Cardiorenal Medicine最新文献

{"title":"Acute Kidney Injury after Cardiac Surgery.","authors":"Thomas M Beaver, Bhagwan Dass, Ami M Patel, A Ahsan Ejaz","doi":"10.1159/000540396","DOIUrl":"10.1159/000540396","url":null,"abstract":"<p><strong>Background: </strong>Cardiac surgery-associated acute kidney injury (CS-AKI) remains a vexing issue. Clinical trials for the prevention of CS-AKI have been disappointing despite enormous initial enthusiasm based on experimental data.</p><p><strong>Summary: </strong>The schism in experimental and clinical data has triggered a relook at our understanding of CS-AKI and the experimental and preclinical models. In this review, we discuss the therapeutic targets of major clinical trials.</p><p><strong>Key messages: </strong>The silver lining in the midst is the standardization of anesthetic and perioperative care proposed by national societies. Implementation of the KDIGO bundle is a reasonable option to decrease the incidence of CS-AKI despite lack of proven robust benefits.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"437-442"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723128","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":"Predictive Value of Serum Soluble ST2 in Adult Patients Undergoing Cardiac Surgery for Acute Kidney Injury.","authors":"Zeling Chen, Jiaxin Li, Xicheng Liu, Xiaolong Liu, Junjiang Zhu, Xuanhe Tang, Yiyu Deng, Chunbo Chen","doi":"10.1159/000540529","DOIUrl":"10.1159/000540529","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac surgery is related to an increased risk of postoperative acute kidney injury (AKI). Serum soluble ST2 (sST2) is highly predictive of several cardiovascular diseases and may also be involved in renal injury. This study explored the relationship between serum sST2 levels measured at intensive care unit (ICU) admission and the development of AKI after cardiac surgery.</p><p><strong>Methods: </strong>We prospectively conducted an investigation on consecutive patients who underwent cardiac surgery. sST2 was immediately measured at ICU admission. The relationship between the levels of sST2 and the development of AKI was explored using stepwise logistic regression.</p><p><strong>Results: </strong>Among the 500 patients enrolled, AKI was observed in 207 (41%) patients. Serum sST2 levels in AKI patients were higher than those without AKI (61.46 ng/mL [46.52, 116.25] vs. 38.91 ng/mL [28.74, 50.93], p &lt; 0.001). Additionally, multivariable logistic regression analysis showed that as progressively higher tertiles of serum sST2, the odds ratios (ORs) of AKI gradually increased (adjusted ORs of 1.97 [95% CI, 1.13-3.45], and 4.27 [95% CI, 2.36-7.71] for tertiles 2 and 3, respectively, relative to tertile 1, p &lt; 0.05). The addition of sST2 further improved reclassification (p &lt; 0.001) and discrimination (p &lt; 0.001) over the basic model, which included established risk factors.</p><p><strong>Conclusion: </strong>Serum sST2 levels at ICU admission were associated with the development of postoperative AKI and improved the identification of AKI after cardiac surgery.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"498-507"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792025","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":"Hemoadsorption Contribution in Failing Fontan Pediatric Heart Transplantation.","authors":"Carlo Pace Napoleone, Enrico Aidala, Maria Teresa Cascarano, Luca Deorsola, Stefania Iannandrea, Annalisa Longobardo, Enrico Bonaveglio, Mattia Zanin, Licia Peruzzi","doi":"10.1159/000535575","DOIUrl":"10.1159/000535575","url":null,"abstract":"<p><strong>Introduction: </strong>A systemic inflammatory response is triggered in patients undergoing cardiothoracic surgery with cardiopulmonary bypass (CPB). This response is particularly evident in pediatric patients, especially those of low weight and after undergoing long CPB, and can severely impair the surgical result. Adsorptive blood purification techniques have been proposed to limit this systemic inflammatory response. To test its efficacy, we added the hemoadsorption filter Jafron HA 380 to CPB in a much compromised pediatric patient who underwent heart transplantation.</p><p><strong>Methods: </strong>A 10-year-old single ventricle patient previously treated with Fontan operation was listed for heart transplantation due to the evidence of failing Fontan condition. He experienced many episodes of cardiac arrest and underwent heart transplantation in much compromised general and hemodynamic conditions. The hemoadsorption filter Jafron HA 380 was used for all the duration of CPB, and the inflammatory biomarker interleukin 6 (IL-6) was assayed.