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Bedside Ultrasound in the Management of Cardiorenal Syndromes: An Updated Review. 床边超声治疗心肾综合征:最新综述。
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-11-18 DOI: 10.1159/000534976
Eduardo R Argaiz, Gregorio Romero-Gonzalez, Philippe Rola, Rory Spiegel, Korbin H Haycock, Abhilash Koratala

Background: Cardiorenal syndromes constitute a spectrum of disorders involving heart and kidney dysfunction modulated by a complex interplay of neurohormonal, inflammatory, and hemodynamic derangements. The management of such patients often poses a diagnostic and therapeutic challenge to physicians owing to gaps in understanding of pathophysiology, paucity of objective bedside diagnostic tools, and individual biases.

Summary: In this narrative review, we discuss the role of clinician who performed bedside ultrasound in the management of patients with cardiorenal syndromes. Novel sonographic applications such as venous excess ultrasound score (VExUS) are reviewed in addition to the lung and focused cardiac ultrasound. Further, underrecognized causes of heart failure such as high-flow arteriovenous fistula are discussed.

Key message: Bedside ultrasound allows a comprehensive hemodynamic characterization of cardiorenal syndromes.

背景:心肾综合征是一系列涉及心脏和肾脏功能障碍的疾病,由神经激素、炎症和血流动力学紊乱的复杂相互作用所调节。由于对病理生理学的理解存在差距,缺乏客观的床边诊断工具和个人偏见,这类患者的管理往往给医生带来诊断和治疗方面的挑战。摘要:在这篇叙述性综述中,我们讨论了临床医生床边超声在心肾综合征患者治疗中的作用。新的超声应用,如静脉超音波(VExUS)除了肺和聚焦心脏超声。此外,未被充分认识的心力衰竭的原因,如高流量动静脉瘘的讨论。关键信息:床边超声可以对心肾综合征进行全面的血流动力学表征。
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引用次数: 0
Effects of Ulinastatin on Postoperative Renal Function in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass: A Prospective Cohort Study with 10-Year Follow-Up. 乌司他丁对体外循环心脏手术患者术后肾功能的影响:一项10年随访的前瞻性队列研究。
IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-06-14 DOI: 10.1159/000531403
Huanran Lv, Qian Li, Yuda Fei, Peng Zhang, Lihuan Li, Jia Shi, Hong Lv

Introduction: The present study aimed to explore the potential effect of ulinastatin on renal function and long-term survival in patients receiving cardiac surgery with cardiopulmonary bypass (CPB).

Methods: This prospective cohort study was conducted at Fuwai Hospital, Beijing, China. Ulinastatin was applied after induction anesthesia. The primary outcome was the rate of new-onset postoperative acute kidney injury (AKI). Moreover, a 10-year follow-up was conducted until January 2021.

Results: The rate of new-onset AKI was significantly lower in the ulinastatin group than in the control group (20.00 vs. 32.40%, p = 0.009). There was no significant difference in renal replacement therapy between the two groups (0.00 vs. 2.16%, p = 0.09). The postoperative plasma neutrophil gelatinase-associated lipocalin (pNGAL) and IL-6 levels were significantly lower in the ulinastatin group compared with the control group (pNGAL: p = 0.007; IL-6: p = 0.001). A significantly lower incidence of respiratory failure in the ulinastatin group compared with the control group (0.76 vs. 5.40%, p = 0.02). The nearly 10-year follow-up (median: 9.37, 95% confidence interval: 9.17-9.57) survival rates did not differ significantly between the two groups (p = 0.076).

Conclusions: Ulinastatin significantly reduced postoperative AKI and respiratory failure in patients receiving cardiac surgery with CPB. However, ulinastatin did not reduce intensive care unit and hospital stays, mortality, and long-term survival rate.

