Cardiorenal Medicine最新文献

Introduction: Patients on extracorporeal membrane oxygenation (ECMO) often experience worse renal outcomes and higher mortality rates as the severity of kidney injury increases. Nevertheless, the in-hospital mortality risks of patients with end-stage renal disease (ESRD) are poorly understood. This study evaluated several prognostic factors associated with in-hospital mortality in patients with ESRD receiving ECMO therapy.

Methods: This study reviewed the medical records of 90 adult patients with ESRD on venoarterial ECMO in intensive care units in Linkou Chang Gung Memorial Hospital between March 2009 and February 2022. Fourteen patients who died within 24 h of receiving ECMO support were excluded; the remaining 76 patients were enrolled. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. The primary outcome was in-hospital mortality.

Results: The overall in-hospital mortality rate was 69.7%. The most common diagnosis requiring ECMO support was postcardiotomy cardiogenic shock, and the most frequent ECMO-associated complication was infection. Multiple logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score on day 1 of ECMO support was an independent risk factor for in-hospital mortality. The APACHE II score demonstrated satisfactory discriminative power (0.788 ± 0.057) in the area under the receiver operating characteristic curve. The cumulative survival rates at the 6-month follow-up differed significantly (p < 0.001) between patients with APACHE II score ≤ 29 versus those with APACHE II score >29.

Conclusion: For patients with ESRD on ECMO, the APACHE II score is an excellent predictor of in-hospital mortality.

Background: Cardiorenal syndrome (CRS) refers to the bidirectional interactions between the acutely or chronically dysfunctioning heart and kidney that lead to poor outcomes. Due to the evolving literature on renal impairment and heart failure with preserved ejection fraction (HFpEF), this review aimed to highlight the pathophysiological pathways, diagnosis using imaging and biomarkers, and management of CRS in patients with HFpEF.

Summary: The mechanism of CRS in HFpEF can be hypothesized due to the interplay of elevated central venous pressure, renin-angiotensin-aldosterone system (RAAS) activation, oxidative stress, endothelial dysfunction, coronary microvascular dysfunction, and chronotropic incompetence. The correlation between HFpEF and worsening renal function seen in both long-term trials and observational data points to the evidence for these mechanisms. Upcoming biomarkers such as cystatin C, NGAL, NAG, KIM-1, ST-2, and galectin-3, along with conventional ones, are promising for early diagnosis, risk stratification, or response to therapy. Despite the lack of specific treatment for CRS in HFpEF, the management can be discussed with similar medications used in goal-directed medical therapy for heart failure with reduced ejection fraction (HFrEF). Additionally, there is increasing evidence for the role of vasodilators, inotropes, assist devices, and renal denervation, although long-term studies are necessary.

Key message: The management of CRS in HFpEF is an evolving field that currently shows promise for using diagnostic and prognostic biomarkers, conventional heart failure medications, and novel therapies such as renal denervation, interatrial shunt, and renal assist devices. Further studies are needed to understand the pathophysiological pathways, validate the use of novel biomarkers, especially for early diagnosis and prognostication, and institute new management strategies for CRS in patients with HFpEF.

Introduction: Acute kidney injury (AKI) frequently complicates ST-elevation myocardial infarction (STEMI) in patients undergoing primary percutaneous coronary intervention (PCI) and is associated with increased short- and long-term mortality. However, the impact of the AKI onset time following PCI on patient outcomes remains uncertain. This study aimed to investigate the timing of post-PCI AKI development and its prognostic significance in STEMI patients.

Methods: This retrospective cohort study included 2,912 STEMI patients who underwent successful PCI upon admission. The timing of AKI was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using routine blood tests conducted during hospitalization. The primary endpoint was all-cause mortality.

Results: Among 2,912 STEMI patients studied, 222 (7.6%) developed AKI. AKI was classified as early if it occurred within 1.5 days (n = 108, 48.6%) or late if it occurred after 1.5 days (n = 114, 51.4%). Early AKI was associated with a significantly higher incidence of cardiogenic shock at presentation, lower post-PCI left ventricular ejection fraction, and increased 30-day mortality compared to late AKI. In a multivariate Cox regression analysis, early AKI emerged as an independent predictor of long-term mortality (adjusted HR 1.8, 95% CI 1.1-2.8, p = 0.015). Additionally, multivariate logistic regression analysis identified cardiogenic shock as a significant predictor of early AKI (adjusted OR 2.3, 95% CI 1.1-4.9, p = 0.03).

Conclusion: In STEMI patients, early AKI - compared to late AKI - is associated with higher short- and long-term mortality and occurs more frequently in those presenting with cardiogenic shock.

Introduction: This study endeavors to evaluate the distribution patterns and research frontiers within the international literature on the association between chronic kidney disease and cardiovascular diseases in the medical field, through bibliometric analysis and visualized information.

