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Tan XY, Jing HY, Ma YR. Interleukin-33/ Suppression of Tumorigenicity 2 in Renal Fibrosis: Emerging Roles in Prognosis and Treatment. Front Physiol 2022; 12:792897. [PMID: 35046838 PMCID: PMC8761767 DOI: 10.3389/fphys.2021.792897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/02/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic kidney disease (CKD) is a major public health problem that affects more than 10% of the population worldwide and has a high mortality rate. Therefore, it is necessary to identify novel treatment strategies for CKD. Incidentally, renal fibrosis plays a central role in the progression of CKD to end-stage renal disease (ESRD). The activation of inflammatory pathways leads to the development of renal fibrosis. In fact, interleukin-33 (IL-33), a newly discovered member of the interleukin 1 (IL-1) cytokine family, is a crucial regulator of the inflammatory process. It exerts pro-inflammatory and pro-fibrotic effects via the suppression of tumorigenicity 2 (ST2) receptor, which, in turn, activates other inflammatory pathways. Although the role of this pathway in cardiac, pulmonary, and hepatic fibrotic diseases has been extensively studied, its precise role in renal fibrosis has not yet been completely elucidated. Recent studies have shown that a sustained activation of IL-33/ST2 pathway promotes the development of renal fibrosis. However, with prolonged research in this field, it is expected that the IL-33/ST2 pathway will be used as a diagnostic and prognostic tool for renal diseases. In addition, the IL-33/ST2 pathway seems to be a new target for the future treatment of CKD. Here, we review the mechanisms and potential applications of the IL-33/ST2 pathway in renal fibrosis; such that it can help clinicians and researchers to explore effective treatment options and develop novel medicines for CKD patients.
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Affiliation(s)
- Xiao-Yang Tan
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao-Yue Jing
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue-Rong Ma
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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2
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Ferrari F, Scalzotto E, Esposito P, Samoni S, Mistrorigo F, Rizo Topete LM, De Cal M, Virzì GM, Corradi V, Torregrossa R, Valle R, Bianzina S, Aspromonte N, Floris M, Fontanelli A, Brendolan A, Ronco C. Neutrophil gelatinase-associated lipocalin does not predict acute kidney injury in heart failure. World J Clin Cases 2020; 8:1600-1607. [PMID: 32432138 PMCID: PMC7211536 DOI: 10.12998/wjcc.v8.i9.1600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/01/2020] [Accepted: 04/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute cardiorenal syndrome type 1 (CRS-1) is defined by a rapid cardiac dysfunction leading to acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) is expressed on the surface of human neutrophils and epithelial cells, such as renal tubule cells, and its serum (sNGAL) and urinary have been used to predict AKI in different clinical settings.
AIM To characterize CRS-1 in a cohort of patients with acute heart diseases, evaluating the potentiality of sNGAL as an early marker of CRS-1.
METHODS We performed a retrospective cohort, multi-centre study. From January 2010 to December 2011, we recruited 202 adult patients admitted to the coronary intensive care unit (CICU) with a diagnosis of acute heart failure or acute coronary syndrome. We monitored the renal function to evaluate CRS-1 development and measured sNGAL levels within 24 h and after 72 h of CICU admission.
RESULTS Overall, enrolled patients were hemodynamically stable with a mean arterial pressure of 92 (82-107) mmHg, 55/202 (27.2%) of the patients developed CRS-1, but none of them required dialysis. Neither the NGAL delta value (AUC 0.40, 95%CI: 0.25-0.55) nor the NGAL peak (AUC 0.45, 95%CI: 0.36-0.54) or NGAL cut-off (≥ 140 ng/mL) values were statistically significant between the two groups (CRS-1 vs no-CRS1 patients). The area under the ROC curve for the prediction of CRS-1 was 0.40 (95%CI: 0.25-0.55) for the delta NGAL value and 0.45 (95%CI: 0.36-0.54) for the NGAL peak value. Finally, in multivariate analysis, the risk of developing CRS-1 was correlated with age > 60 years, urea nitrogen at admission and 24 h-urine output (AUC 0.83, SE = 60.5% SP = 93%), while sNGAL was not significantly correlated.
CONCLUSION In our population, sNGAL does not predict CRS-1, probably as a consequence of the mild renal injury and the low severity of heart disease. So, these data might suggest that patient selection should be taken into account when considering the utility of NGAL measurement as a biomarker of kidney damage.
