Cardiorenal Medicine最新文献

{"title":"The Paradox of Hypertonic Saline Infusion for Patients with Heart Failure.","authors":"Negiin Pourafshar, Siddharth S Madapoosi, Ashkan Karimi, Jeffrey Testani, Christopher S Wilcox","doi":"10.1159/000544046","DOIUrl":"10.1159/000544046","url":null,"abstract":"<p><strong>Background: </strong>Fluid/sodium overload is the primary reason for hospital admission for patients with acute decompensated heart failure. Unfortunately, congestion often remains undertreated and is associated with significant adverse outcomes in patients with congestive heart failure (CHF). Potent loop diuretics have long been accepted as the first-line treatment for these patients. However, recurrent hospital admission, due in part to a lack of response to diuretics, becomes common as heart failure progresses.</p><p><strong>Summary: </strong>While the goal of acute decompensated heart failure (ADHF) therapy has historically been to correct the excess of sodium chloride and water in the body, recent studies in patients with diuretic-resistant CHF have reported a paradoxical role for repletion with hypertonic saline (HS) infusion during continued use of loop diuretics to enhance diuresis. With the increasing use of combined therapy in the intensive care unit and recent trials of combined therapy in ambulatory patients, nephrologists are increasingly involved in its use.</p><p><strong>Key messages: </strong>Several clinical trials in ADHF have demonstrated a role for HS in the improvement of outcomes such as decongestion, diuresis, kidney function, weight loss, mortality, length of stay, and readmission rates. This is a review for nephrologists of the potential effects of infusion of HS in combination with loop diuretics in patients with ADHF.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"552-559"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574894","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":"From Renal Markers to Muscle Mass: A Sarcopenia Index Predicts Outcomes in Coronary Artery Disease Patients with Aortic Valve Sclerosis.","authors":"Yifeng Zhang, Hui Chen, Xihao Du, Yanping Wang, Jiawei Chen, Mirenuer Aikebaier, Shuyao Shan, Ling Yang, Anqi Zhao, Wei Chu, Yehong Liu, Zhongli Chen, Ke Yang","doi":"10.1159/000545619","DOIUrl":"10.1159/000545619","url":null,"abstract":"<p><strong>Background: </strong>Renal function plays a pivotal role in influencing various diseases, particularly cardiovascular conditions. Renal markers show strong associations with coronary artery disease (CAD), aortic valve sclerosis (AVSc), and sarcopenia. The sarcopenia index (SI), a biomarker derived from renal markers, serves a dual purpose: it precisely quantifies muscle mass while also acting as a prognostic indicator for adverse cardiovascular outcomes, especially in patients with concurrent CAD and AVSc.</p><p><strong>Methods: </strong>A retrospective analysis was performed on consecutive CAD patients treated from 2013 to 2014. The SI was calculated using the formula (serum creatinine [mg/dL]/cystatin C [mg/dL]) × 100. The primary composite endpoint was cardiovascular death or rehospitalization for heart failure or acute coronary syndrome events. The secondary endpoint included the primary endpoint plus all-cause mortality. Kaplan-Meier analysis and Cox proportional hazards modeling was applied to analyze the association between SI and outcomes.</p><p><strong>Results: </strong>Among the 1,123 CAD patients, 277 had AVSc. Patients with AVSc had significantly lower SI, which was independently associated with AVSc presence (OR = 1.750, p < 0.001). Associations between SI and both endpoints were identified in CAD patients with AVSc rather than in those without AVSc. SI below the median (89.40) was predictive of worse outcomes. Lower SI significantly increased the risk for the primary (HR = 1.883, p = 0.035) and secondary (HR = 1.910, p = 0.021) endpoints in AVSc subgroup.</p><p><strong>Conclusion: </strong>Lower SI is independently associated with AVSc in CAD patients and was also associated with adverse cardiovascular events and mortality in CAD patients with AVSc.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"374-385"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers for Predicting of Sepsis-Induced Cardiorenal Syndrome in Emergency Settings.","authors":"Yuanyuan Pei, Liping Guo, Guangping Zhou, Lingjie Cao, Wenfeng Huang, Fengtao Yang, Dilu Li, Cheng Chi, Jihong Zhu","doi":"10.1159/000543462","DOIUrl":"10.1159/000543462","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiorenal syndrome (CRS) is a common and critical complication of sepsis, with high morbidity and mortality rates. Studies on biomarkers for the early prediction of septic CRS are sporadic. Classic and novel potential biomarkers were identified to explore their diagnostic performance of in patients with septic CRS.