</p><p><strong>Results: </strong>Postoperative outcome was uneventful and comparable to that of elective pediatric heart transplantation. IL-6 levels showed an impressive postoperative reduction, and after 2 days, the IL-6 level was comparable with a typical uneventful post-transplant course.</p><p><strong>Conclusions: </strong>The use of hemoadsorption filter can contribute to improve the pediatric transplant results, especially in very high-risk patients.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"67-73"},"PeriodicalIF":3.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466338","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":"Trajectory of Urine Albumin-Creatinine Ratio in Patients with Acute Heart Failure.","authors":"Pau Llàcer, François Croset, Rafael de la Espriella, Elena Torres, Jorge Campos, Marina García-Melero, Alberto Pérez-Nieva, María Pumares, Martín Fabregate, Genoveva López, Raúl Ruiz, Susana Tello, José María Fernández, Julio Núñez, Luis Manzano","doi":"10.1159/000536222","DOIUrl":"10.1159/000536222","url":null,"abstract":"<p><strong>Introduction: </strong>Albuminuria is prevalent in patients with chronic heart failure and is a risk factor for disease progression. However, its clinical meaning in acute heart failure remains elusive. This study analyzed the trajectory of urine albumin to creatinine ratio (UACR) between admission and discharge and its association with decongestion.</p><p><strong>Methods: </strong>In this prospective observational study, 63 patients were enrolled. UACR, B-type natriuretic peptide (BNP), and clinical congestion score (CCS) were obtained at admission and discharge. We used linear mixed regression analysis to compare changes in the natural logarithm of UACR (logUACR) and its association with changes in markers of decongestion. Estimates were reported as least squares mean with their respective 95% CIs.</p><p><strong>Results: </strong>The median age of the study population was 87 years, 68.5% were women, and 69.8% had a left ventricular ejection fraction &gt;50%. LogUACR at discharge significantly decreased in the overall population compared to admission (Δ -0.47, 95% CI: -0.78 to -0.15, p value = 0.003). The magnitude of UACR drop at discharge was associated with changes in surrogate markers of decongestion. Patients who showed a greater reduction in BNP at discharge exhibited a greater reduction in UACR (p = 0.016). The same trend was also found with clinical decongestion, as assessed by changes in CCS, however, without achieving statistical significance (p = 0.171). UACR change at discharge was not associated with changes in serum creatinine (p value = 0.923).</p><p><strong>Conclusion: </strong>In elderly patients with AHF and volume overload, the level of UACR significantly decreased upon discharge compared to admission. This reduction in UACR was closely linked to decreases in BNP.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"74-80"},"PeriodicalIF":3.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575198","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":"Perspectives in Managing Kidney Disease and Atherosclerotic Cardiovascular Disease.","authors":"Tarlan Namvar, Matthew A Cavender, Eden Miller, Sherif Mehanna, Reese Ochsner, Dominic S Raj","doi":"10.1159/000539804","DOIUrl":"10.1159/000539804","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (ASCVD) share a complex and dependent link with each other and other cardiometabolic conditions. Currently, there is insufficient data regarding patient and provider perceptions about this important clinical overlap. This study sought to evaluate healthcare provider (HCP) and patient attitudes and perceptions about CKD and ASCVD, including risk, diagnosis, and management of both conditions.</p><p><strong>Methods: </strong>Cross-sectional surveys of 58 nephrologists and 74 cardiologists who treat patients with CKD and ASCVD and 195 patients who self-reported having CKD and ASCVD were conducted in the USA between May and June 2021.