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Affiliation(s)
- Fiorenza Ferrari
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Elisa Scalzotto
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, Nephrology, Dialysis and Transplantation Clinics, Genoa University and IRCCS Policlinico San Martino, Genova 16132, Italy
| | - Sara Samoni
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Flavio Mistrorigo
- Department of Cardiology, Coronary Intensive Care Unit, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Lilia Maria Rizo Topete
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Massimo De Cal
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Grazia Maria Virzì
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Valentina Corradi
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Rossella Torregrossa
- Department of Cardiology Coronary, Intensive Care Unit, Chioggia Hospital, Venezia 36100, Italy
| | - Roberto Valle
- Department of Cardiology Coronary, Intensive Care Unit, Chioggia Hospital, Venezia 36100, Italy
| | - Stefania Bianzina
- Neonatal and Pediatric Intensive Care Unit, G. Gaslini Institute, Genoa 16147, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart Agostino Gemelli Foundation, Rome 00168, Italy
| | - Matteo Floris
- Division of Nephrology and Dialysis, Azienda Ospedaliera G. Brotzu, Piazzale Ricchi n°1, Cagliari 09134, Italy
| | - Alessandro Fontanelli
- Department of Cardiology, Coronary Intensive Care Unit, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Alessandra Brendolan
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
| | - Claudio Ronco
- Department of Nephrology Dialysis & Transplantation, International Renal Research Institute Vicenza, St. Bortolo Hospital, Vicenza 36100, Italy
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Mulè G, Sorce A, Nardi E, Geraci G, Cottone S. The nephroprotective effect of sacubitril/valsartan in heart failure: insights from the real-life clinical setting. Intern Emerg Med 2019; 14:1205-1208. [PMID: 31309521 DOI: 10.1007/s11739-019-02149-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Giuseppe Mulè
- Unit of Nephrology and Hypertension, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, European Society of Hypertension Excellence Centre, University of Palermo, Via Monte San Calogero, 29, 90146, Palermo, Italy.
| | - Alessandra Sorce
- Unit of Nephrology and Hypertension, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, European Society of Hypertension Excellence Centre, University of Palermo, Via Monte San Calogero, 29, 90146, Palermo, Italy
| | - Emilio Nardi
- Dipartimento di Scienze della Promozione della Salute, Materno-Infantile, Medicina Interna e Specialistica d'Eccellenza "G. D'Alessandro" (PROMISE), Unit of Internal Medicine, University of Palermo, Palermo, Italy
| | - Giulio Geraci
- Unit of Nephrology and Hypertension, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, European Society of Hypertension Excellence Centre, University of Palermo, Via Monte San Calogero, 29, 90146, Palermo, Italy
| | - Santina Cottone
- Unit of Nephrology and Hypertension, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, European Society of Hypertension Excellence Centre, University of Palermo, Via Monte San Calogero, 29, 90146, Palermo, Italy
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4
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Hou J, Xie X, Tu Q, Li J, Ding J, Shao G, Jiang Q, Yuan L, Lai X. SIRT1 gene polymorphisms are associated with nondiabetic type 1 cardiorenal syndrome. Ann Hum Genet 2019; 83:445-453. [PMID: 31355422 DOI: 10.1111/ahg.12338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/08/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022]
Abstract
Type 1 cardiorenal syndrome (CRS1) is characterized by acute cardiac disease (e.g., acute heart failure [AHF]), leading to acute kidney injury. Sirtuin 1 (SIRT1), an NAD+ -dependent deacylase, has been found to be associated with CRS1. To confirm whether a correlation exists between SIRT1 variants and the risk of CRS1, the association between the prevalence of CRS1 and single-nucleotide polymorphisms (SNPs) within the SIRT1 gene was investigated in AHF patients. A total of 316 Chinese AHF participants (158 patients with CRS1 and 158 age- and sex-matched controls) were recruited for the present observational study to investigate the association between nine common SIRT1 SNPs (i.e., rs7895833 G > A, rs10509291 T > A, rs3740051 A > G, rs932658 A > C, rs33957861 C > T, rs7069102 C > G, rs2273773 T > C, rs3818292 A > G, and rs1467568 A > G) and the susceptibility to CRS1. Significant differences in genotype distribution between the control and CRS1 groups were found for rs7895833 and rs1467568. After applying a Bonferroni adjustment, the A allele of rs7895833 was still found to be protective (p = 0.001; odds ratio [OR] = 0.77) against CRS1 in this study population. The AA genotype of rs7895833 and the GA genotype of rs1467568 were associated with a significantly reduced risk of CRS1 (OR = 0.23 and 0.49, respectively). rs7895833 and rs1467568 were further analyzed as a haplotype, and the GA haplotype (rs7895833-rs1467568) exhibited a significant association with CRS1 (p = 0.008), while the AA haplotype showed a significant protective effect (p = 0.022). Our study showed that SIRT1 rs7895833 and rs1467568 polymorphisms had a significant effect on the risk of developing CRS1 in a population in China.