</p><p><strong>Methods: </strong>A total of 138 patients with sepsis from Peking University People's Hospital were enrolled in this prospective observational study, which was conducted between May 2019 and June 2022. The patients were divided into non-CRS (n = 106) and CRS (n = 32) groups. Serum levels of cystatin C, KIM-1, neutrophil gelatinase-associated lipocalin (NGAL), and α-Klotho were detected at admission using enzyme-linked immunosorbent assay. The relationship between the biomarker levels and risk factors of CRS were analyzed, as well as discrimination accuracy comparisons were performed.</p><p><strong>Results: </strong>The incidence of CRS in patients with sepsis was 23.2% (32/138) during hospitalization, with an obvious mortality. Compared with the non-CRS group, serum cystatin C, brain natriuretic peptide (BNP), troponin-I (TNI), KIM-1, and NGAL levels were both significantly elevated at admission in patients with sepsis complicated with CRS. Logistic regression analysis revealed that BNP, TNI, cystatin C, albumin, Lac, D-dimer were risk factors for CRS in sepsis patients. Compared with other biomarkers, serum cystatin C had moderate discriminative power for predicting septic CRS (area under a receiver operating characteristic curve, 0.746; sensitivity, 0.719; specificity, 0.783). BNP combined with cystatin C and D-dimer demonstrated an excellent discrimination performance, for its AUROC was up to 0.878 (sensitivity, 0.844; specificity, 0.759).</p><p><strong>Conclusion: </strong>Serum cystatin C, BNP, TNI, KIM-1, and NGAL levels are elevated in patients with septic CRS. Our study provides reliable evidence that cystatin C in combination with BNP and D-dimer might better predict septic CRS upon admission. Further research on sensitive biomarkers is needed.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"198-208"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439630","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":"Fluid Overload in Cardiorenal Medicine: From Bench to Bedside.","authors":"Marta Cobo Marcos, Gregorio Romero-González, Julio Núñez","doi":"10.1159/000546349","DOIUrl":"10.1159/000546349","url":null,"abstract":"","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"427-429"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141447","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":"Effects of Renal Denervation on Cardiac Remodeling, Cardiac Function, and Cardiovascular Neurohormones in Heart Failure with Reduced Ejection Fraction Patients: A Meta-Analysis and Systematic Review.","authors":"Fei Si, Qian Liu, Xin Ma, Jing Yu","doi":"10.1159/000545078","DOIUrl":"10.1159/000545078","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to evaluate the effects of renal denervation (RDN) on cardiac remodeling, cardiac function, and cardiovascular (CV) neurohormones in heart failure patients with reduced ejection fraction (HFrEF).</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI), identifying 6 randomized controlled trials (RCTs) and 9 single-arm studies, totaling 352 participants. Meta-analyses for RCTs and single-arm studies were conducted using STATA 17 software and the metafor package in R, respectively.</p><p><strong>Results: </strong>In RCTs, RDN significantly reduced left ventricular end-diastolic diameter (LVEDD) (weighted mean difference [WMD] = -3.55 mm, 95% CI [-5.51, -1.59], p < 0.01), left ventricular end-systolic diameter (LVESD) (WMD = -4.13 mm, 95% CI [-6.08, -2.18], p < 0.01), and significantly increased left ventricular ejection fraction (LVEF) (WMD = 6.30%, 95% CI [4.64, 7.96], p < 0.01) and 6-min walk test (6MWT) distance (WMD = 51.25 m, 95% CI [8.30, 94.20], p < 0.05). Brain natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were significantly reduced (standardized mean difference = -1.24, 95% CI [-1.57, -0.90], p < 0.01). In single-arm studies, RDN significantly reduced LVEDD (MC = -2.41 mm, 95% CI [-3.74, -1.09], p < 0.01), LVESD (MC = -1.72 mm, 95% CI [-2.77, -0.67], p < 0.01), left atrial diameter (MC = -1.62 mm, 95% CI [-3.16, -0.08], p < 0.01), and interventricular septal thickness (IVST) (MC = -0.76 mm, 95% CI [-1.05, -0.47], p < 0.01). RDN significantly increased LVEF (MC = 29.52%, 95% CI [12.74, 46.31], p < 0.01) and 6MWT distance (MC = 100.49 m, 95% CI [49.12, 151.86], p < 0.05). RDN significantly reduced BNP or NT-proBNP levels (SMC = -0.57, 95% CI [-0.83, -0.31], p < 0.01). Our study also found that RDN had varying degrees of reduction on renin, angiotensin II, aldosterone, and norepinephrine in HFrEF patients. Additionally, we found that RDN had no significant effect on SBP/DBP in HFrEF patients but reduced heart rate (WMD = -7.22 bpm, 95% CI [-9.84, -4.60], p < 0.01).