Chronic kidney disease (CKD) is considered a model of accelerated aging. More specifically, CKD leads to reduced physical functioning and increased frailty, increased vascular dysfunction, vascular calcification and arterial stiffness, high levels of systemic inflammation, and oxidative stress, as well as increased cognitive impairment. Increasing evidence suggests that the cognitive impairment associated with CKD may be related to cerebral small vessel disease and overall impairment in white matter integrity. The triad of poor physical function, vascular dysfunction, and cognitive impairment places patients living with CKD at an increased risk for loss of independence, poor health-related quality of life, morbidity, and mortality. The purpose of this review is to discuss the available evidence of cerebrovascular-renal axis and its interconnection with early and accelerated cognitive impairment in patients with CKD and the plausible role of exercise as a therapeutic modality. Understanding the cerebrovascular-renal axis pathophysiological link and its interconnection with physical function is important for clinicians in order to minimize the risk of loss of independence and improve quality of life in patients with CKD.

CKD is associated with increased (inactive) dp-ucMGP, a vitamin K-dependent inhibitor of vascular calcification, which correlates with large artery stiffness. Further studies are needed to assess whether vitamin K2 supplementation represents a suitable therapeutic strategy to prevent or reduce arterial stiffening in CKD.

Early treatment of patients with acute coronary syndromes (ACS) is crucial to reduce morbidity and mortality. The purpose of this study was to examine delay in seeking care for ACS symptoms in a Lebanese sample and identify predictors of delay. Medical record reviews and interviews using the Response to Symptoms Questionnaire were conducted with 204 ACS patients in coronary care within 72 hours of admission. Median time from symptom onset to hospital arrival was 4.5 hours. Higher education, presence of dyspnea, intermittent symptoms, and waiting for symptoms to go away predicted longer delays, whereas intensity of symptoms and active response (going to the hospital) predicted shorter delays. The findings suggest lack of knowledge of ACS symptoms and the need for public education in this regard.

Background Signs and symptoms of acute coronary syndromes differ between men and women, but whether men and women respond differently to these indications is not well understood. Such responses influence health outcomes because success of treatment depends on how quickly healthcare is sought. Objective To explore differences between Lebanese men and women in cognitive, emotional, and behavioral responses to signs and symptoms of acute coronary syndromes. Methods A convenience sample of 149 men and 63 women with unstable angina or acute myocardial infarction were interviewed within 72 hours of admission to coronary care in a tertiary center by using the Response to Symptoms Questionnaire. Demographic and clinical data were obtained from medical records. Results Women were older, less educated, and more often widowed than men. More women had hypertension but more men were current smokers. Women had shoulder pain, dyspnea, nausea and vomiting, and palpitations more often than men did. Women’s signs and symptoms were rated more severe by the women than men’s were by the men. Women were less likely to know signs and symptoms of myocardial infarction than were men and delayed coming to the hospital longer than men did. Delay correlated with the characteristics of the signs and symptoms and not realizing their importance in men and with dyspnea and taking the “wait and see” approach in women. Conclusion Factors related to promptness in seeking care for acute coronary syndromes differ between Lebanese men and women.

The purpose of this review was to synthesize evidence on symptom clusters in patients with chronic kidney disease (CKD). The quality of studies was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twelve articles met inclusion criteria. Patients had CKD ranging from Stages 2 through 5. Most studies determined clusters using variable-centered approaches based on symptoms; however, one used a person-centered approach based on demographic and clinical characteristics. The number of clusters identified ranged from two to five. Several clusters were prominent across studies including symptom dimensions of fatigue/energy/sleep, neuromuscular/pain, gastrointestinal, skin, and uremia; however, individual symptoms assigned to clusters varied widely. Several clusters correlated with patient outcomes, including health-related quality of life and mortality. Identifying symptom clusters in CKD is a nascent field, and more research is needed on symptom measures and statistical methods for clustering. The clinical implications of symptom clusters remain unclear.

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Background A low-sodium diet is a core component of heart failure self-care but patients have difficulty following the diet. Aim The aim of this study was to identify predictors of higher than recommended sodium excretion among patients with heart failure. Methods The World Health Organization Five Dimensions of Adherence model was used to guide analysis of existing data collected from a prospective, longitudinal study of 280 community-dwelling adults with previously or currently symptomatic heart failure. Sodium excretion was measured objectively using 24-hour urine sodium measured at three time points over six months. A mixed effect logistic model identified predictors of higher than recommended sodium excretion. Results The adjusted odds of higher sodium excretion were 2.90, (95% confidence interval (CI): 1.15–4.25, p<0.001) for patients who were obese; 2.80 (95% CI: 1.33–5.89, p=0.007) for patients with diabetes; and 2.22 (95% CI: 1.09–4.53, p=0.028) for patients who were cognitively intact. Conclusion Three factors were associated with excess sodium excretion and two factors, obesity and diabetes, are modifiable by changing dietary food patterns.

Prevention of cardiovascular disease (CVD) remains one of the largest public health challenges of our time. Identifying individuals at increased cardiovascular risk at an asymptomatic, subclinical stage is of paramount importance for minimizing disease progression as well as the substantial health and economic burden associated with overt CVD. Vascular ageing (VA) involves the deterioration in vascular structure and function over time, and ultimately leads to damage in the heart, brain, kidney, and other organs. VA encompasses the cumulative effect of all cardiovascular risk factors on the arterial wall over the life course and thus may help identify those at elevated cardiovascular risk, early in disease development. Although the concept of VA is gaining interest clinically, it is seldom measured in routine clinical practice due to lack of consensus on how to characterise VA as physiological versus pathological and various practical issues. In this state-of-the-art review and as a network of scientists, clinicians, engineers and industry partners with expertise in VA, we address six questions related to VA in an attempt to increase knowledge among the broader medical community and move the routine measurement of VA a little closer from bench towards bedside.