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Affiliation(s)
- Jiebin Hou
- Department of Nephrology, the Second Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing, China
| | - Xinyue Xie
- Division of Nephrology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Qingxian Tu
- Department of Cardiology, The First People's Hospital of ZunYi, Zunyi, Guizhou, China
| | - Jie Li
- Department of Cardiology, The First People's Hospital of ZunYi, Zunyi, Guizhou, China
| | - Jiarong Ding
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, China
| | - Guojian Shao
- Department of Nephrology, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Qianfeng Jiang
- Department of Cardiology, The First People's Hospital of ZunYi, Zunyi, Guizhou, China.,The Third Affiiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Li Yuan
- Division of Nephrology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xueli Lai
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, China
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Harmon DM, Tecson KM, Lima B, Collier JDG, Shaikh AF, Still S, Baxter RD, Lew N, Thakur R, Felius J, Hall SA, Gonzalez-Stawinski GV, Joseph SM. Outcomes of Moderate-to-Severe Acute Kidney Injury following Left Ventricular Assist Device Implantation. Cardiorenal Med 2019; 9:100-107. [PMID: 30673661 DOI: 10.1159/000492476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although acute kidney injury (AKI) is a common complication following cardiac surgery, less is known about the occurrence and consequences of moderate/severe AKI following left ventricular assist device (LVAD) implantation. METHODS All patients who had an LVAD implanted at our center from 2008 to 2016 were reviewed to determine the incidence of, and risk factors for, moderate/severe (stage 2/3) AKI and to compare postoperative complications and mortality rates between those with and those without moderate/severe AKI. RESULTS Of 246 patients, 68 (28%) developed moderate/severe AKI. A multivariable logistic regression comprising body mass index and prior sternotomy had fair predictive ability (area under the curve = 0.71). A 1-unit increase in body mass index increased the risk of moderate/severe AKI by 7% (odds ratio = 1.07; 95% confidence interval: 1.03-1.11); a prior sternotomy increased the risk more than 3-fold (odds ratio = 3.4; 95% confidence interval: 1.84-6.43). The group of patients with moderate/severe AKI had higher rates of respiratory failure and death than the group of patients with mild/no AKI. Patients with moderate/severe AKI were at 3.2 (95% confidence interval: 1.2-8.2) times the risk of 30-day mortality compared to those without. Even after adjusting for age and Interagency Registry for Mechanically Assisted Circulatory Support profile, those with moderate/severe AKI had 1.75 (95% confidence interval: 1.03-3.0) times the risk of 1-year mortality compared to those without. DISCUSSION Risk-stratifying patients prior to LVAD placement in regard to AKI development may be a step toward improving surgical outcomes.
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Affiliation(s)
- David M Harmon
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Kristen M Tecson
- Texas A&M University College of Medicine, Dallas, Texas, USA.,Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Brian Lima
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA.,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Justin D G Collier
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | - Asad F Shaikh
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | - Sasha Still
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | - Ronald D Baxter
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | - Nicole Lew
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Richa Thakur
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Texas A&M University College of Medicine, Dallas, Texas, USA
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Shelley A Hall
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Gonzalo V Gonzalez-Stawinski
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA.,Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA.,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Susan M Joseph
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA, .,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, Texas, USA,
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6
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Zhang D, Li H, Chen H, Ma Q, Chen H, Xing Y, Zhao X. Combination of Amino-Terminal Pro- BNP , Estimated GFR , and High-Sensitivity CRP for Predicting Cardiorenal Syndrome Type 1 in Acute Myocardial Infarction Patients. J Am Heart Assoc 2018; 7:e009162. [PMID: 30371311 PMCID: PMC6404877 DOI: 10.1161/jaha.118.009162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/14/2018] [Indexed: 12/28/2022]
Abstract