背景:本研究旨在探讨乌司他丁对体外循环心脏手术患者肾功能和长期生存的潜在影响。方法:本前瞻性队列研究在中国北京阜外医院进行。诱导麻醉后应用乌司他丁。主要结果是术后新发急性肾损伤(AKI)的发生率。此外进行了为期十年的随访,直到2021年1月。结果:乌司他丁组的新发AKI发生率显著低于对照组(20.00%vs.32.40%,p=0.009)。两组之间的RRT没有显著差异(0.00%vs.2.16%,p=0.09)。乌司他丁的术后pNGAL和IL-6水平显著低于对照组(pNGAL:p=0.007;IL-6:p=0.001)。与对照组相比,乌司他丁组的呼吸衰竭发生率显著降低(0.76%对5.40%,p=0.02)。两组近10年的随访(9.37,95CI%:9.17-9.57)生存率没有显著差异(p=0.076)接受CPB心脏手术的患者。然而,乌司他丁并没有降低ICU和住院时间、死亡率和长期生存率。关键词:乌司他丁,急性肾损伤,心脏外科手术,体外循环。
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引用次数: 0
Soluble CD14 and Osteoprotegerin Associate with Ankle-Brachial Index as a Measure of Arterial Stiffness in Patients with Mild-to-Moderate Chronic Kidney Disease in a Five-Year Prospective Study. 在一项为期五年的前瞻性研究中,可溶性 CD14 和骨保护蛋白与作为动脉僵硬度测量指标的轻度至中度慢性肾病患者踝肱指数有关。
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-05-15 DOI: 10.1159/000530985
Senka Sendic, Ladan Mansouri, Mun-Gwan Hong, Jochen M Schwenk, Maria J Eriksson, Britta Hylander, Joachim Lundahl, Stefan H Jacobson

Introduction: Vascular lesions and arterial stiffness appear at early stages of chronic kidney disease (CKD) and follow an accelerated course with disease progression, contributing to high cardiovascular mortality. There are limited prospective data on mechanisms contributing to progression of arterial stiffness in mild-to-moderate CKD (stages 2-3).

Methods: We applied an affinity proteomics approach to identify candidates of circulating biomarkers with potential impact on vascular lesions in CKD and selected soluble cluster of differentiation 14 (sCD14), angiogenin (ANG), and osteoprotegerin (OPG) for further analysis. We studied their association with ankle-brachial index (ABI) and carotid intima-media thickness, as measures of arteriosclerosis and atherosclerosis, respectively, in 48 patients with CKD stages 2-3, who were prospectively followed and intensively treated for 5 years, and 44 healthy controls.

Results: Concentrations of sCD14 (p < 0.001), ANG (p < 0.001), and OPG (p < 0.05) were higher in patients with CKD 2-3 at baseline, and sCD14 (p < 0.001) and ANG (p < 0.001) remained elevated in CKD patients at follow-up. There were positive correlations between ABI and sCD14 levels (r = 0.36, p = 0.01) and between ABI and OPG (r = 0.31, p = 0.03) at 5 years. The changes in sCD14 during follow-up correlated to changes in ABI from baseline to 5 years (r = 0.41, p = 0.004).

Conclusion: Elevated levels of circulating sCD14 and OPG in patients with CKD 2-3 were significantly associated with ABI, a measure of arterial stiffness. An increase in sCD14 over time in CKD 2-3 patients was associated with a corresponding increase in ABI. Further studies are needed to examine if early intensive multifactorial medication to align with international treatment targets may influence cardiovascular outcomes.

