Recent Developments in the Evaluation and Management of Cardiorenal Syndrome: A Comprehensive Review

Kim, Jitae A; Wu, Lingling; Rodríguez, Mario; Lentine, Krista L.; Virk, Hafeez Ul Hassan; Hachem, Karim El; Lerma, Edgar V.; Kiernan, Michael S.; Rangaswami, Janani; Krittanawong, Chayakrit

doi:10.1016/j.cpcardiol.2022.101509

Cited by 10 publications

(7 citation statements)

References 194 publications

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“…The extensive impact of CKD on the CVD system mainly involves the following common risk factors (particularly hypertension and diabetes) [35][36][37] and the underlying common pathophysiological mechanisms, including changes in volume overload, inflammation, bone mineral metabolism, anemia, electrolyte abnormalities, dialysis-induced hemodynamic stress, and the presence of uremic toxins [10,38,39]. Numerous potential explanations for the increased cancer hazard of the CKD population include the influences of chronic infection, malnutrition, immunosuppressive therapy carcinogen accumulation, and DNA repair damage [40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Life’s Essential 8 and Mortality in US Adults with Chronic Kidney Disease

Chen,

Tang,

Huang

et al. 2023

Am J Nephrol

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Introduction: The current prevalence of chronic kidney disease (CKD) is substantial, and CKD individuals face a heightened risk of mortality, encompassing both all-cause and cause-specific outcomes. The current study aims to investigate the potential impact of adhering to Life’s Essential 8 (LE8) on reducing mortality among CKD individuals. Methods: Using the National Health and Nutrition Survey (NHANES) data from 2005 to 2018, we analyzed 22,420 US adults (≥20 years old). CKD is defined by urinary albumin-to-creatinine ratio (≥30 mg/g or 3 mg/mmol) and estimated glomerular filtration rate (<60 mL/min/1.73 m2). The components of LE8, including diet, physical activity (PA), nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure (BP), were measured and given a score of 0–100. The total LE8 score was the unweighted average of all components and was divided into low cardiovascular health (CVH) (0–49), moderate CVH (50–79), and high CVH (80–100). A Cox proportional hazards regression model was used to explore the associations of LE8 with all-cause, cardiovascular disease (CVD), and cancer mortality, which were followed prospectively by the National Center for Health Statistics until December 31, 2019. Results: In the overall population, individuals with moderate CVH had a 47% lower risk of CKD, while high CVH was linked to a 55% lower risk compared to low CVH. During a median follow-up of 7.58 years, CKD individuals had a 93% higher all-cause mortality rate and a 149% higher CVD mortality rate compared to those without CKD. Among the CKD individuals, every 10-point increase in the LE8 score was associated with reduced risks of 17% for all-cause mortality (especially PA, nicotine exposure, blood glucose, and BP), 18% for CVD mortality (especially PA), and 12% for cancer mortality (especially PA and sleep health). In additional and sensitivity analysis, the results remained significant after further consideration of potential confounding of renal function. Additionally, LE8 demonstrated superior risk stratification for CVD mortality among CKD patients compared with LS7. Interaction was observed between LE8 and age, education level, marital status, and drinking status. Conclusion: The current study demonstrates that adherence to higher LE8 levels within CKD individuals is associated with a reduced risk of both all-cause and cause-specific mortality.

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Section: Discussionmentioning

confidence: 99%

Life’s Essential 8 and Mortality in US Adults with Chronic Kidney Disease

Chen,

Tang,

Huang

et al. 2023

Am J Nephrol

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“…Renal insufficiency, a cardiovascular risk factor, is closely related with all-cause mortality. 18 Mitsuru et al have shown that CA-AKI was significantly correlated with long-term mortality in 1650 patients (71.6 ± 8.7 years) with chronic kidney disease (CKD) undergoing PCI. 19 In our study cohort, CKD was not correlated with long-term mortality.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Contrast-Associated Acute Kidney Injury on All-Cause Mortality in Older Patients After Coronary Angiography:A 7.5-year Follow-Up

