Cardiorenal Interactions

Publication Trends and Research Hotspots of the Cardiorenal Syndrome: A Bibliometrics and Visual Analysis from 2003 to 2023

INTRODUCTION

Cardiorenal syndrome encompasses a range of disorders involving both the heart and kidneys, wherein dysfunction in one organ may induce dysfunction in the other, either acutely or chronically.

METHODS

This study conducted a literature search on cardiorenal syndrome from January 1, 2003, to September 8, 2023. Meanwhile, a quantitative analysis of the developmental trajectory, research hotspots and evolutionary trends in the field of cardiorenal syndrome through bibliometric analysis and knowledge mapping was carried out.

RESULTS

The annual publication trend analysis revealed a consistent annual increase in cardiorenal syndrome literature over the last 20 years. The IL6, REN, and INS genes were identified as the current research hotspots.

CONCLUSION

The field of cardiorenal syndrome exhibits promising potential to grow and is emerging as a prominent research area. Future endeavours should prioritise a comprehensive understanding of the field and foster multi-centre co-operation among different countries and regions.

Drug Related Problems among Older Inpatients at a Tertiary Care Setting

Background: Older persons are more likely to have multiple chronic diseases, leading to the simultaneous use of many medications. This situation results in increased drug-related problems (DRPs), which are the causes of adverse health outcomes. Therefore, we aimed to evaluate the prevalence of and associated risk factors for exposure to >1 criterion of DRPs among older adults admitted to a tertiary care hospital. Methods: We conducted a cross-sectional study involving 357 participants aged ≥60 years admitted to Ramathibodi Hospital from 1 February 2022 to 30 November 2022. The participants were evaluated for baseline characteristics, medications and DRPs and were classified into two groups, according to their exposure to DRPs: patients with exposure to ≤1 criteria and patients with exposure to >1 criterion of DRPs. Multivariate logistic regression analysis was performed to determine the independent risk factors for exposure to >1 criterion of DRPs. Results: Overall, 205 (57.4%) patients experienced >1 criterion of DRPs. Approximately 67.8%, 71.7% and 7.6% of the participants were exposed to at least one potentially inappropriate medication (PIM), drug-drug interaction (DDI) and adverse drug events (ADE), respectively. The most frequently prescribed PIMs were proton pump inhibitors (PPIs) (17.3%). Antineoplastics (48.1%) were the most frequently drug class related to ADEs. Overall, 37% of the ADEs in the current study were considered preventable ADEs. After adjustment for potential confounders, polypharmacy and the use of proton pump inhibitors, hypoglycemics, diuretics, psycholeptics, psychoanaleptics and cardiac therapy medications were correlated with a higher risk of exposure to > 1 criterion of PIMs, DDIs or ADEs. Conclusions: Therefore, comprehensive medication reviews and careful medication prescriptions are recommended in the geriatric population.

The influence of heart failure on the pharmacokinetics of cardiovascular and non-cardiovascular drugs: a critical appraisal of the evidence

Prescribing in heart failure (HF), a common disease state that predominantly affects the older population, is often a challenging task because of the dynamic nature of the condition, requiring frequent monitoring and medication review, the presence of various comorbidities, and the frailty phenotype of many patients. The significant alterations in various organs and tissues occurring in HF, particularly the reduced cardiac output with peripheral hypoperfusion and the structural and functional changes of the gastrointestinal tract, liver and kidney, might affect the pharmacokinetics of several drugs. This review critically appraises the results of published studies investigating the pharmacokinetics of currently marketed cardiovascular and selected non-cardiovascular drugs in HF patients and control groups, identifies gaps in the current knowledge, and suggests avenues for future research in this complex patient population.

Negotiating renal dysfunction when treating patients with heart failure

INTRODUCTION

Chronic kidney disease (CKD) is one of the most prevalent comorbidities in HF, and no specific treatment is still available for the so-called cardiorenal syndrome. Areas covered: The aim of this review is to describe the interaction of heart and kidney function and the consequences of cardiorenal syndrome, focusing on the use of available therapeutics. Expert commentary: The presence of CKD has been associated with adverse outcomes in HF regardless of ejection fraction. On the other hand, cardiovascular events are the most common causes of morbidity and mortality among CKD patients, reflecting the close pathophysiological crosstalk between these organs. Multiple mechanisms are involved in the development of cardiorenal syndrome, including hemodynamic, neurohormonal and inflammatory mediators. The management of several HF drugs is a challenge in the presence of CKD mainly due to blunted diuretic response and increased risk of worsening of kidney function. Therefore, finding a balance between the optimization of cardiac and renal outcomes is a real negotiation in the everyday clinical practice.

Preanesthetic evaluation of the patient with end-stage heart failure

Heart failure (HF) currently affects more than 5 million patients in the United States [1]. Advanced HF is associated with high mortality and poor quality of life. It is estimated that between 5% and 10% of all patients with HF have an advanced form of the disease [1]. Orthotopic heart transplantation (OHT) is an accepted therapy for stage D HF [3] (Fig. 1). Unfortunately, the number of patients with the disease exceeds the number of available organs. This makes appropriate patient selection vital in the field of heart transplantation. Anesthetic evaluation of the patient presenting for OHT or mechanical circulatory support (MCS) implantation is a vital component of the patient's perioperative course. Patients often have had extensive diagnostic testing and assessment prior to being listed for OHT or considered for MCS implantation. Because of the often urgent nature of these procedures, the cardiac anesthesiologist must conduct a focused review of the relevant information and perform a focused patient interview and physical exam.

A large retrospective review of persistent proteinuria in children

BACKGROUND

Proteinuria is a common finding in children. It may be due to a benign cause, but it can also represent early renal injury. Of children with persistent proteinuria noted in mass urine screening programs, 35% have a urine protein level greater than 100 mg/dl and many of them are associated with many underlying renal diseases. The aim of this study was to identify the etiology and prognosis of persistent proteinuria in children.

METHODS

We collected data on urine protein from January 2011 to December 2016 in a tertiary medical center. During this 6-year period, 37,645 children received urinalysis, and 2.3% were found to have persistent proteinuria. We reviewed their medical charts for clinical diagnoses and renal function. According to the level of persistent proteinuria, we divided the children into three groups (mild, moderate, and severe).

RESULTS

Most clinical diagnoses in the mild persistent proteinuria group were not readily identifiable. In the moderate and severe groups, acute kidney injury was the leading cause of significant proteinuria, followed by systemic lupus erythematosus, steroid-sensitive nephrotic syndrome, and congenital urogenital tract anomalies. There were significant differences in the rate of chronic renal insufficiency among the three groups. Prematurity with extremely low birth weight was also a major factor associated with pediatric chronic renal insufficiency.

CONCLUSION

Assessing persistent proteinuria in children is important due to the diverse range of associated diseases or mortality.

Heart Failure and Chronic Kidney Disease in Type 2 Diabetes

Complex hemodynamic, neurohormonal and biochemical changes occur in heart failure and chronic kidney disease, and hyperglycemia/diabetes further accentuate the multifactorial pathogenetic mechanisms. The acknowledgement of concomitant heart and kidney dysfunction in patients with type 2 diabetes has major clinical implications with regards to prognosis, as they significantly increase the risk of mortality, and to therapeutical strategy of both conditions, as well as of hyperglycemia. A comprehensive interdisciplinary approach is needed in these cases in order to improve the outcomes.