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Zoccali C, Mallamaci F, Halimi JM, Rossignol P, Sarafidis P, De Caterina R, Giugliano R, Zannad F. From Cardiorenal Syndrome to Chronic Cardiovascular and Kidney Disorder: A Conceptual Transition. Clin J Am Soc Nephrol 2024; 19:813-820. [PMID: 37902772 PMCID: PMC11168830 DOI: 10.2215/cjn.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/23/2023] [Indexed: 10/31/2023]
Abstract
The association between cardiac and kidney dysfunction has received attention over the past two decades. A putatively unique syndrome, the cardiorenal syndrome, distinguishing five subtypes on the basis of the chronology of cardiac and kidney events, has been widely adopted. This review discusses the methodologic and practical problems inherent to the current classification of cardiorenal syndrome. The term "disorder" is more appropriate than the term "syndrome" to describe concomitant cardiovascular and kidney dysfunction and/or damage. Indeed, the term disorder designates a disruption induced by disease states to the normal function of organs or organ systems. We apply Occam's razor to the chronology-based construct to arrive at a simple definition on the basis of the coexistence of cardiovascular disease and CKD, the chronic cardiovascular-kidney disorder (CCKD). This conceptual framework builds upon the fact that cardiovascular and CKD share common risk factors and pathophysiologic mechanisms. Biological changes set in motion by kidney dysfunction accelerate cardiovascular disease progression and vice versa . Depending on various combinations of risk factors and precipitating conditions, patients with CCKD may present initially with cardiovascular disease or with hallmarks of CKD. Treatment targeting cardiovascular or kidney dysfunction may improve the outcomes of both. The portfolio of interventions targeting the kidney-cardiovascular continuum is in an expanding phase. In the medium term, applying the new omics sciences may unravel new therapeutic targets and further improve the therapy of CCKD. Trials based on cardiovascular and kidney composite end points are an attractive and growing area. Targeting pathways common to cardiovascular and kidney diseases will help prevent the adverse health effects of CCKD.
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Affiliation(s)
- Carmine Zoccali
- Renal Research Institute, New York and Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy
- Associazione Ipertensione Nefrologia Trapianto Renal (IPNET), c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Francesca Mallamaci
- Nefrologia and CNR Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | | | - Patrick Rossignol
- Inserm, Centre d'Investigations Cliniques-1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Université de Lorraine, Nancy, France
- Department of Medical Specialties-Nephrology Hemodialysis, Princess Grace Hospital, Monaco Private Hemodialysis Centre, Monaco, Monaco
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Raffaele De Caterina
- University of Pisa and Cardiology Division, Pisa University Hospital, Pisa, Italy
| | | | - Faiez Zannad
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Sovetova SA, Nikiforova TA, Charaya KV, Shchekochikhin DY, Kulikov VM, Dubovitsky AM, Suchkova SA, Bogdanova AA, Ananicheva NA, Andreev DA. Hemodynamic Changes in Intrarenal Blood Flow are Associated With Poor Prognosis in Patients With Acute Decompensated Heart Failure. KARDIOLOGIIA 2024; 64:38-44. [PMID: 38742514 DOI: 10.18087/cardio.2024.4.n2575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 05/16/2024]
Abstract
AIM To evaluate a potential role of different patterns of intrarenal blood flow using Doppler ultrasound as a part of determining the severity of venous congestion, predicting impairment of renal function and an unfavorable prognosis in patients with acute decompensated chronic heart failure (ADCHF). MATERIAL AND METHODS This prospective observational single-site study included 75 patients admitted in the intensive care unit for ADCHF. Upon admission all patients underwent bedside renal venous Doppler ultrasound to determine the blood flow pattern (continuous, biphasic, monophasic). In one hour after the initiation of intravenous diuretic therapy, sodium concentration was measured in a urine sample. The primary endpoint was the development of acute kidney injury (AKI). The secondary endpoints were the development of diuretic resistance (a need to increase the furosemide daily dose by more than 2 times compared with the baseline), decreased natriuretic response (defined as urine sodium concentration less than 50-70 mmol/l), and in-hospital death. RESULTS According to the data of Doppler ultrasound, normal renal blood flow was observed in 40 (53%) patients, biphasic in 21 (28%) patients, and monophasic in 14 (19%) patients. The monophasic pattern of intrarenal blood flow was associated with the highest incidence of AKI: among 14 patients in this group, AKI developed in 100% of cases (OR 3.8, 95% CI: 2.5-5.8, p<0.01), while among patients with normal and moderate impairment of renal blood flow, there was no significant increase in the risk of developing AKI. The odds of in-hospital death were increased 25.77 times in patients with monophasic renal blood flow (95% CI: 5.35-123.99, p<0.001). Patients with a monophasic intrarenal blood flow pattern were also more likely to develop diuretic resistance compared to patients with other blood flow patterns (p<0.001) and had a decreased sodium concentration to less than 50 mmol/l (p<0.001) in a spot urine test obtained one hour after the initiation of furosemide administration. CONCLUSION Patients with monophasic intrarenal blood flow are at a higher risk of developing AKI, diuretic resistance with decreased natriuretic response, and in-hospital death.
