p><p><strong>Key messages: </strong>Together, these advances, termed the \"Fantastic Four,\" have redefined standards of care in DKD. This review synthesizes pivotal clinical trials and highlights evolving strategies to guide individualized treatment and future research.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"44-57"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12923249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965452","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}