Insights of Worsening Renal Function in Type 1 Cardiorenal Syndrome: From the Pathogenesis, Biomarkers to Treatment

Fu, Kang; Hu, Yue; Hui, Zhang; Wang, Chen; Lin, Zongwei; Lu, Huixia; Ji, Xiaoping

doi:10.3389/fcvm.2021.760152

Cited by 9 publications

(8 citation statements)

References 144 publications

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“…Cardiac and renal function always closely interact with each other (27,28). In our study population, 46.3% of the AKI group developed low cardiac output, and 81.5% of the patients with low cardiac output also had acute kidney injury.…”

Section: Discussionmentioning

confidence: 99%

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

Wang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesAcute kidney injury is a common complication after pericardiectomy for constrictive pericarditis, which predisposes patients to worse outcomes and high medical costs. We aimed to investigate potential risk factors and consequences and establish a prediction model.MethodsWe selected patients with constrictive pericarditis receiving isolated pericardiectomy from January 2013 to January 2021. Patients receiving concomittant surgery or repeat percardiectomy, as well as end-stage of renal disease were excluded. Acute kidney injury was diagnosed and classified according to the KDIGO criteria. Clinical features were compared between patients with and without postoperative acute kidney injury. A prediction model was established based on multivariable regression analysis.ResultsAmong two hundred and eleven patients, ninety-five (45.0%) developed postoperative acute kidney injury, with fourty-three (45.3%), twenty-eight (29.5%), and twenty-four (25.3%) in mild, moderate and severe stages, respectively. Twenty-nine (13.7%) patients received hemofiltration. Nine (4.3%) patients died perioperatively and were all in the acute kidney injury (9.5%) group. Eleven (5.2%) patients were considered to have chronic renal dysfunction states at the 6-month postoperative follow-up, and eight (72.7%) of them experienced moderate to severe stages of postoperative acute kidney injury. Univariable analysis showed that patients with acute kidney injury were older (difference 8 years, P < 0.001); had higher body mass index (difference 1.68 kg·m−2, P = 0.002); rates of smoking (OR = 2, P = 0.020), hypertension (OR = 2.83, P = 0.004), and renal dysfunction (OR = 3.58, P = 0.002); higher central venous pressure (difference 3 cm H2O, P < 0.001); and lower cardiac index (difference −0.23 L·min−1·m−2, P < 0.001) than patients without acute kidney injury. Multivariable regression analysis showed that advanced age (OR 1.03, P = 0.003), high body mass index (OR 1.10, P = 0.024), preoperative atrial arrhythmia (OR 3.12, P = 0.041), renal dysfunction (OR 2.70 P = 0.043), high central venous pressure (OR 1.12, P = 0.002), and low cardiac index (OR 0.36, P = 0.009) were associated with a high risk of postoperative acute kidney injury. A nomogram was established based on the regression results. The model showed good model fitness (Hosmer-Lemeshow test P = 0.881), with an area under the curve value of 0.78 (95% CI: 0.71, 0.84, P < 0.001).ConclusionThe prediction model may help with early recognition, management, and reduction of acute kidney injury after pericardiectomy.

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Section: Discussionmentioning

confidence: 99%

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

Wang

Zhang

et al. 2022

Front. Cardiovasc. Med.

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“…Increased CVP leads to depressed renal venous pressure (RVP), creating a low flow state that reduces the blood flow gradient to kidneys and leading to renal hypoperfusion ( Bock and Gottlieb, 2010 ; Prastaro et al, 2022 ). In patients with reduced cardiac functionalities, the low-flow state occurs due to kidney artery under-filling, resulting in a reduced eGFR (glomerular filtration rate) and reduced renal functionalities, which are associated with higher mortality ( Damman et al, 2009 ; Fu et al, 2021 ). Reduced renal functionalities account for acute kidney injury (AKI), worsening renal function (WRF), and ischemic injury of glomerular and renal tubules, consequently worsening cardio-renal syndrome.…”

Section: Pathophysiology Of Acute Crsmentioning

confidence: 99%

A comprehensive review of acute cardio-renal syndrome: need for novel biomarkers

et al. 2023

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Cardiorenal syndrome represents a wide-spectrum disorder involving the heart and kidneys as the primary affected organs. India has an increasingly high burden of acute CRS, coinciding with the rise in global statistics. Up to 2022, approximately 46.1% of all cardiorenal patients have been diagnosed with acute CRS in India. Acute CRS involves a sudden deterioration of kidney functionalities, referred to as acute kidney injury (AKI) in acute heart failure patients. The pathophysiology of CRS involves hyperactivation of the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS) following acute myocardial stress. The pathological phenotype of acute CRS is associated with perturbed inflammatory, cellular, and neurohormonal markers in circulation. These complications increase the risk of mortality in clinically diagnosed acute CRS patients, making it a worldwide healthcare burden. Hence, effective diagnosis and early prevention are crucial to prevent the progression of CRS in AHF patients. Present biomarkers, such as serum creatinine (sCr), cystatin C (CysC), glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum and/or urine neutrophil gelatinase-associated lipocalin (NGAL), B-type natriuretic peptide (BNP), and NT-proBNP, are clinically used to diagnose AKI stages in CRS patients but are limitedly sensitive to the early detection of the pathology. Therefore, the need for protein biomarkers is emerging for early intervention in CRS progression. Here, we summarized the cardio-renal nexus in acute CRS, with an emphasis on the present clinicopathological biomarkers and their limitations. The objective of this review is to highlight the need for novel proteomic biomarkers that will curb the burgeoning concern and direct future research trials.

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“…Результаты назначения антикоагулянтов в нефрологической клинике [19,123] позволяют надеяться на то, что их применение при РД будет способствовать восстановлению чувствительности к петлевым диуретикам и пациентов с ХСН [19,124]. С учетом известной роли медиаторов воспаления в механизмах дисфункции почек у пациентов с кардиоренальным синдромом 1-го и 2-го типов, возможно полезной будет и иммунная разгрузка сердца и почек [125][126][127][128].…”

Section: профилактика и преодоление резистентности к диуретикамunclassified

Diuretic resistance in patients with chronic heart failure: mechanisms, prevention, and treatment

et al. 2022

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The authors analyzed the problem of diuretic resistance (DR) in patients with chronic heart failure (CHF). Most of the symptoms and signs of CHF are associated with hypervolemia and vascular congestion in the systemic and pulmonary circulation. The severity of the latter is the main factor which negatively affects the overall assessment of life satisfaction in patients with CHF. Since the patient, even at the incurable stage of CHF, primarily expects a rapid decrease in the severity of manifestations of decompensation from the prescribed therapy, achieving euvolemia is the essence of its short-term objective. Without diuretics, these immediate effects, according to which most CHF patients judge the qualifications of the doctor, are almost impossible to achieve. Unfortunately, apparently, not a single clinician was able to avoid disappointment in the effectiveness of CHF therapy associated with DR in their practice. As a rule, DR reflects the progressive course of CHF and is often associated with a poor prognosis. The review consistently covers the issues of terminology, diagnosis, pathogenesis, and prevention of DR, which aggravates CHF, and discusses measures aimed at restoring sensitivity to diuretics.

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Insights of Worsening Renal Function in Type 1 Cardiorenal Syndrome: From the Pathogenesis, Biomarkers to Treatment

Cited by 9 publications

References 144 publications

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

A comprehensive review of acute cardio-renal syndrome: need for novel biomarkers

Diuretic resistance in patients with chronic heart failure: mechanisms, prevention, and treatment

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