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Affiliation(s)
| | | | - K V Charaya
- Sechenov First Moscow State Medical University
| | - D Yu Shchekochikhin
- Sechenov First Moscow State Medical University; Pirogov Municipal Clinical Hospital #1
| | - V M Kulikov
- Sechenov First Moscow State Medical University
| | | | | | | | | | - D A Andreev
- Sechenov First Moscow State Medical University
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Iacoviello M, Di Serio F, Rizzo C, Leone M, Grande D, Guida P, Gioia MI, Parisi G, Leopizzi T, Caldarola P, Ciccone MM, Gesualdo L. Association between high Gal-3 serum levels and worsening of renal function in chronic heart failure outpatients. Biomark Med 2019; 13:707-713. [PMID: 31157541 DOI: 10.2217/bmm-2018-0349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: The aim of the study was to evaluate the association between Gal-3 serum levels and the progression of renal dysfunction in chronic heart failure outpatients. Methods & results: This prospective study of 260 chronic heart failure patients showed that Gal-3 was associated with 1-year worsening of renal function both in univariate (odds ratio: 1.12; 95% CI: 1.06-1.18; p < 0.001) and in forward stepwise multivariate (odds ratio: 1.09; 95% CI: 1.03-1.15; p = 0.004) logistic regression analyses. Moreover, high Gal-3 levels at baseline were associated with a progressive decline in the estimated glomerular filtration rate. Conclusion: Gal-3 is a biomarker associated with the progression of renal function decline thus further supporting its possible usefulness in predicting cardiorenal syndrome progression.
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Affiliation(s)
- Massimo Iacoviello
- University Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, 70124, Bari, Italy
| | - Francesca Di Serio
- Clinic Pathology Unit, Policlinic University Hospital, 70124, Bari, Italy
| | - Caterina Rizzo
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS, Institute of Cassano delle Murge, 70020, Cassano delle Murge, Bari, Italy
| | - Marta Leone
- Cardiology Unit, Santissima Annunziata Hospital, 74100, Taranto, Italy
| | - Dario Grande
- Cardiology Department, Bari Local Health Service, 70123, Bari, Italy
| | - Pietro Guida
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS, Institute of Cassano delle Murge, 70020, Cassano delle Murge, Bari, Italy
| | | | - Giuseppe Parisi
- Cardiology Department, Bari Local Health Service, 70123, Bari, Italy
| | - Tiziana Leopizzi
- Cardiology Department, Bari Local Health Service, 70123, Bari, Italy
| | | | | | - Loreto Gesualdo
- University Nephrology Unit, D.E.T.O., University of Bari, 70124, Bari, Italy
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Renal Venous Pattern: A New Parameter for Predicting Prognosis in Heart Failure Outpatients. J Cardiovasc Dev Dis 2018; 5:jcdd5040052. [PMID: 30400289 PMCID: PMC6306853 DOI: 10.3390/jcdd5040052] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 12/13/2022] Open
Abstract
Aim of the study: In chronic heart failure (CHF) patients, renal congestion plays a key role in determining the progression of renal dysfunction and a worse prognosis. The aim of this study was to define the role of Doppler venous patterns reflecting renal congestion that predict heart failure progression. Methods: We enrolled outpatients affected by CHF, in stable clinical conditions and in conventional therapy. All patients underwent a clinical evaluation, routine chemistry, an echocardiogram and a renal echo-Doppler. Pulsed Doppler flow recording was performed at the level of interlobular renal right veins in the tele-expiratory phase. The venous flow patterns were divided into five groups according to the fluctuations of the flow. Type A and B were characterized by a continuous flow, whereas type C was characterized by a short interruption or reversal flow during the end-diastolic or protosystolic phase. Type D and E were characterized by a wide interruption and/or reversal flow. The occurrence of death and/or of heart transplantation and/or of hospitalization due to heart failure worsening was considered an event during follow-up. Results: During a median follow-up of 38 months, 126 patients experienced the considered end-point. Venous pattern C (HR 4.04; 95% CI: 2.14–7.65; p < 0.001), pattern D (HR 7.16; 95% CI: 3.69–13.9; p < 0.001) and pattern E (HR 8.94; 95% CI: 4.65–17.2; p < 0.001) were all associated with events using an univariate Cox regression analysis. Moreover, both the presence of pattern C (HR: 1.79; 95% CI: 1.09–2.97; p: 0) and of pattern D or E (HR: 1.90; 95% CI: 1.16–3.12; p: 0.011) remained significantly associated to events using a multivariate Cox regression analysis after correction for a reference model with an improvement of the overall net reclassification index (0.46; 95% CI 0.24–0.68; p < 0.001). Conclusions: Our findings demonstrate the independent and incremental role of Doppler venous patterns reflecting renal congestion in predicting HF progression among CHF patients, thus suggesting its possible utility in daily clinical practice to better characterize patients with cardio-renal syndrome.
