Cardiorenal Medicine最新文献

{"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":"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 h 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":"453-461"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","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 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":3.2,"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":3.2,"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}

{"title":"Finerenone: Evidence for Benefit in Early Stages of Cardiovascular-Kidney-Metabolic Syndrome.","authors":"Diego Francisco Márquez, Alberto Ortiz, Daniel González-Moreno, Luis Miguel Ruilope, Gema Ruiz-Hurtado","doi":"10.1159/000548494","DOIUrl":"10.1159/000548494","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome is a recently introduced concept that links chronic kidney disease (CKD), cardiovascular disease, and metabolic risk factors such as obesity or diabetes mellitus (DM). The use of eGFR <60 mL/min/1.73 m2 as a CKD indicator often detects more advanced stages of renal disease, even though risk is present at earlier stages, particularly in the presence of albuminuria.</p><p><strong>Summary: </strong>The nonsteroidal mineralocorticoid receptor antagonist finerenone has demonstrated efficacy in reducing cardiovascular and renal outcomes in patients with CKD and type 2 DM. Data from FIDELITY, a pooled analysis of FIDELIO-DKD and FIGARO-DKD, showed significant reductions in kidney failure and cardiovascular outcomes in patients with CKD and type 2 DM. Moreover, data from FINEARTS-HF trial revealed that finerenone prevents onset of albuminuric CKD in patients.</p><p><strong>Key messages: </strong>These results support a paradigm shift toward earlier intervention in CKM syndrome, with the aim of preserving renal function. Finerenone holds promise for changing the trajectory of CKD within a broader CKM framework. Ongoing trials will further define its role in diverse patient populations and stages of CKM syndrome.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"619-625"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205816","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":"Health Implications Associated with Fat-Free Mass: A Phenome-Wide Mendelian Randomization Study.","authors":"Yuchen Ying, Chunxia Zhang, Shanshan Wu, Shudan Wang, Jiangfang Lian, Yupin Lin, Haiwang Guan, Dihui Cai","doi":"10.1159/000545641","DOIUrl":"10.1159/000545641","url":null,"abstract":"<p><strong>Introduction: </strong>Fat-free mass (FFM) is a critical component of the human body, with implications for various diseases.</p><p><strong>Methods: </strong>We conducted a comprehensive analysis integrating a phenome-wide association study (PheWAS), a two-sample Mendelian randomization (MR) analysis, and a systematic review to investigate the associations between FFM and health outcomes.</p><p><strong>Results: </strong>PheWAS identified 183 phenotypes enriched for FFM associations, including diseases, body composition, and lifestyle factors. A two-sample MR analysis using the FinnGen and UK Biobank dataset revealed significant associations between genetically determined FFM and 36 disease outcomes, including cardiovascular diseases, metabolic disorders, and musculoskeletal conditions. The mediation MR analysis indicates that FFM indirectly influences the levels of five biomarkers in visceral adipose tissue. A systematic review identified consistent associations between FFM and several diseases, including type 2 diabetes and cervical disc disorders. Moreover, new associations such as low back pain and ovarian cancer were discovered.</p><p><strong>Conclusion: </strong>These findings challenge the conventional notion of FFM as a protective factor in health, suggesting that higher FFM levels may be linked to an increased risk of various diseases. Further clinical studies are warranted to validate these findings and elucidate the underlying mechanisms.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"295-308"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779265","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":"The Association of Cumulative Chinese Visceral Adiposity Index and New-Onset Hypertension in Middle-Aged and Elderly Chinese Populations: A Cohort Study.","authors":"Song Wen, Xueting Qiu, Xingjie Huang, Zehan Huang, Feng Wang, Dunliang Ma, Zhonghua Xia, Feihuang Han, Jiquan Xiao, Qiheng Wan, Bin Zhang, Nan Chen, Yuqing Huang","doi":"10.1159/000545821","DOIUrl":"10.1159/000545821","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have reported a significant relationship between the baseline Chinese visceral adipose index (CVAI) and the risk of new-onset hypertension (NOH). However, the long-term effect of the CVAI and the risk of NOH remains uncertain. This study aimed to investigate the association between the cumulative CVAI and the risk of NOH.</p><p><strong>Methods: </strong>Data were obtained from the China Health and Retirement Longitudinal Study from 2011 to 2020. In total, 2,836 Chinese participants ≥45 years were included. Multivariable logistic regression analysis as well as restricted cubic spline regression analysis were performed to assess the association of the cumulative CVAI, visceral adiposity index (VAI), and lipid accumulation product (LAP) with the risk of NOH. Furthermore, receiver operating characteristic (ROC) curve analysis was used to determine the area under the ROC curves between the risk of NOH and the adiposity indices to compare the predictive powers of the cumulative CVAI, VAI, and LAP for NOH.</p><p><strong>Results: </strong>During the 5-year follow-up period, 433 cases of NOH were recorded. The cumulative CVAI, VAI, and LAP were positively associated with the risk of NOH. After adjusting for potential confounders, as compared to the lowest quartile of the cumulative CVAI, VAI, and LAP, the participants in the highest quartile had a significantly higher risk for NOH (odds ratio = 1.74, 1.46, and 1.95; 95% confidence interval = 1.25-2.42, 1.05-2.03, and 1.39-2.75, respectively). ROC analysis revealed that the cumulative CVAI had the highest relationship with the risk of NOH.</p><p><strong>Conclusion: </strong>The cumulative CVAI was positively associated with an increased risk of NOH in middle-aged and elderly Chinese populations. In addition, the performance of the cumulative CVAI to predict NOH was superior to other visceral obesity indices. Monitoring long-term changes to the CVAI may assist with early identification of individuals at high risk of NOH.