</p><p><strong>Conclusion: </strong>Our meta-analysis demonstrates that RDN can improve cardiac remodeling, enhance cardiac function, reduce CV neurohormones and has no significant effect on blood pressure in patients with HFrEF.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"261-280"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708721","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":"Hepatocardiorenal Syndrome: Integrating Pathophysiology with Clinical Decision-Making via Point-Of-Care Ultrasound.","authors":"Abhilash Koratala, Claudio Ronco, Amir Kazory","doi":"10.1159/000543681","DOIUrl":"10.1159/000543681","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence has challenged the traditional model of the liver-kidney connection in hepatorenal syndrome. Cirrhosis can significantly impact cardiac function, leading to cirrhotic cardiomyopathy. Recent understanding reveals how cardiac dysfunction plays a pivotal role in the development of renal dysfunction in this setting, suggesting that disturbances traditionally categorized under hepatorenal syndrome may actually represent a hepatic form of cardiorenal syndrome - hepatocardiorenal syndrome - where the liver affects the kidney through cardiorenal pathways.</p><p><strong>Summary: </strong>Effective management of hepatocardiorenal syndrome and acute kidney injury in cirrhosis relies on accurately assessing a patient's hemodynamic and volume status. Point-of-care ultrasound, including lung and focused cardiac ultrasound, is a valuable diagnostic tool that provides crucial data on fluid tolerance, subclinical pulmonary congestion, and left ventricular filling pressures. This objective, bedside approach offers a comprehensive assessment that directly influences patient management and therapeutic decisions.</p><p><strong>Key messages: </strong>Point-of-care ultrasound plays an essential role in evaluating and managing hepatocardiorenal syndrome, providing insights into the underlying pathophysiology. By assessing hemodynamic parameters, it helps guide therapy and monitor patient responses, ensuring more accurate and effective treatment of patients with cirrhosis and acute kidney injury.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"184-197"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398241","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":"A New Era in the Management of Cardiorenal Syndrome: The Importance of Cardiorenal Units.","authors":"Juan León-Román, María Antonieta Azancot, Catarina Marouco, Marc Patricio-Liebana, Jorge Iván Zamora, Natalia Ramos Terrades, Néstor Toapanta, Sara Núñez-Delgado, Ana Belen Mendez Fernandez, María José Soler","doi":"10.1159/000543294","DOIUrl":"10.1159/000543294","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately 70% of patients with heart failure (HF) also have kidney disease. Mortality is increased both by cardiorenal syndrome (CRS) and by the exacerbation of other comorbidities. The purpose of this study is to evaluate the clinical performance of patients with CRS who are followed up by the Cardiorenal Unit (CRU).</p><p><strong>Methods: </strong>We conducted a retrospective observational study of patients referred to the CRU from April 1, 2022, to April 30, 2023. Demographics, laboratory and ultrasonographic tests, and outcomes were evaluated.</p><p><strong>Results: </strong>Fifty-four patients were seen in the CRU. A total of 45 (83%) and 16 (30%) patients completed follow-up in the CRU at 6 and 12 months, respectively. The mean age was 70 years ± 1.6, and 65% were men. Almost 50% of patients had ischemic heart disease-related HF. The mean cardiac ejection fraction (EF) was 40% ± 1.6, and 61% of patients had HF with reduced EF (HFrEF). NYHA functional classes II and III were the most frequent (60% and 35%, respectively). At 6 months after follow-up, treatment was optimized with sacubitril-valsartan in 33% vs. 49% (p = 0.02) and SGLT2 inhibitors in 48% vs. 72% (p = 0.008), without significant deterioration in renal function (creatinine: p = 0.61; eGFR: p = 0.19). There was also a reduction of more than 50% in the number of hospital admissions (p = 0.002). A total of 22% required peritoneal dialysis, and 20% required hemodialysis. Ten (19%) patients died, five of them due to cardiovascular (CV) events.