Gender differences in the prognostic impact of chronic kidney disease in patients with left ventricular systolic dysfunction following ST elevation myocardial infarction treated with primary percutaneous coronary intervention

The Factors Influencing Chronic Kidney Disease Incidence: Database from the Korean National Health Insurance Sharing Service (NHISS)

Background: The global prevalence of chronic kidney disease (CKD) is increasing, with diabetes accounting for the highest proportion. We analyzed the influence of clinical factors on the incidence of CKD according to the renal function, primary focusing on patients with diabetes. Methods: We used the Sample Cohorts Database provided by the National Health Insurance Sharing Service (NHISS) in Korea. Participants aged ≥ 40 years who underwent a health checkup in 2009 were categorized into six groups based on their eGFR values (<60 mL/min, 60-89 mL/min, ≥90 mL/min) and the presence of diabetes. And all patients with CKD at 2009 screening were excluded. The participants were tracked from 2010 to 31 December 2019. The CKD incidence rate according to the eGFR values and the effect of the accompanying factors on CKD incidence were confirmed. Results: 148,089 people without CKD were analyzed. The CKD incidence rate was highest in those with eGFR < 60 mL/min with diabetes and lowest in those with eGFR ≥ 90 mL/min without diabetes. The CKD incidence rates were similar between the eGFR < 60 mL/min group without diabetes and the eGFR 60-89 mL/min group with diabetes. Compared to under 44 years of age, the hazard ratio of CKD incidence was 8 times higher in over 75 years of age. Men had a 1.7-fold higher risk of developing CKD than women. Current smoker, hypertension, dyslipidemia, myocardial infarction history, and atrial fibrillation and flutter increased the risk of CKD incidence. Age, diabetes, and baseline eGFR are important factors in the occurrence of CKD. As age increases, the risk of developing CKD in men increases compared to women. Conclusions: These results will be helpful in predicting risk groups for CKD and establishing strategies to lowering CKD incidence.

Pharmacokinetics and pharmacodynamics of TTI-101, a STAT3 inhibitor that blocks muscle proteolysis in rats with chronic kidney disease

Loss of muscle proteins increases the morbidity and mortality of patients with chronic kidney disease (CKD), and there are no reliable preventive treatments. We uncovered a STAT3/CCAAT-enhancer-binding protein-δ to myostatin signaling pathway that activates muscle protein degradation in mice with CKD or cancer; we also identified a small-molecule inhibitor of STAT3 (TTI-101) that blocks this pathway. To evaluate TTI-101 as a treatment for CKD-induced cachexia, we measured TTI-101 pharmacokinetics and pharmacodynamics in control and CKD rats that were orally administered TTI-101or its diluent. The following two groups of gavage-fed rats were studied: sham-operated control rats and CKD rats. Plasma was collected serially (0, 0.25, 0.5, 1, 2, 4, 8, and 24 h) following TTI-101 administration (at oral doses of 0, 10, 30, or 100 mg/kg). Plasma levels of TTI-101 were measured by LC-MS/MS, and pharmacokinetic results were analyzed with the PKSolver program. Plasma TTI-101 levels increased linearly with doses; the maximum plasma concentrations and time to maximal plasma levels (~1 h) were similar in sham-operated control rats and CKD rats. Notably, gavage treatment of TTI-101 for 3 days produced TTI-101 muscle levels in sham control rats and CKD rats that were not significantly different. CKD rats that received TTI-101 for 7 days had suppression of activated STAT3 and improved muscle grip strength; there also was a trend for increasing body and muscle weights. TTI-101 was tolerated at doses of 100 mg·kg^-1·day^-1 for 7 days. These results with TTI-101 in rats warrant its development as a treatment for cachexia in humans.

Chronic kidney disease predicts atrial fibrillation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