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"309-322"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980286","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":"Addressing Renal Sodium Avidity in Chronic Heart Failure: There Is Always More than One Way to Skin a Cat.","authors":"Marco Montomoli, Miguel Gonzalez Ricoa, José Luis Górriz Terue, Maria Jesus Puchades Montesa, Gonzalo Nuñez Marín, Maria Soledad Lecueder","doi":"10.1159/000545017","DOIUrl":"10.1159/000545017","url":null,"abstract":"<p><strong>Background: </strong>Renal sodium avidity is a defining characteristic of chronic cardiorenal syndrome (CRS), leading to persistent sodium retention despite significant fluid overload. This phenomenon exacerbates volume overload, contributes to hemodynamic instability, and accelerates the decline of cardiac and renal function. Conventional diuretic therapies, though effective in acute settings, often fail chronically due to neurohormonal activation, renal tubular adaptations, and diuretic resistance.</p><p><strong>Summary: </strong>This review explores innovative approaches to overcoming natriuresis and diuresis resistance in CRS patients. Emerging pharmacological treatments, including sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor (GLP-1R) agonists, show potential in enhancing sodium excretion. Additionally, extracorporeal techniques such as ultrafiltration (UF) via hemodialysis and peritoneal dialysis (PD) provide precise sodium and fluid removal, bypassing many of the limitations of traditional pharmacotherapy. PD, in particular, has demonstrated efficacy in refractory cases by preserving residual renal function and improving diuretic responsiveness. As the saying goes, \"there's always more than one way to skin a cat.\"</p><p><strong>Key messages: </strong>(1) Renal sodium avidity plays a crucial role in CRS progression, necessitating targeted interventions. (2) Standard diuretic therapies often fail to provide sustained relief due to compensatory mechanisms. (3) Novel pharmacological agents (SGLT2 inhibitors, GLP-1R agonists) and extracorporeal techniques (UF, PD) offer promising alternatives for managing sodium retention and fluid overload. (4) A multidisciplinary and personalized treatment strategy is essential for optimizing patient outcomes and improving quality of life.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"399-412"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062448","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":"Ultrafiltration in Elderly Patients with Type 1 Cardiorenal Syndrome: Efficacy and Safety Outcomes.","authors":"Lijuan Xu, Zhen Wang, Lei Sun, Bin Liu, Hongxiao Li","doi":"10.1159/000546387","DOIUrl":"10.1159/000546387","url":null,"abstract":"<p><strong>Introduction: </strong>Due to the typical exclusion of very elderly patients from clinical trials, the applicability of trial results to this population with heart failure remains uncertain. Limited data exist regarding the efficacy and safety of ultrafiltration in elderly patients with type 1 cardiorenal syndrome (CRS). Consequently, our study aimed to compare the efficacy and safety of ultrafiltration versus diuretics, providing evidence-based insights into the optimal management strategy for elderly patients with type 1 CRS.</p><p><strong>Methods: </strong>In this prospective pilot trial, patients aged over 70 years old with type I CRS were treated with either diuretics or ultrafiltration. All patients were followed for up to 180 days post-discharge. Efficacy outcomes encompassed both immediate measures (changes in weight and dyspnea score from baseline to 48 h posttreatment) and long-term stability indicators (length of hospital stay and heart failure-related medical visits within 180 days post-discharge). Safety outcomes were assessed in both groups, focusing on changes in systolic blood pressure, heart rate, serum creatinine, blood urea nitrogen, blood potassium, and sodium ion concentrations, bleeding or thromboembolic events, and major adverse cardiovascular events.</p><p><strong>Results: </strong>A total of 159 patients with type I CRS were enrolled, with 80 receiving diuretics and 79 undergoing ultrafiltration. The mean age was 82.1 ± 5.8 years. At 48 h, patients in the ultrafiltration group demonstrated significantly greater weight loss and improvements in dyspnea score compared to those in the diuretic group (p < 0.05). Furthermore, the ultrafiltration group had shorter hospital stays and fewer medical visits for heart failure within 180 days post-discharge (p < 0.05). Notably, there were no statistically significant differences in safety outcomes between the two groups, indicating comparable safety profiles.</p><p><strong>Conclusion: </strong>Ultrafiltration demonstrated superior efficacy with comparable safety profiles compared to diuretics. Therefore, ultrafiltration may be considered a preferred treatment option for elderly patients with type I CRS.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"430-438"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101470","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":"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":"10.1159/000546520","url":null,"abstract":"<p><strong>Background: </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 1,913 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 a 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 in 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":"462-483"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215157/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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, Jordi Comas, Ana Sánchez-Escuredo, María José Soler","doi":"10.1159/000546924","DOIUrl":"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 cardiorenal 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 and 2022. Baseline clinical characteristics and follow-up until December/2022 was studied.</p><p><strong>Results: </strong>Of the 1,874 incident patients on PD, 198 (10.6%) were PD-UF, 73.2% of the patients were male, and the mean age was 70.7 ± 9.3 years. Median estimated glomerular filtration rate (eGFR) at start was 22.6 (IQR: 14.8-32.8) mL/min×1.73 m2 and 75.0% have an eGFR above 15 mL/min×1.73 m2. Previous history of ischemic heart disease, arrhythmia, or cardiac surgery was recorded, and 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 (IQR: 17.3-24.3) months. Technique survival at 1 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 (HR: 2.18 [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×1.73 m2 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-UF 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":"560-571"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","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}