</p><p><strong>Results: </strong>Most nephrologists agreed that the presence of cardiometabolic comorbidities increased patients' risk of developing CKD; 86% agreed that type 2 diabetes increased the risk, and 67% agreed that ASCVD increased the risk. However, only 52% of the nephrologists reported they typically discuss the risk of developing CKD with patients prior to diagnosing them. Slightly more than one-third of patients (35%) reported their HCP discussed other conditions' impact on the development of CKD; of all HCPs surveyed, nephrologists were the least likely to discuss CKD risk with their patients. Most nephrologists (83%) also reported they recommended lifestyle modification to patients; however, only about half of patients (53%) reported they were currently using a lifestyle change to treat CKD and/or ASCVD.</p><p><strong>Conclusion: </strong>Although CKD and ASCVD are known to have a bidirectional relationship, HCPs in our study did not report routinely educating patients about the risk of developing one or both conditions. As HCPs with perhaps the deepest understanding of the interplay between CKD and cardiorenal comorbidities, nephrologists are well positioned to help patients understand the link between cardiovascular and renal health, help identify strategies to limit risk, and appropriately treat the conditions.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"426-436"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330376","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":"Portal Vein Doppler Is a Sensitive Marker for Evaluating Venous Congestion in End-Stage Kidney Disease.","authors":"Melinda M Tonelli, Eduardo R Argaiz, Joseph R Pare, Erika Hooker, Helena Kurniawan, Krithika M Muruganandan, Jean M Francis, Aala Jaberi","doi":"10.1159/000539901","DOIUrl":"10.1159/000539901","url":null,"abstract":"<p><strong>Introduction: </strong>Determining ultrafiltration volume in patients undergoing intermittent hemodialysis (IHD) is an essential component in the assessment and management of volume status. Venous excess ultrasound (VExUS) is a novel tool used to quantify the severity of venous congestion at the bedside. Given the high prevalence of pulmonary hypertension in patients with end-stage kidney disease (ESKD), venous Doppler could represent a useful tool to monitor decongestion in these patients.</p><p><strong>Methods: </strong>This is a prospective observational study conducted in ESKD patients who were admitted to the hospital requiring IHD and ultrafiltration. Inferior vena cava maximum diameter (IVCd), portal vein Doppler (PVD), and hepatic vein Doppler (HVD) were performed in all patients before and after a single IHD session.</p><p><strong>Results: </strong>Forty-one patients were included. The prevalence of venous congestion was 88% based on IVCd and 63% based on portal vein pulsatility fraction (PVPF). Both mean IVCd and PVPF displayed a significant improvement after ultrafiltration. The percent decrease in PVPF was significantly larger than the percent decrease in IVCd. HVD alterations did not significantly improve after ultrafiltration.</p><p><strong>Conclusions: </strong>Our study revealed a high prevalence of venous congestion in hospitalized ESKD patients undergoing hemodialysis. After a single IHD session, there was a significant improvement in both IVCd and PVPF. HVD showed no significant improvement with one IHD session. PVPF changes were more sensitive than IVCd changes during volume removal. This study suggests that, due to its rapid response to volume removal, PVD, among the various components of the VExUS grading system, could be more effective in monitoring real-time decongestion in patients undergoing IHD.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"375-384"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426373","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":"Impact of Dysmagnesemia on Atrial Fibrillation in Maintenance Hemodialysis Patients: A Nationwide Study.","authors":"Tatsunori Toida, Noriaki Kurita, Masanori Abe, Norio Hanafusa, Nobuhiko Joki","doi":"10.1159/000536595","DOIUrl":"10.1159/000536595","url":null,"abstract":"<p><strong>Introduction: </strong>The dose-response relationship between serum magnesium (sMg) and atrial fibrillation (AF) and the contribution of dysmagnesemia to AF among hemodialysis patients remain unknown. Hence, we examined the dose-response correlation between sMg and AF and estimated the extent of the contribution of dysmagnesemia to AF in this population.</p><p><strong>Methods: </strong>This was a nationwide cross-sectional study on the Japanese Society for Dialysis Therapy registry, also known as Japanese Renal Data Registry (JRDR), encompassing a nationwide population of dialysis centers, as of the end of 2019. Eligible participants were adult patients undergoing hemodialysis three times per week. The main exposure was sMg, categorized into seven categories (≤1.5, &gt;1.5-≤2, &gt;2-≤2.5, &gt;2.5-≤3, &gt;3-≤3.5, &gt;3.5-≤4, and ≥4.0 mg/dL). The outcome was AF reported by dialysis facilities. The independent contribution to AF was assessed via logistic regression to generate population-attributable fractions, assuming a causal relationship between sMg and AF.