Methods: The Web of Science Core Collection database was selected as the data source from 2010 to 2023, and articles related to the association between chronic kidney disease and cardiovascular diseases were retrieved. The article data were analyzed through CiteSpace for bibliometric mapping, involving the examination of keywords, references, country/region distributions, and institutional contributions to identify and understand the evolving research dynamics and frontiers in this interdisciplinary field.

Results: A total of 2,936 publications on the association between chronic kidney disease and cardiovascular diseases were included. The country with the most publications was USA (n = 904), and the institution with the most publications was University of Pennsylvania (n = 116). The most frequent keywords were chronic kidney disease (n = 2,194), cardiovascular disease (n = 1,188), and mortality (n = 604). The top 20 keywords and top 10 references that burst during 2010 to 2023 were listed.

Conclusion: The association between chronic kidney disease and cardiovascular diseases has sparked extensive research, particularly in high-prevalence areas. From 2010 to 2023, publications on the association between chronic kidney disease and cardiovascular diseases show a linear increase. Current research hotspots and frontiers are mainly in cardiovascular-kidney-metabolic syndrome; innovative therapies and drug impact; gut microbiome; Mendelian randomization analysis. Overall, our study offers a comprehensive scientometric analysis of the association between chronic kidney disease and cardiovascular diseases, providing valuable insights for both researchers and healthcare professionals in the field.

Introduction: In acute heart failure (AHF), the factors associated with successful renal replacement therapy (RRT) discontinuation are largely undefined. We hypothesized that improvements in Doppler-derived renal venous flow (RVF) waveforms may serve as indicators of recovering cardiorenal function associated with successful liberation from RRT.

Methods: We performed a post hoc analysis of a prospective cohort study involving inpatients with AHF undergoing serial renal Doppler evaluations. Patients who received acute RRT were retained for analysis, with Doppler assessments conducted both before RRT initiation and after discontinuation. Successful RRT discontinuation was defined as RRT cessation without relapse for at least 14 days. Logistic regression was used to evaluate the association between changes in RVF markers - including intra-renal venous flow (IRVF) and the renal venous stasis index (RVSI) - and RRT discontinuation, along with echocardiographic and clinical data from pre- to post-RRT Doppler measurements.

Results: Overall, 10/53 (19%) patients successfully discontinued RRT. Increases in the severity of IRVF patterns and RVSI were negatively associated with RRT discontinuation (IRVF per 1-pattern increase in severity: OR 0.01, 95% CI, <0.001-0.11; p < 0.001; RVSI per 0.1-unit increase: OR 0.11, 95% CI, 0.03-0.48; p < 0.001). Additionally, improvements in right ventricular function markers, such as the TAPSE/sPAP ratio (per 0.1 mm/mm Hg increase: OR 1.83, 95% CI, 1.03-3.32; p = 0.049), were associated with higher odds of RRT discontinuation.

Conclusions: In AHF patients requiring acute RRT, improvements in RVF were associated with successful RRT discontinuation. Serial RVF assessment may offer a noninvasive means of capturing dynamic changes in cardiorenal syndrome physiology and renal recovery. Larger studies with more frequent and appropriately timed Doppler assessments are needed to determine whether RVF monitoring may guide RRT management in AHF.

Introduction: Cardiovascular-kidney-metabolic (CKM) syndrome is a condition characterized by the interplay between cardiovascular disease, kidney disease, diabetes, and obesity, resulting in adverse health outcomes. This study aimed to investigate the differential associations between various adipose tissue types and the progression of CKM syndrome, as well as their relationship with the individual components of the syndrome.

Methods: We conducted a retrospective review of 441 individuals with preserved left ventricular (LV) systolic function who underwent both transthoracic echocardiography and abdominal computed tomography. LV structural and functional parameters, along with the thickness of epicardial adipose tissue (EAT), perirenal adipose tissue (PAT), and subcutaneous adipose tissue (SAT), were assessed through these imaging modalities. Additionally, the triglyceride and glucose (TyG) index was evaluated as a marker of insulin resistance, while glomerular filtration rate (GFR) was estimated to assess kidney function.

Results: EAT and PAT demonstrated a progressive increase in thickness with advancing stages of CKM syndrome, whereas body mass index and SAT did not show similar trends. EAT was predominantly associated with markers of LV diastolic dysfunction, while PAT was uniquely associated with GFR, independent of other adipose tissue. Furthermore, the TyG index was independently correlated with the thickness of both EAT and PAT, but not with SAT thickness.

Conclusion: Heart, kidney, and metabolic disorders associated with CKM syndrome demonstrated varying correlations depending on the specific regional adipose tissue depot. EAT and PAT were identified as key regional adipose tissue linked to the progression of CKM syndrome.