Background: Atrial fibrillation (AF) often complicates ST-segment elevation myocardial infarction (STEMI). Predictors of AF in this setting include factors related to the acute phase of STEMI and pre-existing conditions. More recently, novel AF predictors have been identified in the general population. We aimed to assess the ability of such novel factors to predict STEMI-related AF.Methods: Data were collected from STEMI patients treated by primary PCI. Factors related to the acute phase of STEMI (Killip class, heart rate, blood pressure on admission, post-PCI TIMI flow), classic (age, hypertension, heart failure, previous myocardial infarction), and more novel (body mass index [BMI], diabetes, chronic kidney disease [CKD], chronic obstructive pulmonary disease [COPD]) AF predictors were evaluated. The ability of these novel factors to predict STEMI-related AF was assessed.Results: Of the 629 studied patients, 10.5% presented STEMI-related AF. AF patients had higher Killip class on admission (p < .0001) and lower post-PCI TIMI flow (p < .01), they were older (p < .0001) and more likely to have a history of heart failure (p = .02) and myocardial infarction (p = .04). BMI, history of diabetes and COPD were similar between patients with and without AF (all p > .05), but CKD was more common in AF patients (p < .0001). In multiple regression analysis, CKD remained a strong independent predictor of STEMI-related AF (p < .0001).Conclusion: Irrespective of other factors, CKD was associated with increased risk of STEMI-related AF. CKD could be used to identify patients who will develop AF in this setting and who would benefit from closer follow-up and more intensive prophylactic strategies.

Prognostic impact of renal dysfunction on long-term mortality in patients with preserved, moderately impaired, and severely impaired left ventricular systolic function following myocardial infarction

Objective:

The aim of this study was to investigate and compare the prognostic impact of renal dysfunction (RD) at admission in patients with preserved, moderately impaired and severely impaired left ventricular systolic function following ST-elevation myocardial infarction (STEMI).

Methods:

We included 2436 patients with STEMI treated with primary percutaneous coronary intervention (pPCI). Patients presenting with cardiogenic shock and those on hemodyalisis were excluded. According to the left ventricular ejection fraction (EF), patients were divided in three groups: preserved left ventricular systolic function – EF >50%, moderately impaired – EF=40%-50% and severely impaired left ventricular systolic function-EF <40%. RD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m² at admission. The follow-up period was 6 years.

Results:

Preserved, moderately impaired and severely impaired systolic function were found in 741 (30.5%), 1367 (56.1%) and 328 (13.4%) patients, respectively. RD was present in 105 (14.2%) patients with preserved systolic function, 247 (18.1%) patients with moderately impaired, and 120 (36.5%) patients with severely impaired systolic function.Regardless of the presence of RD, 6-year mortality rates in patients with preserved, moderately impaired, and severely impaired systolic function were 2.7%, 5.2% and 31.1% respectively. Within each LVEF group, patients with RD had a worse outcome, both in the short- and long-term. In the Mulivariate Cox Analysis, RD remained an independent predictor of 6-year mortality in patients with moderately (HR 2.52, 95% CI 1.54-3.78) and severely impaired systolic function (HR 2.84, 95% CI 1.68-5.34), but not in patients with preserved left ventricular systolic function (HR 0.59, 95% CI 0.14-1.41).

Conclusion:

Although patients with RD had higher 6-year mortallity following STEMI regardless of LVEF, RD at admission remained a strong independent predictor for 6-year mortality only in patients with moderately and severely impaired left ventricular systolic function.

Effects of oral paricalcitol therapy on arterial stiffness and osteopontin in hypertensive patients with chronic kidney disease and secondary hyperparathyroidism

BACKGROUND

Arterial stiffness is linked to the progression of atherosclerosis, while activation of vitamin D receptor exerts favorable cardiovascular effects in patients with renal insufficiency. In this study, we investigated the effects of oral treatment with paricalcitol, a potent vitamin D receptor activator, on arterial stiffness and osteopontin, a marker of atherosclerosis, in hypertensive patients with chronic kidney disease (CKD) and secondary hyperparathyroidism.

METHODS

We followed up 29 treated hypertensive patients (mean age: 74.1 years, 19 men, office blood pressure = 132/85 mmHg) with CKD stages 3-5 (mean glomerular filtration rate [GFR] = 19.4 ml/min/1.73 m²) who were on therapy with oral paricalcitol for 1 year. The control group consisted of 10 age-, sex-, and GFR-matched hypertensive patients with secondary hyperparathyroidism.

RESULTS

After 1 year of treatment with paricalcitol compared to baseline, there was no statistical difference in levels of GFR, office blood pressure, and osteopontin (p = NS for all), while carotid-femoral PWV was reduced from 11.8 ± 2.6 m/s to 11.2 ± 2.4 m/s (p < 0.05). The control group exhibited no significant changes in carotid-femoral PWV (p = NS).

CONCLUSIONS

Treatment with oral paricalcitol in hypertensive subjects suffering from CKD stages 3-5 and secondary hyperparathyroidism is accompanied by amelioration of arterial stiffness as reflected by the reduction of carotid-femoral PWV.