New aspects in cardiorenal syndrome and HFpEF

Méndez, A.; Azancot, María A; Olivella, A.; Soler, María José

doi:10.1093/ckj/sfac133

Cited by 12 publications

(6 citation statements)

References 82 publications

(84 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Over the last decade, several drugs have shown cardio- and nephroprotective effects in patients with either HF or CKD. SGLT2is, mineral receptor antagonists and renin–angiotensin system inhibitors and angiotensin receptor–neprilysin inhibitors, along with beta-blockers and depletive therapy, have become the pillars of HFrEF therapy [ 19 ]. At the same time, SGLT2is are the only pharmacological group with proven prognostic benefit in HFpEF [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary approach to patients with heart failure and kidney disease: preliminary experience of an integrated cardiorenal unit

Marques,

Cobo,

López-Sánchez

et al. 2023

Clinical Kidney Journal

View full text Add to dashboard Cite

Background Cardiorenal programs have emerged to improve the management of cardiorenal disease (CRD). Evidence about the benefits of these programs is still scarce. This work aims to evaluate the performance of a novel cardiorenal program and describe the clinical profile and outcomes of patients with CRD. Methods Retrospective observational study of patients with CRD attended in a Cardiorenal Unit (CRU) from February 2021 to February 2022. Demographics and laboratory tests were collected, and events (all-cause death and cardiovascular hospitalizations) were evaluated. Optimization of comorbidities and protective therapies was also assessed. Results Eighty-two patients were included, with a mean age of 76.8 (SD 8.5) and 72% men. 58.5% (n = 47) had left ventricular ejection fraction less than 50%. The mean follow-up was 11 months (standard deviation (SD) 4.0). Almost fifty-four % of the patients (n = 44) required hospitalization, 30.5% for heart failure (HF) decompensation. Total hospitalizations significantly decreased after CRU inclusion: 0.70 admissions/year vs. 0.45 admissions/year (P < 0.02). Global mortality was 17.1% (n = 14). The percentage of patients with HF with reduced ejection fraction (HFrEF) on quadruple therapy increased by 20%, and up to 60% of the patients were on three drugs. 39% of the patients with HF and preserved ejection fraction started treatment with sodium-glucose cotransporter inhibitors. Hyperkaliemia required the use of potassium binders in 12.2% of the patients, treatment of secondary hyperparathyroidism was started in 42.7%, and renal anemia in 23.2%. Renal replacement therapy was initiated in 10% of the patients (n = 8). Conclusion CRD confers a considerable risk of adverse outcomes. Cardiorenal programs may improve cardiorenal syndrome (CRS) management by optimizing therapies, treating comorbidities, and reducing hospitalizations.

show abstract

Section: Discussionmentioning

confidence: 99%

Multidisciplinary approach to patients with heart failure and kidney disease: preliminary experience of an integrated cardiorenal unit

Marques,

Cobo,

López-Sánchez

et al. 2023

Clinical Kidney Journal

View full text Add to dashboard Cite

show abstract

“…Although CRS definition and its subtypes has not changed, several authors have been published about its pathophysiology, diagnostic tools—including biomarkers and imaging tests—as well as pharmacological treatment and the need for a multidisciplinary approach through cardiorenal units (CRU) ( 9 , 10 ).…”

Section: New Aspects In Cardiorenal Syndromementioning

confidence: 99%

Cardiorenal syndrome and diabetes: an evil pairing

Fernández

Arana

Olivella

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Cardiorenal syndrome (CRS) is a pathology where the heart and kidney are involved, and the deterioration of one of them leads to the malfunction of the other. Diabetes mellitus (DM) carries a higher risk of HF and a worse prognosis. Furthermore, almost half of people with DM will have chronic kidney disease (CKD), which means that DM is the main cause of kidney failure. The triad of cardiorenal syndrome and diabetes is known to be associated with increased risk of hospitalization and mortality. Cardiorenal units, with a multidisciplinary team (cardiologist, nephrologist, nursing), multiple tools for diagnosis, as well as new treatments that help to better control cardio-renal-metabolic patients, offer holistic management of patients with CRS. In recent years, the appearance of drugs such as sodium-glucose cotransporter type 2 inhibitors, have shown cardiovascular benefits, initially in patients with type 2 DM and later in CKD and heart failure with and without DM2, offering a new therapeutic opportunity, especially for cardiorenal patients. In addition, glucagon-like peptide-1 receptor agonists have shown CV benefits in patients with DM and CV disease in addition to a reduced risk of CKD progression.

show abstract

“…Patients with HFpEF are more likely to have chronic systemic comorbidities (such as hypertension, T2DM, and obesity), whereas HFrEF often occurs as a consequence of acute or chronic loss of cardiomyocytes (due to ischemia, myocarditis, valvular disease, etc.) (reviewed in [53]) [49]; thus, any ensuing kidney disease may reflect these differences in etiology.…”

Section: The Relationship Between Ckd and Hf: Cardiorenal Syndromementioning

confidence: 99%

Sodium-glucose cotransporter-2 inhibition for heart failure with preserved ejection fraction and chronic kidney disease with or without type 2 diabetes mellitus: a narrative review

Mentz,

Brunton,

Rangaswami

2023

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background Heart failure (HF), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM) are common and interrelated conditions, each with a significant burden of disease. HF and kidney disease progress through pathophysiologic pathways that culminate in end-stage disease, for which T2DM is a major risk factor. Intervention within these pathways can disrupt disease processes and improve patient outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have been investigated in patient populations with combinations of T2DM, CKD, and/or HF. However, until recently, the effect of these agents in patients with HF with preserved ejection fraction (HFpEF) was not well studied. Main body The aim of this review is to summarize key information regarding the interaction between HFpEF, CKD, and T2DM and discuss the role of SGLT2 inhibition in the management of patients with comorbid HFpEF and CKD, with or without T2DM. Literature was retrieved using Boolean searches for English-language articles in PubMed and Google Scholar and included terms related to SGLT2is, HFpEF, T2DM, and CKD. The reference lists from retrieved articles were also considered. Conclusion SGLT2is are efficacious and safe in treating HFpEF in patients with comorbid CKD with and without T2DM. The totality of evidence from clinical trials data suggests there are benefits in using SGLT2is across the spectrum of left ventricular ejection fractions, but there may be a potential for different renal effects in the different ejection fraction groups. Further analysis of these clinical trials has highlighted the need to obtain more accurate phenotypes for patients with HF and CKD to better determine which patients might respond to guideline-directed medical therapies, including SGLT2is. Graphical Abstract CI confidence interval, EF ejection fraction, eGFR estimated glomerular filtration rate, HF heart failure, HHF hospitalization for HF, HR hazard ratio, LVEF left ventricular ejection fraction, SGLT2i sodium-glucose cotransporter-2 inhibitor, UACR urine albumin-creatinine ratio. a Mean value, unless otherwise stated, b SGLT2i vs. placebo, c Data reanalyzed using more conventional endpoints (≥ 50% sustained decrease in eGFR, and including renal death) (UACR at baseline not stated in trial reports)

show abstract

New aspects in cardiorenal syndrome and HFpEF

Cited by 12 publications

References 82 publications

Multidisciplinary approach to patients with heart failure and kidney disease: preliminary experience of an integrated cardiorenal unit

Multidisciplinary approach to patients with heart failure and kidney disease: preliminary experience of an integrated cardiorenal unit

Cardiorenal syndrome and diabetes: an evil pairing

Sodium-glucose cotransporter-2 inhibition for heart failure with preserved ejection fraction and chronic kidney disease with or without type 2 diabetes mellitus: a narrative review

Contact Info

Product

Resources

About