</p><p><strong>Results: </strong>Total 165,926 patients from 2,549 facilities were investigated. AF prevalence was 7.9%. Compared with the reference (&gt;2.5-≤3 mg/dL), lower sMg was associated with increased AF (adjusted odds ratios (ORs) (95% confidence interval, CI) of 1.49 (1.19-1.85), 1.24 (1.17-1.32), and 1.11 (1.06-1.16) for sMg of ≤1.5, &gt;1.5-≤2.0, and &gt;2.0-≤2.5 mg/dL categories, respectively). Elevated sMg was associated with fewer AF (adjusted OR 0.87 [95% CI, 0.79-0.96] for sMg of &gt;3.0-≤3.5 mg/dL). The adjusted population-attributable fraction of lower sMg and higher and lower sMg for AF was 7.4% and 6.9%, respectively. An association did indeed exist between lower sMg and AF, with the lowest percentages of AF at sMg levels above the reference range for the general population.</p><p><strong>Conclusion: </strong>Dysmagnesemia may be an important contributor to AF among adult hemodialysis patients. Further, longitudinal studies are warranted to determine whether sMg correction reduces the AF incidence.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"105-112"},"PeriodicalIF":3.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139680660","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":"Bypass of Coronary Artery in Renal Artery Stenosis Patients with Heart Chronic Total Occlusion Might Explain the 5-Year Follow-Up after Percutaneous Coronary Intervention: B-RASHEF Study.","authors":"Bin Zheng","doi":"10.1159/000542449","DOIUrl":"10.1159/000542449","url":null,"abstract":"<p><strong>Introduction: </strong>Renal artery stenosis (RAS) is associated with poor outcome in patients with ischemic heart disease. In this study, we investigated the development of coronary collateral in RAS patients and possible association of RAS with a 5-year outcome after chronic total occlusion-percutaneous coronary intervention (CTO PCI).</p><p><strong>Methods: </strong>Consecutive 58 patients with CTO PCI were enrolled prospectively, including 21 RAS patients (15 unilateral RAS and 6 bilateral RAS) and 37 non-RAS patients. RAS was diagnosed by renal duplex. Coronary collaterals were appraised by CC classification and Rentrop classification.</p><p><strong>Results: </strong>Development of left anterior descending artery coronary collateral by Rentrop classification was significantly worse in RAS patients than non-RAS patients. Kaplan-Meier curve of survival was significantly worse in RAS patients than non-RAS patients (p = 0.027). By univariate COX proportional hazard regression analysis, collateral development by CC classification was a significant predictor for 5-year survival. When age, RAS, and collateral development by CC classification were included in multivariate COX proportional hazard regression analysis, only age (hazard ratio: 1.349; 95% confidential interval: 1.058-1.720; p = 0.016) and RAS (hazard ratio: 6.680; 95% confidential interval: 1.322-33.747; p = 0.022) were significant predictors for 5-year survival.</p><p><strong>Discussion/conclusion: </strong>We concluded that survival in RAS patients after CTO PCI is significantly worse than non-RAS patients, and RAS is a significant predictor for survival after CTO PCI. It seems that injured collateral development might partly explain increased all cause death in RAS patients.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"624-634"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581966","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":"Understanding Prescribing Practices and Patient Experiences with Renin Angiotensin System Inhibitors Use in Chronic Kidney Disease: A Qualitative Study.","authors":"Jennifer Arney, L Parker Gregg, Sheena Wydermyer, Michael A Herrera, Peter A Richardson, Michael E Matheny, Julia M Akeroyd, Glenn T Gobbel, Adriana Hung, Salim S Virani, Sankar D Navaneethan","doi":"10.1159/000535829","DOIUrl":"10.1159/000535829","url":null,"abstract":"<p><strong>Introduction: </strong>Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) improve outcomes but are underutilized in patients with chronic kidney disease (CKD). Little is known about reasons for discontinuation and lack of reinitiating these medications. We aimed to explore clinicians' and patients' experiences and perceptions of ACEI/ARB use in CKD.