导言:血管病变和动脉僵化出现在慢性肾脏病(CKD)的早期阶段,并随着疾病的进展而加速,导致心血管死亡率居高不下。有关轻度至中度 CKD(2-3 期)动脉僵化进展机制的前瞻性数据十分有限:方法:我们采用亲和蛋白质组学方法确定了对 CKD 血管病变有潜在影响的循环生物标志物候选物,并选择了可溶性分化簇 14(sCD14)、血管生成素(ANG)和骨蛋白激酶(OPG)进行进一步分析。我们对 48 名接受了为期 5 年的前瞻性随访和强化治疗的 2-3 期 CKD 患者和 44 名健康对照者进行了研究,探讨了它们与踝肱指数(ABI)和颈动脉内膜中层厚度(分别作为动脉硬化和动脉粥样硬化的测量指标)之间的关系:结果:基线时,CKD 2-3 期患者的 sCD14 (p < 0.001)、ANG (p < 0.001) 和 OPG (p < 0.05) 浓度较高,随访时,CKD 患者的 sCD14 (p < 0.001) 和 ANG (p < 0.001) 浓度仍然较高。5 年后,ABI 与 sCD14 水平呈正相关(r = 0.36,p = 0.01),ABI 与 OPG 呈正相关(r = 0.31,p = 0.03)。随访期间 sCD14 的变化与 ABI 从基线到 5 年的变化相关(r = 0.41,p = 0.004):结论:CKD 2-3 患者循环中 sCD14 和 OPG 水平的升高与衡量动脉僵化程度的 ABI 显著相关。随着时间的推移,CKD 2-3 患者体内 sCD14 的增加与 ABI 的相应增加有关。还需要进一步的研究来探讨早期强化多因素药物治疗以与国际治疗目标保持一致是否会影响心血管预后。
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引用次数: 0
Low Lean Tissue Index and Muscle Strength Combined with High Fat Tissue Index Are Associated with Cardiovascular Disease-Related Hospitalisation in Patients on Haemodialysis. 在接受血液透析的患者中,低瘦组织指数和肌肉力量结合高脂肪组织指数与心血管疾病相关的住院有关。
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-10-13 DOI: 10.1159/000534399
Maolu Tian, Qin Lan, Jing Yuan, Pinghong He, Fangfang Yu, Changzhu Long, Yan Zha

Introduction: The combined clinical impact of muscle mass, muscle function, and adipose mass on hospitalisation events, especially those that have exact causes, such as cardiovascular diseases (CVDs), had been rarely studied in patients on haemodialysis (HD). This study aimed to determine the influence of lean tissue index (LTI), fat tissue index (FTI), and hand grip strength (HGS) on the risk of CVD-related hospitalisation in patients undergoing chronic HD.

Methods: This multi-centre observational study enrolled a total of 2,041 clinically stable patients aged >18 years and who had undergone HD for at least 3 months at 17 HD units in 2019. The follow-up period was up to 2 years. LTI and FTI were assessed using a body composition monitoring machine, and HGS was measured by a CAMRY® dynamometer. Cox regression models were fit to estimate the associations of body composition and HGS with CVD-related hospitalisation risk.

Results: During a mean follow-up of 22.6 months, CVD-related hospitalisation occurred in 492 patients. Compared with the non-CVD group, patients with CVD-related hospitalisation were older; had lower diastolic blood pressure; were more likely to have a history of diabetes; had worse activity status scores and lower levels of LTI, HGS, serum uric acid, and serum creatinine; and had higher FTI levels, body mass index, and extracellular water/intracellular water ratio. In the Cox regression models, low LTI and high FTI were independently associated with CVD-related hospitalisation in both men and women. In men, low HGS was an independent risk factor for CVD-related hospitalisation. When patients were further stratified into four distinct groups according to the sex-specific median values of LTI and FTI, the combination of low LTI and high FTI was an independent risk factor for CVD-related hospitalization (hazard ratio [HR] = 1.79 in men, 95% confidence interval 1.26-2.55; HR = 2.48 in women, 95% confidence interval 1.66-3.71; reference: high LTI/low FTI group).

Conclusions: Among patients on chronic HD, low LTI, and high FTI were associated with CVD-related hospitalisation in men and women, whereas HGS was an independent risk factor for CVD-related hospitalisation in men but not in women. Combining low LTI and high FTI increased the association with hospitalisation risk and was an independent predictor of CVD-related hospitalisation.