Background: The estimated glucose disposal rate (eGDR) is a useful indicator of insulinresistance. Thisstudy explores its asociation with cadiovascular-kidney-metabolic syndrome (CKM), a relationship that has rarely been investigated. The aim of this research was toexamine potential correlations between eGDR and CKM.

Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. eGDR was categorized into three quartiles: Q1, Q2, and Q3. Weighted multivariate cox regression models, competing risk models and restricted cubic spline (RCS) models were applied to investigate the association between eGDR and mortality outcomes, including all-cause and cause-specific mortality. Subgroup analysis was performed to test the robustness of the results.

Results: Of the 14,074 patients with CKM, 2,426 died, including 767 from cardio-cerebrovascular disease and 39 from kidney disease. After adjustment for all potential confounders, weighted multivariate cox models showed that eGDR was inversely associated with mortality from all causes and with mortality from cardio-cerebrovascular (p < 0.05), but not with mortality from kidney disease (p > 0.05). The RCS model further confirmed the linear relationship between eGDR all-cause cardio-cerebrovascular, with statistical evidence supporting this (p for nonlinear >0.05). Even when using non-cardiovascular-cerebrovascular mortality as a competitive risk, the adjusted Fine-Gray model demonstrated that eGDR remains an independent predictor of cardiovascular-cerebrovascular mortality (SHR 0.560, 95% CI 0.460-0.680, p < 0.001).

Conclusion: Our findings reveal a significant inverse association between eGDR and the risk of both all-cause and cardio-cerebrovascular mortality in patients with CKM. This suggests that higher levels of eGDR are linked to a lower risk of death from these causes, indicating that improving insulin sensitivity may have protective effects on survival outcomes in CKM patients.

Background: Recently, a large clinical trial found that treatment with semaglutide significantly reduced the risk of renal damage and cardiovascular death in patients with type 2 diabetes (T2D). To validate these findings and ensure the suitability of the drug, it is necessary to address the renal and cardiac safety of semaglutide in patients with T2D through real-world safety evidence.

Methods: We examined post-marketing data on the use of semaglutide in patients with T2D using disproportionality analysis based on the FDA Adverse Event Reporting System database. We focused on the detection of positive signals for acute and chronic renal injury and cardiac adverse events associated with semaglutide therapy.

Results: A total of 2,380 patients were enrolled in semaglutide therapy in T2D patients with no renal or cardiac positive signals in four algorithmic thresholds, including disproportionality analysis.

Conclusions: In the current study, we observed no significant cardiac or renal safety signals in patients with T2D treated with semaglutide. Our results provide further support for its use as initial and combination therapy in relevant populations.

Background: Emerging evidence indicates that serum polyamines, including putrescine, spermidine, and spermine, may serve as potential biomarkers for chronic kidney disease (CKD) and its progression. However, the association between serum polyamine levels, cardiovascular (CV) events, and mortality in CKD patients remains poorly understood.

Methods: A retrospective cohort study was conducted, involving 297 adult patients with CKD at stages 1-5 from March 2015 to September 2018, with follow-up until May 2023. Serum polyamine levels were quantified using high-performance liquid chromatography and subsequently categorized into quartiles. The Kaplan-Meier curve was employed to assess the survival probabilities of CV events and overall mortality in relation to serum polyamine levels. The relationship between serum polyamines and the risk of cardiovascular disease (CVD) and overall mortality was explored using univariate and multivariate Cox regression analyses. Furthermore, we conducted a competing-risk analysis to investigate the link between serum polyamines and CV events, with mortality as the competing event.

Results: Over a median follow-up of 6.11 years, our findings revealed a negative correlation between putrescine levels and estimated glomerular filtration rate (eGFR), while spermidine and spermine levels were positively correlated with eGFR. The Kaplan-Meier curve demonstrated that serum polyamines were significantly associated with risk of CV events and all-cause mortality. Moreover, Cox regression analyses showed that, in a multivariate Cox model, patients in the highest quartile of putrescine displayed a significantly higher risk of CV events (hazard ratio [HR] 6.972, 95% confidence interval [CI] 2.520-19.294, p < 0.001) compared to those in the lowest quartile. Conversely, higher levels of spermidine were associated with a lower risk of CV events (HR = 0.077, 95% CI 0.022-0.274, p < 0.001), and higher levels of spermine also appeared to reduce the risk of CV events (HR = 0.180, 95% CI 0.061-0.530, p = 0.002). The relationship between serum polyamines and CVD remained robust in the competing risk models. Additionally, in the multivariate model, spermidine and spermine showed a significant protective effect on the risk of overall mortality; however, the protective effect was diminished upon the inclusion of eGFR as a covariate.

Conclusions: Our study demonstrates significant disruption in serum polyamine levels among CKD patients, which correlates with eGFR. Altered polyamine levels are linked to an increased risk of CV events and overall mortality. Thus, serum polyamines may be considered valuable prognostic indicators for CKD patients.