</p><p><strong>Conclusions: </strong>The CRU is vital for the management of complex patients as it ensures the implementation of medications that reduce CV mortality and decrease the number of hospital admissions in HF.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"174-183"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Recovery after Acute Kidney Injury: A Comprehensive Review.","authors":"Mehrbod Vakhshoori, Amir Abdipour, Jasjot Bhullar, Melin Narayan, Sergio Infante, Sayna Norouzi, Roy O Mathew","doi":"10.1159/000546156","DOIUrl":"10.1159/000546156","url":null,"abstract":"<p><strong>Background: </strong>Acute Kidney Injury (AKI) is a common and critical condition associated with significant morbidity and mortality across various patient populations. The recovery process following AKI is complex and involves a multitude of biological, clinical, and environmental factors. Despite considerable research, there remains substantial debate regarding the exact role and significance of these factors, as well as how they interact with one another.</p><p><strong>Summary: </strong>This systematic review aims to examine the currently available evidence on the key factors influencing AKI recovery. We hope to offer a clearer understanding of the complex dynamics in AKI recovery, including where current evidence remains inconclusive or contradictory.</p><p><strong>Key messages: </strong>This review will provide valuable insights for clinicians and researchers aiming to improve treatment strategies and patient outcomes in AKI recovery.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"439-452"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Interplay of Heart Failure and Chronic Kidney Disease in Atrial Fibrillation: Focus on Cardiorenal Outcomes.","authors":"Ulrike Baumer, Lea Pedarnig, Andreas Hammer, Eva Steinacher, Niema Kazem, Lorenz Koller, Ulrike Pailer, René Rettl, Gere Sunder-Plassmann, Alice Schmidt, Christian Hengstenberg, Patrick Sulzgruber, Alexander Niessner, Felix Hofer","doi":"10.1159/000548380","DOIUrl":"10.1159/000548380","url":null,"abstract":"<p><p><p>Background: Heart failure (HF) and chronic kidney disease (CKD) create a mutually reinforcing cycle, escalating disease development, and increasing morbidity and mortality rates. Both are common comorbidities promoting AF and contributing to heightened symptom burden and poorer outcomes in AF. Here our aim was to investigate the relationship of HF and CKD with cardiorenal outcomes in patients with atrial fibrillation (AF).</p><p><strong>Methods: </strong>Patients with AF, treated at a tertiary centre between January 2005 and July 2019, were included. The primary endpoint was a composite of cardiovascular (CV) death and hospitalization for HF (HHF). Secondary outcomes were the individual components of the primary endpoint, all-cause death, renal death, and dialysis.</p><p><strong>Results: </strong>We included a total of 7,412 patients (median age 70 years, 39.7% female) with AF and followed them over a median of 4.5 years. There was a significant stepwise increase in 5-year event rates for the composite of CV death/HHF (no CKD and no HF: 23%, HF: 61%, CKD: 63%, CKD and HF: 82%; P log-rank <0.001). Both CKD (adjusted hazard ratio [HR]: 1.87, 95% confidence interval [CI]: 1.55-2.25) and HF (adjusted HR: 2.57, 95% CI: 2.22-2.98) were significantly associated with CV death/HHF after multivariable adjustment. A similar association was observed for the individual components of the primary endpoint and renal death/dialysis.</p><p><strong>Conclusions: </strong>Both CKD and HF significantly increase the risk of CV death and HHF, as well as renal death/dialysis in patients with AF. Risk assessment should expand beyond stroke and bleeding to cardiorenal complications including HHF, CV, and renal death, as well as kidney failure. </p>.</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"607-618"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147862","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":"Point-of-Care Ultrasonography in Chronic Kidney Disease: Addressing Congestion Management.","authors":"Gregorio Romero-González, Faeq Husain-Syed, Abhilash Koratala, Néstor Rodriguez-Chitiva, María Azancot, Marta Cobo Marcos, Amir Kazory, Claudio Ronco","doi":"10.1159/000545621","DOIUrl":"10.1159/000545621","url":null,"abstract":"","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"281-284"},"PeriodicalIF":2.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779272","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}