引言:很少在接受血液透析(HD)的患者中研究肌肉质量、肌肉功能和脂肪质量对住院事件的综合临床影响,尤其是那些有确切原因的事件,如心血管疾病(CVD)。本研究旨在确定瘦组织指数(LTI)、脂肪组织指数(FTI)和握力(HGS)对慢性HD患者CVD相关住院风险的影响。方法:这项多中心观察性研究共招募了2041名临床稳定的患者,年龄>18岁,2019年在17个HD单位接受HD至少三个月。随访期长达两年。LTI和FTI使用身体成分监测机进行评估,HGS通过CAMRY®测功机进行测量。Cox回归模型适用于估计身体成分和HGS与CVD相关住院风险的相关性。结果:在平均22.6个月的随访中,492名患者发生了心血管疾病相关的住院治疗。与非心血管疾病组相比,心血管疾病相关住院患者年龄较大;舒张压较低;更有可能有糖尿病病史;活动状态评分较差,LTI、HGS、血清尿酸和血清肌酐水平较低,FTI水平、体重指数和细胞外水/细胞内水比率较高。在Cox回归模型中,在男性和女性中,低LTI和高FTI与CVD相关的住院独立相关。在男性中,低HGS是心血管疾病相关住院的独立风险因素。当根据LTI和FTI的性别特异性中值将患者进一步分为四个不同的组时,低LTI和高FTI的组合是CVD相关住院的独立危险因素(男性的危险比=1.79,95%置信区间1.26-2.55;女性的危险比=2.48,95%置信间隔1.66-3.71;参考:高LTI/低FTI组),而HGS是男性心血管疾病相关住院的独立风险因素,而女性则不然。低LTI和高FTI的结合增加了与住院风险的相关性,是CVD相关住院的独立预测因素。
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引用次数: 0
One Heartbeat Away from a Prediction Model for Cardiovascular Diseases in Patients with Chronic Kidney Disease: A Systematic Review. 距离慢性肾病患者心血管疾病预测模型仅一步之遥:系统回顾
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-02-20 DOI: 10.1159/000529791
Leanne C M Smit, Michiel L Bots, Joep van der Leeuw, Johanna A A G Damen, Peter J Blankestijn, Marianne C Verhaar, Robin W M Vernooij

Introduction: Patients with chronic kidney disease (CKD) have a high risk of cardiovascular disease (CVD). Prediction models, combining clinical and laboratory characteristics, are commonly used to estimate an individual's CVD risk. However, these models are not specifically developed for patients with CKD and may therefore be less accurate. In this review, we aim to give an overview of CVD prognostic studies available, and their methodological quality, specifically for patients with CKD.

Methods: MEDLINE was searched for papers reporting CVD prognostic studies in patients with CKD published between 2012 and 2021. Characteristics regarding patients, study design, outcome measurement, and prediction models were compared between included studies. The risk of bias of studies reporting on prognostic factors or the development/validation of a prediction model was assessed with, respectively, the QUIPS and PROBAST tool.

Results: In total, 134 studies were included, of which 123 studies tested the incremental value of one or more predictors to existing models or common risk factors, while only 11 studies reported on the development or validation of a prediction model. Substantial heterogeneity in cohort and study characteristics, such as sample size, event rate, and definition of outcome measurements, was observed across studies. The most common predictors were age (87%), sex (75%), diabetes (70%), and estimated glomerular filtration rate (69%). Most of the studies on prognostic factors have methodological shortcomings, mostly due to a lack of reporting on clinical and methodological information. Of the 11 studies on prediction models, six developed and internally validated a model and four externally validated existing or developed models. Only one study on prognostic models showed a low risk of bias and high applicability.

Conclusion: A large quantity of prognostic studies has been published, yet their usefulness remains unclear due to incomplete presentation, and lack of external validation of prognostic models. Our review can be used to select the most appropriate prognostic model depending on the patient population, outcome, and risk of bias. Future collaborative efforts should aim at improving existing models by externally validating them, evaluating the addition of new predictors, and assessment of the clinical impact.

Registration: We have registered the protocol of our systematic review on PROSPERO (CRD42021228043).