</p><p><strong>Methods: </strong>A multi-profession sample of health care clinicians and patients with documented ACEI/ARB-associated side effects in the past 6 months. Participants were recruited from 2 Veterans Affairs healthcare systems in Texas and Tennessee. A total of 15 clinicians and 10 patients completed interviews. We used inductive and deductive qualitative data analysis approaches to identify themes related to clinician and patient experiences with ACEI/ARB. Thematic analysis focused on prescribing decisions and practices, clinical guidelines, and perception of side effects. Data were analyzed as they amassed, and recruitment was stopped at the point of thematic saturation.</p><p><strong>Results: </strong>Clinicians prescribe ACEI/ARB for blood pressure control and kidney protection and underscored the importance of these medications in patients with diabetes. While clinicians described providing comprehensive patient education about ACEI/ARB in CKD, patient interviews revealed significant knowledge gaps about CKD and ACEI/ARB use. Many patients were unaware of their CKD status, and some did not know why they were prescribed ACEI/ARB. Clinicians' drug management strategies varied widely, as did their understanding of prescribing guidelines. They identified structural and patient-level barriers to prescribing and many endorsed the development of a decision support tool to facilitate ACEI/ARB prescribing and management.</p><p><strong>Discussion/conclusion: </strong>Our qualitative study of clinicians and providers identified key target areas for improvement to increase ACEI/ARB utilization in patients with CKD with the goal to improve long-term outcomes in high-risk patients. These findings will also inform the development of a decision support tool to assist with prescribing ACEI/ARBs for patients with CKD.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"34-44"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048386","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":"Mortality and Renal Outcomes Are Impacted by Obesity in Cardiorenal Metabolic Disease but Not in People with Concomitant Diabetes Mellitus.","authors":"Saif Al-Chalabi, Rajkumar Chinnadurai, Philip A Kalra, Smeeta Sinha","doi":"10.1159/000536038","DOIUrl":"10.1159/000536038","url":null,"abstract":"<p><strong>Introduction: </strong>Mounting evidence in the literature describes a reverse association, whereby obesity may have a protective effect on mortality - the \"obesity paradox.\" Due to the significant overlap between elements of cardiorenal metabolic disease, we examined the effects of obesity on outcomes in a cohort of patients with non-dialysis chronic kidney disease (ND-CKD) by grouping patients according to their level of cardiometabolic co-morbidity to reduce the risk of bias.</p><p><strong>Methods: </strong>This study was undertaken on all patients with a documented body mass index (BMI) in the Salford Kidney Study database from October 2002 until December 2016. Patients were grouped according to their BMI into normal weight, overweight, and obese, and also according to their level of co-morbidity into 4 groups: group 1 had CKD only; group 2 had CKD and heart failure (HF); group 3 had CKD and diabetes mellitus (DM); and group 4 had CKD, DM, and HF. Univariate and multivariate Cox regression analyses were performed.</p><p><strong>Results: </strong>A total of 2,416 patients were included in the analysis. The median age was 67.3 years, 61.8% were male, and 96.4% were Caucasian. Obesity was associated with a lower incidence of combined outcomes in patients with ND-CKD who did not have DM (hazard ratio [HR] 0.74; p = &lt;0.001 and HR 0.48; p = 0.008 for CKD alone and CKD + HF groups, respectively). This protective effect remained significant after correcting for major factors. In patients with ND-CKD and DM, there was no difference in all-cause mortality between the normal weight group and the obesity groups.</p><p><strong>Conclusion: </strong>Obesity may be protective against adverse outcomes only in groups 1 (CKD alone) and 2 (CKD + HF). This \"protective\" effect was not seen in patients who had concomitant diabetes. These data suggest that diabetes is a potent predictor of adverse outcomes, irrespective of BMI; however, in patients without diabetes, obesity may play a protective role.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"23-33"},"PeriodicalIF":3.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139073433","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}