Background Cardiorenal syndrome type 1 ( CRS 1) as a complication of acute myocardial infarction can lead to adverse outcomes, and a method for early detection is needed. This study investigated the individual and integrated effectiveness of amino-terminal pro-brain natriuretic peptide (Pro-BNP), estimated glomerular filtration rate (eGFR), and high-sensitivity C-reactive protein (CRP) as predictive factors for CRS 1 in patients with acute myocardial infarction. Methods and Results In a retrospective analysis of 2094 patients with acute myocardial infarction, risk factors for CRS 1 were analyzed by logistic regression. Receiver operating characteristic curves were constructed to determine the predictive ability of the biomarkers individually and in combination. Overall, 177 patients (8.45%) developed CRS 1 during hospitalization. On multivariable analysis, all 3 biomarkers were independent predictors of CRS 1 with odds radios and 95% confidence intervals for a 1-SD change of 1.792 (1.311-2.450) for log(amino-terminal pro-brain natriuretic peptide, 0.424 (0.310-0.576) for estimated glomerular filtration rate, and 1.429 (1.180-1.747) for high-sensitivity C-reactive peptide. After propensity score matching, the biomarkers individually and together significantly predicted CRS 1 with areas under the curve of 0.719 for amino-terminal pro-brain natriuretic peptide, 0.843 for estimated glomerular filtration rate, 0.656 for high-sensitivity C-reactive peptide, and 0.863 for the 3-marker panel (all P<0.001). Also, the integrated 3-marker panel performed better than the individual markers ( P<0.05). CRS 1 risk correlated with the number of biomarkers showing abnormal levels. Abnormal measurements for at least 2 biomarkers indicated a greater risk of CRS 1 (odds ratio 36.19, 95% confidence interval 8.534-153.455, P<0.001). Conclusions The combination of amino-terminal pro-brain natriuretic peptide, estimated glomerular filtration rate, and high-sensitivity C-reactive peptide at presentation may assist in the prediction of CRS 1 and corresponding risk stratification in patients with acute myocardial infarction.
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Affiliation(s)
- De‐Qiang Zhang
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Hong‐Wei Li
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
- Department of CardiologyBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Hai‐Ping Chen
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Qing Ma
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Hui Chen
- Department of CardiologyBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Yun‐Li Xing
- Internal Medical DepartmentMedical Health CenterBeijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Xue‐Qiao Zhao
- Clinical Atherosclerosis Research LaboratoryDivision of CardiologyUniversity of WashingtonSeattleWA
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Mailhot T, Cossette S, Lambert J, Beaubien-Souligny W, Cournoyer A, O'Meara E, Maheu-Cadotte MA, Fontaine G, Bouchard J, Lamarche Y, Benkreira A, Rochon A, Denault A. Delirium After Cardiac Surgery and Cumulative Fluid Balance: A Case-Control Cohort Study. J Cardiothorac Vasc Anesth 2018; 33:93-101. [PMID: 30122614 DOI: 10.1053/j.jvca.2018.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess a novel hypothesis to explain delirium after cardiac surgery through the relationship between cumulative fluid balance and delirium. This hypothesis involved an inflammatory process combined with a hypervolemic state, which could lead to venous congestion reaching the brain. DESIGN Retrospective case-control (1:1) cohort study. SETTING University-affiliated tertiary cardiology center. PARTICIPANTS Cardiac surgery intensive care unit (ICU) patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Cumulative fluid balance was evaluated at 3 times: (1) upon arrival at the ICU after surgery, (2) 24 hours post-ICU arrival, and (3) 48 hours post-ICU arrival. A generalized estimated equation was used to model the association between cumulative fluid balance and delirium occurrence 24 hours later. Covariates were selected based on the statistical differences between cases and controls on delirium risk factors and clinical characteristics. The cohort included 346 patients, of which 39 (11%), 104 (30%), and 142 patients (41%) presented delirium at 24, 48, and 72 hours post-ICU arrival, respectively. The effect of time had an odds ratio (OR) of 2.14, 95% confidence interval (CI) 1.603 to 2.851, and a p value < 0.001. The cumulative fluid balance was associated with delirium occurrence (OR 1.20, 95% CI: 1.066-1.355, p = .003). History of neurological disorder, having both hearing and visual impairment, type of procedure, perioperative cerebral oximetry, mean pulmonary artery pressure pre-cardiopulmonary bypass (CPB), and mean arterial pressure post-CPB also contributed to delirium in the model. CONCLUSION Delirium is associated with a cumulative fluid balance, but the extent through which this plays an etiologic role remains to be determined.
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Affiliation(s)
- Tanya Mailhot
- Faculty of Nursing, Faculty of Medicine, Université de Montréal, Montreal Heart Institute Research Center, 5000 Bélanger St, S-2490, Montreal, Quebec, H1T 1C8, Canada.