简介慢性肾脏病(CKD)患者罹患心血管疾病(CVD)的风险很高。结合临床和实验室特征的预测模型通常用于估算个人的心血管疾病风险。然而,这些模型并不是专门为慢性肾脏病患者开发的,因此可能不太准确。在这篇综述中,我们旨在概述现有的心血管疾病预后研究及其方法质量,特别是针对 CKD 患者的研究:方法:检索了 MEDLINE 上 2012 年至 2021 年间发表的报道 CKD 患者心血管疾病预后研究的论文。对纳入研究的患者特征、研究设计、结果测量和预测模型进行了比较。分别使用QUIPS和PROBAST工具评估了报告预后因素或预测模型开发/验证的研究的偏倚风险:总共纳入了 134 项研究,其中 123 项研究测试了一个或多个预测因子对现有模型或常见风险因素的增量价值,只有 11 项研究报告了预测模型的开发或验证情况。不同研究在队列和研究特征(如样本大小、事件发生率和结果测量的定义)方面存在很大的异质性。最常见的预测因素是年龄(87%)、性别(75%)、糖尿病(70%)和估计肾小球滤过率(69%)。大多数关于预后因素的研究都存在方法上的缺陷,主要是由于缺乏临床和方法学信息的报告。在 11 项关于预测模型的研究中,有 6 项研究开发并在内部验证了一个模型,4 项研究从外部验证了现有或开发的模型。只有一项关于预后模型的研究显示偏倚风险低,适用性强:结论:大量的预后研究已经发表,但由于介绍不完整以及预后模型缺乏外部验证,这些研究的实用性仍不明确。我们的综述可用于根据患者人群、结果和偏倚风险选择最合适的预后模型。未来的合作目标应该是通过外部验证来改进现有模型,评估新增的预测因子,并评估其临床影响:我们已在 PROSPERO(CRD42021228043)上注册了我们的系统综述方案。
{"title":"One Heartbeat Away from a Prediction Model for Cardiovascular Diseases in Patients with Chronic Kidney Disease: A Systematic Review.","authors":"Leanne C M Smit, Michiel L Bots, Joep van der Leeuw, Johanna A A G Damen, Peter J Blankestijn, Marianne C Verhaar, Robin W M Vernooij","doi":"10.1159/000529791","DOIUrl":"10.1159/000529791","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with chronic kidney disease (CKD) have a high risk of cardiovascular disease (CVD). Prediction models, combining clinical and laboratory characteristics, are commonly used to estimate an individual's CVD risk. However, these models are not specifically developed for patients with CKD and may therefore be less accurate. In this review, we aim to give an overview of CVD prognostic studies available, and their methodological quality, specifically for patients with CKD.</p><p><strong>Methods: </strong>MEDLINE was searched for papers reporting CVD prognostic studies in patients with CKD published between 2012 and 2021. Characteristics regarding patients, study design, outcome measurement, and prediction models were compared between included studies. The risk of bias of studies reporting on prognostic factors or the development/validation of a prediction model was assessed with, respectively, the QUIPS and PROBAST tool.</p><p><strong>Results: </strong>In total, 134 studies were included, of which 123 studies tested the incremental value of one or more predictors to existing models or common risk factors, while only 11 studies reported on the development or validation of a prediction model. Substantial heterogeneity in cohort and study characteristics, such as sample size, event rate, and definition of outcome measurements, was observed across studies. The most common predictors were age (87%), sex (75%), diabetes (70%), and estimated glomerular filtration rate (69%). Most of the studies on prognostic factors have methodological shortcomings, mostly due to a lack of reporting on clinical and methodological information. Of the 11 studies on prediction models, six developed and internally validated a model and four externally validated existing or developed models. Only one study on prognostic models showed a low risk of bias and high applicability.</p><p><strong>Conclusion: </strong>A large quantity of prognostic studies has been published, yet their usefulness remains unclear due to incomplete presentation, and lack of external validation of prognostic models. Our review can be used to select the most appropriate prognostic model depending on the patient population, outcome, and risk of bias. Future collaborative efforts should aim at improving existing models by externally validating them, evaluating the addition of new predictors, and assessment of the clinical impact.</p><p><strong>Registration: </strong>We have registered the protocol of our systematic review on PROSPERO (CRD42021228043).</p>","PeriodicalId":9584,"journal":{"name":"Cardiorenal Medicine","volume":" ","pages":"109-142"},"PeriodicalIF":3.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10472924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10139700","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}
引用次数: 0
Diuretics and Ultrafiltration in Heart Failure. 心力衰竭的利尿剂和超滤。
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-01-11 DOI: 10.1159/000529068
Thiago Reis, Federico Ronco, Marlies Ostermann

Fluid overload is a risk factor for increased morbidity and mortality, especially in patients with heart disease. The treatment options are limited to diuretics and mechanical fluid removal using ultrafiltration or renal replacement therapy. This paper provides an overview of the challenges of managing fluid overload, outlines the risks and benefits of different pharmacological options and extracorporeal techniques, and provides guidance for clinical practice.