Guo

Liu

et al. 2023

Angiology

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Older patients (≥75 years) after coronary angiography constitute an increasing proportion, but only limited data are available regarding the prognosis of geriatric contrast-associated acute kidney injury (CA-AKI). Patients (≥75 years) undergoing coronary angiography between December 2010 and September 2013 were consecutively enrolled. CA-AKI was defined as an increase in serum creatinine of 25% or .5 mg/dL from the baseline within 48–72 h of contrast exposure. All-cause mortality was assessed during median 7.5 years (interquartile range [IQR] 6.7–8.7 years) follow-up period. In total, 571 patients aged >75 years undergoing coronary angiography were enrolled in a single center study; 82 (14.4%) patients had CA-AKI. The all-cause mortality during the median 7.5 years follow-up period was 22.0% in patients with CA-AKI and 13.1% in patients without CA-AKI (P = .015). After adjusting for potential confounding factors, the multivariable analysis indicated that CA-AKI was related to an increased risk of all-cause mortality during the median 7.5-year follow-up (hazard ratio [HR]: 2.46; 95% CI: 1.29–4.7; P = .006). CA-AKI is a significant and independent predictor of long-term mortality for patients aged over 75 years who underwent coronary angiography.

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“…Acute or chronic involvement of one can lead to acute or chronic alteration of the other; this relationship is bidirectional and further worsens the clinical situation. The risk of adverse events increases, with high morbidity and mortality having been reported [11][12][13][14][15][16]. The pathophysiology of CRS is complex, multifactorial, and dynamic and includes bidirectional hemodynamic changes associated with heart and kidney failure, neurohormonal abnormalities, and an increased oxidative and inflammatory response (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiology of CRS is complex, multifactorial, and dynamic and includes bidirectional hemodynamic changes associated with heart and kidney failure, neurohormonal abnormalities, and an increased oxidative and inflammatory response (Fig. 1) [11][12][13][14][15][16]. Consequently, it is necessary to move from the old concept of renal dysfunction or kidney failure due to low cardiac output, and vice versa, to the current concept of heartkidney interaction in the setting of HF.…”

Section: Introductionmentioning

confidence: 99%

Practical requirements for the development of an advanced cardiorenal unit

Almenar-Bonet,

Sánchez-Lázaro,

Soldevila

et al. 2024

Cardiorenal Med

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Background: Heart failure is frequently associated with kidney disease, and patients with kidney disease are at increased risk of heart failure. The co-occurrence of both entities not only significantly increases morbidity and mortality, but also complicates therapy. Summary: Cardiorenal syndrome often requires a broad, comprehensive, and multidisciplinary approach. As a result, a need has arisen to create specialized cardiorenal units that allow for rigorous and personalized management of this condition. Moreover, in some cases, cardiorenal syndrome is more complex owing to an acute and critical situation that requires the concept of cardiorenal unit to be extended towards advanced diagnostic and therapeutic positions, thus confirming the need for an advanced cardiorenal unit. The creation of these units constitutes a real challenge, necessitating a specific multilevel action plan, covering governance and management, type of patient, personnel requirements, service portfolio, care process, information systems, and other resources. Specific lines of action must be proposed for each of the relevant points in order to facilitate development of these units, together with continuous evaluation of unit activity through specific indicators, and to detect areas for improvement.

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Recent Developments in the Evaluation and Management of Cardiorenal Syndrome: A Comprehensive Review

Cited by 10 publications

References 194 publications

Life’s Essential 8 and Mortality in US Adults with Chronic Kidney Disease

Life’s Essential 8 and Mortality in US Adults with Chronic Kidney Disease

The Impact of Contrast-Associated Acute Kidney Injury on All-Cause Mortality in Older Patients After Coronary Angiography:A 7.5-year Follow-Up

Practical requirements for the development of an advanced cardiorenal unit

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