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Canada
| | - Jean Lambert
- School of Public Health, Department of Preventive Medicine, Montreal Heart Institute Research Center, Montreal, Canada
| | | | - Alexis Cournoyer
- Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | - Eileen O'Meara
- Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | | | - Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, Montreal Heart Institute Research Center, Montreal, Canada
| | - Josée Bouchard
- Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | - Yoan Lamarche
- Faculty of Medicine, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | - Aymen Benkreira
- Faculty of Medicine, Université de Sherbrooke, Montreal Heart Institute Research Center, Montreal, Canada
| | - Antoine Rochon
- Faculty of Medicine, Department of Anesthesiology, Université de Montréal, Montreal Heart Institute, Montreal, Canada
| | - André Denault
- Faculty of Medicine, Department of Anesthesiology, Université de Montréal, Montreal Heart Institute, Montreal, Canada
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Ronco C, Ronco F, McCullough PA. A Call to Action to Develop Integrated Curricula in Cardiorenal Medicine. Blood Purif 2017; 44:251-259. [PMID: 29065398 DOI: 10.1159/000480318] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
With the adoption of the new definition and classification of cardiorenal syndrome (CRS) and its relevant subtypes, much attention has been placed on elucidating the mechanisms of heart and kidney interactions. Of great interest are the pathophysiological pathways by which acute heart failure may result in acute kidney injury (AKI; type 1), chronic heart failure accelerating the progression of chronic kidney disease (CKD; type 2), AKI provoking cardiac events (type 3), and CKD increasing the risk and severity of cardiovascular disease (type 4). A remarkable interest has also been placed on the acute and chronic systemic conditions, such as sepsis and diabetes, which simultaneously affect heart and kidney function (type 5). Furthermore, the physiology of acute and chronic heart-kidney cross talk is drawing attention to hemodynamics (fluids, pressures, flows, resistances, perfusion), physiochemical (electrolytes, pH, and toxins), and biological (inflammation, immune system activation, neurohormonal signals) processes. Common clinical scenarios call for recognition, knowledge, and skill in managing CRS. There is a clear need for medical and surgical specialists that are well versed in the pathophysiology and the clinical manifestations that arise in the setting of CRS. With this editorial, we are making a call to action to stimulate universities, medical schools, and teaching hospitals to create a core curriculum for cardiorenal medicine to better equip the physicians of the future for these common, serious, and frequently fatal syndromes.
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Affiliation(s)
- Claudio Ronco
- Department of Nephrology, San Bortolo Hospital, Vicenza, Italy
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Zhang J, Fallahzadeh MK, McCullough PA. Aging Male Spontaneously Hypertensive Rat as an Animal Model for the Evaluation of the Interplay between Contrast-Induced Acute Kidney Injury and Cardiorenal Syndrome in Humans. Cardiorenal Med 2016; 7:1-10. [PMID: 27994597 DOI: 10.1159/000447542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although there are some animal models for biomarkers of contrast-induced acute kidney injury (CI-AKI), for cardiorenal syndrome (CRS) and for acute renal failure, the interplay between CI-AKI and CRS has yet to be evaluated. Insight into the pathogenesis of CRS is urgently needed from animal models in order to foster the discovery and implementation of novel biomarkers for this disease. Specially designed animal models for type 1 and 3 CRS, particularly CI-AKI, have not yet emerged. SUMMARY We hypothesize that the aging male spontaneously hypertensive rat (SHR) is likely to be a suitable model. The SHR model is able to mimic risk factors for preclinical CRS that appears in the clinical setting, specifically hypertension, age, preexisting damage and dysfunction of the heart and kidney, endothelial dysfunction, increased level of reactive oxygen species, decreased level and bioavailability of nitric oxide (NO), impairment of the L-arginine-NO pathway, and insulin resistance. In the SHR, CI-AKI results in a different profile of AKI biomarkers than is seen with preexisting chronic kidney injury. KEY MESSAGES The SHR model can be used to evaluate the interaction between CI-AKI and CRS type 1 and 3 and to verify neutrophil gelatinase-associated lipocalin (NGAL) as a reliable CI-AKI biomarker for clinical application. Further research is warranted with a large number of aging male SHRs to prove NGAL as a sensitive, specific, highly predictive, early biomarker for CI-AKI.
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Affiliation(s)
- Jun Zhang
- Baylor Heart and Vascular Institute, Dallas, Tex., USA
| | | | - Peter A McCullough
- Baylor Heart and Vascular Institute, Dallas, Tex., USA; Department of Internal Medicine, Baylor University Medical Center, Dallas, Tex., USA; Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Tex, Tex., USA; The Heart Hospital Baylor Plano, Plano, Tex., USA
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10
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The importance of renal function for the management of the sick newborn with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Flores S, Rhodes Proctor Short S, Basu RK. Acute kidney injury in pediatric heart transplantation and extracorporeal cardiac support therapies. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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