体液超负荷是发病率和死亡率升高的一个危险因素,尤其是对心脏病患者而言。治疗方法仅限于利尿剂和使用超滤或肾脏替代疗法进行机械性液体清除。本文概述了处理体液超负荷所面临的挑战,概述了不同药理选择和体外技术的风险和益处,并为临床实践提供了指导。
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引用次数: 0
The War of Attrition on Diuretic Resistance: We Need to Open a Third Front. 利尿剂耐药性的消耗战:我们需要开辟第三条战线。
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-08-28 DOI: 10.1159/000533478
Amir Kazory
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引用次数: 0
Transcatheter Aortic Valve Replacement-Associated Acute Kidney Injury: An Update. 经导管主动脉瓣置换术相关急性肾损伤:更新。
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-02-17 DOI: 10.1159/000529729
Frederick Berro Rivera, Abdullah Al-Abcha, Marie Francesca Mapua Ansay, John Vincent Usita Magalong, Vincent Anthony Songheng Tang, Hannah May Ona, Karissa Alyanna Miralles, Rausche Sausa, Rodie Abram Florendo Uy, Edgar V Lerma, Fareed Moses S Collado, Peter A McCullough, Annabelle Santos Volgman

Background: Transcatheter aortic valve replacement (TAVR) is a relatively novel minimally invasive procedure for the treatment of symptomatic patients with severe aortic stenosis. Although it has been proven effective in improving mortality and quality of life, TAVR is associated with serious complications, such as acute kidney injury (AKI).

Summary: TAVR-associated AKI is likely due to several factors such as sustained hypotension, transapical approach, volume of contrast use, and baseline low GFR. This narrative review aims to present an overview of the latest literature and evidence regarding the definition of TAVR-associated AKI, its risk factors, and its impact on morbidity and mortality. The review used a systematic search strategy with multiple health-focused databases (Medline, EMBASE) and identified 8 clinical trials and 27 observational studies concerning TAVR-associated AKI. Results showed that TAVR-associated AKI is linked to several modifiable and nonmodifiable risk factors and is associated with higher mortality. A variety of diagnostic imaging modalities have the potential to identify patients at high risk for development of TAVR-AKI; however, there are no existing consensus recommendations regarding their use as of this time. The implications of these findings highlight the importance of identifying high-risk patients for which preventive measures may play a crucial role, and should be maximized.

Key message: This study reviews the current understanding of TAVR-associated AKI including its pathophysiology, risk factors, diagnostic modalities, and preventative management for patients.

背景:经导管主动脉瓣置换术(TAVR)是一种相对新颖的微创手术,用于治疗有症状的重度主动脉瓣狭窄患者。摘要:经导管主动脉瓣置换术相关的急性肾损伤(AKI)可能是由多种因素造成的,如持续低血压、经心尖入路、造影剂用量和基线低 GFR。本叙述性综述旨在概述有关 TAVR 相关性 AKI 的定义、风险因素及其对发病率和死亡率的影响的最新文献和证据。该综述采用了系统性检索策略,在多个以健康为重点的数据库(Medline、EMBASE)中进行了检索,确定了 8 项临床试验和 27 项有关 TAVR 相关性 AKI 的观察性研究。结果显示,TAVR相关性AKI与多种可改变和不可改变的风险因素有关,并与较高的死亡率相关。各种诊断成像模式都有可能识别出发生 TAVR-AKI 的高风险患者;但是,目前还没有关于使用这些模式的共识性建议。这些研究结果的意义强调了识别高风险患者的重要性,预防措施可能对这些患者起到至关重要的作用,并应最大限度地利用这些措施:本研究回顾了目前对 TAVR 相关性 AKI 的理解,包括其病理生理学、风险因素、诊断方法和患者的预防管理。
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引用次数: 0
Association of Chronic Kidney Disease with Cardiovascular Disease in Cancer Patients: A Cross-Sectional Study. 癌症患者慢性肾脏疾病与心血管疾病的相关性:一项横断面研究。
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-10-14 DOI: 10.1159/000534182
An-Bang Liu, Dan Zhang, Ting-Ting Meng, Yu Zhang, Peng Tian, Jian-Lin Chen, Yan Zheng, Guo-Hai Su

Introduction: Due to the cardiotoxicity of cancer treatment and traditional risk factors for cardiovascular disease (CVD) such as obesity, diabetes, dyslipidemia, and hypertension, cancer patients are at higher risk of developing CVD. However, limited research exists on the correlation between chronic kidney disease (CKD) and CVD risk in cancer patients.

Methods: This cross-sectional study selected cancer patients aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) conducted from 2015 to 2020. Multivariable logistic regression was used to assess the association between CKD and CVD in cancer patients. Additionally, subgroup analyses were conducted to investigate the association among different groups of cancer patients.

Results: We included 1,700 adult cancer patients (52.53% were females). After multivariable adjustment for covariates including traditional CVD factors, CKD was significantly associated with CVD, with an odds ratio (95% confidence interval) and p value of 1.61 (1.18, 2.19) and 0.004. Subgroup analyses after multivariable adjustment showed a significant correlation between CKD and increased CVD risk in the following cancer patients: age ≥60 years, males, white ethnicity, and individuals with or without traditional CVD factors (obesity, diabetes, dyslipidemia, and hypertension).

Conclusions: CKD remains a significant factor in the higher risk of CVD among adult cancer patients in the United States, even after adjustment for traditional CVD risk factors. Therefore, to reduce the risk of CVD in cancer patients, it is important to treat CKD as a non-traditional risk factor for CVD and actively manage it.

简介:由于癌症治疗的心脏毒性以及肥胖、糖尿病、血脂异常和高血压等心血管疾病(CVD)的传统危险因素,癌症患者患CVD的风险更高。然而,对癌症患者慢性肾脏疾病(CKD)与心血管疾病风险之间的相关性研究有限。方法:本横断面研究从2015年至2020年进行的全国健康与营养检查调查(NHANES)中选择年龄≥20岁的癌症患者。多因素逻辑回归用于评估癌症患者CKD和CVD之间的相关性。此外,还进行了亚组分析,以调查癌症患者不同群体之间的关联。结果:我们纳入了1700名成年癌症患者(52.53%为女性)。在对包括传统CVD因素在内的协变量进行多变量校正后,CKD与CVD显著相关,优势比(95%置信区间)和P值分别为1.61(1.18,2.19)和0.004。多变量校正后的亚组分析显示,CKD与以下人群心血管疾病风险增加之间存在显著相关性:年龄≥60岁、男性、白人、,以及有或没有传统心血管疾病因素(肥胖、糖尿病、血脂异常和高血压)的个体。结论:即使在对传统心血管疾病风险因素进行调整后,CKD仍然是美国成年癌症患者心血管疾病高风险的重要因素。因此,为了降低癌症患者患心血管疾病的风险,将CKD作为心血管疾病的非传统危险因素进行治疗并积极管理至关重要。
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引用次数: 0
Vascular Calcification Exacerbates Abnormal Blood Pressure Variability in Chronic Kidney Disease: A "Two-Step" Study in Rats. 血管钙化加剧慢性肾病患者血压的异常变化:大鼠的 "两步 "研究
IF 3.8 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2023-01-01 Epub Date: 2023-02-10 DOI: 10.1159/000528898
Yuqin Xiong, Yang Yu, Ke Huang, Ruoxi Liao, Liya Wang, Zhuyun Zhang, Jiameng Li, Zheng Qin, Si Sun, Yupei Li, Baihai Su

Introduction: Vascular calcification (VC) is a common complication of chronic kidney disease (CKD) with poor cardiovascular prognosis. The aim of this study was to explore the impact of VC on blood pressure variability (BPV) in animal models of CKD.

Methods: Two optimal modelling methods, adenine high-phosphorus (HP) diet + calcitriol and 5/6 nephrectomy (Nx) + HP diet + calcitriol, for CKD-VC were chosen from the first-step experiment for the next step. A total of 36 male Wistar rats were randomly assigned to the standard-chow, sham-operated, adenine, 5/6Nx, adenine-VC, and 5/6Nx-VC groups. Continuous blood pressure (BP) measurement using the BP-2000 animal noninvasive BP analyser was started at the 9th week for the standard-chow, adenine, and adenine-VC groups and at the 7th week for the sham-operated, 5/6Nx, and 5/6Nx-VC groups. BPV metrics (BPVs), including the difference between maximum and minimum values, standard deviation, coefficient of variation, average real variability, and residuals derived from the generalized linear model of BP, were calculated.

Results: The first experiment showed that the use of calcitriol accelerated the progression of VC in CKD rats (the modelling period was shortened from 16 weeks to 4-8 weeks) and confirmed the occurrence of VC at weeks 8 and 6 in the adenine-VC and 5/6Nx-VC groups, respectively. In the second experiment, 13 of 20 hour-to-hour BPVs increased significantly with the development of CKD and VC. BPV differences among the standard-chow, adenine, and adenine-VC groups were mainly due to the differences between the standard-chow and adenine-VC groups (7 of 10 BPVs were significantly different), followed by the differences between the standard-chow and adenine groups (3 of 10). BPV differences among the sham-operated, 5/6Nx, and 5/6Nx-VC groups were caused by the differences between the 5/6Nx-VC and 5/6Nx groups (4 of 10) or the 5/6Nx-VC and sham-operated groups (3 of 10).

Conclusion: An increased BPV is observed in CKD rats, and VC further aggravates the abnormality of BPVs independent of CKD.

简介:血管钙化(VC)是慢性肾脏病(CKD)的常见并发症,心血管预后不良。本研究旨在探讨血管钙化对 CKD 动物模型血压变异性(BPV)的影响:从第一步实验中选择了两种针对 CKD-VC 的最佳建模方法:腺嘌呤高磷(HP)饮食 + 降钙素三醇和 5/6 肾切除术(Nx) + HP 饮食 + 降钙素三醇。总共 36 只雄性 Wistar 大鼠被随机分配到标准牛、假手术、腺嘌呤、5/6Nx、腺嘌呤-VC 和 5/6Nx-VC 组。标准牛组、腺嘌呤组和腺嘌呤-VC 组在第 9 周开始使用 BP-2000 动物无创血压分析仪连续测量血压,假手术组、5/6Nx 组和 5/6Nx-VC 组在第 7 周开始测量血压。计算了血压值指标(BPVs),包括最大值和最小值之差、标准偏差、变异系数、平均实际变异性以及从血压的广义线性模型中得出的残差:第一个实验表明,使用降钙素三醇加速了 CKD 大鼠 VC 的进展(建模期从 16 周缩短至 4-8 周),并证实腺嘌呤-VC 组和 5/6Nx-VC 组分别在第 8 周和第 6 周出现了 VC。在第二项实验中,随着 CKD 和 VC 的发展,20 个小时到小时 BPV 中的 13 个显著增加。标准牛组、腺嘌呤组和腺嘌呤-VC 组之间的 BPV 差异主要来自标准牛组和腺嘌呤-VC 组之间的差异(10 个 BPV 中有 7 个存在显著差异),其次是标准牛组和腺嘌呤组之间的差异(10 个 BPV 中有 3 个存在显著差异)。假手术组、5/6Nx组和5/6Nx-VC组之间的BPV差异是由5/6Nx-VC组和5/6Nx组之间的差异(10个中的4个)或5/6Nx-VC组和假手术组之间的差异(10个中的3个)造成的:结论:观察到 CKD 大鼠的 BPV 增加,VC 进一步加剧了 BPV 的异常,与 CKD 无关。
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Cardiorenal Medicine
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