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Sljivic A, Pavlovic Kleut M, Bukumiric Z, Celic V. Association between right ventricle two- and three-dimensional echocardiography and exercise capacity in patients with reduced left ventricular ejection fraction. PLoS One 2018; 13:e0199439. [PMID: 29928010 PMCID: PMC6013250 DOI: 10.1371/journal.pone.0199439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction Echocardiography represents the most commonly performed noninvasive cardiac imaging test for patients with heart failure (HF). The aim of this study was to assess the relationship between exercise capacity parameters (peak oxygen consumption (VO2) and the minute ventilation-carbon dioxide production relationship (VE/VCO2)), two-dimensional speckle-tracking echocardiography (2D-STE) and three-dimensional echocardiography (3DE) imaging of right ventricular (RV) function in HF patients with reduced ejection fraction (EF). Material and methods This cross-sectional study included 54 patients with diagnosed ischemic LV systolic dysfunction (HF with reduced EF <40%) divided in subgroups based on the proposed values of the analyzed cardiopulmonary exercise testing (CPET) variables: VO2 peak ≤ 15 ml/kg/min, VO2 peak > 15 ml/kg/min, VE/VCO2 slope < 36 and VE/VCO2 slope ≥ 36. All patients underwent a physical examination, laboratory testing, conventional echocardiography, 2D-STE, 3DE, and CPET. Results RV fractional area change (FAC), 2D RV global longitudinal strain (GLS), 3D RV EF were significantly decreased, and RV basal diameter (BD), systolic pulmonary artery pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), ratio between tricuspid flow and tissue Doppler derived e’ of the lateral tricuspid annulus (TV E/e’) were significantly increased in the subgroups of subjects with a worse VO2 peak and VE/VCO2 slope values. There was a significant positive correlation between the peak VO2 values and TAPSE, 2D RV GLS, 3D RV SV, and 3D RV EF as well as a significantly inverse correlation with VE/VCO2 slope. Conclusions The observed significant correlation between the examined parameters suggests that 2D RV GLS and 3D RV EF, SV are associated with exercise capacity in patients with reduced HF.
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Affiliation(s)
- Aleksandra Sljivic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic—Dedinje", Belgrade, Serbia
- * E-mail:
| | - Milena Pavlovic Kleut
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic—Dedinje", Belgrade, Serbia
| | - Zoran Bukumiric
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic—Dedinje", Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Agricola E, Marini C, Stella S, Monello A, Fisicaro A, Tufaro V, Slavich M, Oppizzi M, Castiglioni A, Cappelletti A, Margonato A. Effects of functional tricuspid regurgitation on renal function and long-term prognosis in patients with heart failure. J Cardiovasc Med (Hagerstown) 2017; 18:60-68. [DOI: 10.2459/jcm.0000000000000312] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Long-term changes in renal function and perfusion in heart failure patients with reduced ejection fraction. Clin Res Cardiol 2015; 105:10-6. [PMID: 26123828 PMCID: PMC4712227 DOI: 10.1007/s00392-015-0881-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/09/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Little is known about the natural course of renal function and renal hemodynamics in heart failure patients with reduced ejection fraction (HFREF). METHODS AND RESULTS We prospectively studied effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) in 73 HFREF patients with (125)I-iothalamate/(131)I-hippuran clearances with a mean follow-up of 34.6 ± 4.4 months. Fifteen percent were female, with age 58 ± 12 years and left ventricular ejection fraction (LVEF) 29 ± 10%. Baseline GFR was 81 ± 23 mL/min/1.73 m(2) and declined 0.6 ± 4.7 mL/min/1.73 m(2) per year. Baseline ERPF was 292 ± 83 mL/min/1.73 m(2) and declined 4.3 ± 19 mL/min/1.73 m(2) per year. Of the baseline variables, older age and high urinary kidney injury molecule-1 were the only variables associated with GFR decline (p < 0.05). Following stepwise backward analysis, only age (p < 0.001) remained significant. In addition, we found an association between change in GFR and changes in ERPF, N-terminal pro-brain natriuretic peptide and renovascular resistance. In the multivariable analysis, only the change in ERPF remained significantly associated with a change in GFR (p < 0.001). CONCLUSION In this cohort of stable chronic HFREF patients, the average decline in GFR over time was small. The decline of GFR was associated with a higher age and a lower baseline GFR, and was strongly related to changes in renal perfusion.
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Wu-Wong JR, Li X, Chen YW. Different vitamin D receptor agonists exhibit differential effects on endothelial function and aortic gene expression in 5/6 nephrectomized rats. J Steroid Biochem Mol Biol 2015; 148:202-9. [PMID: 25500070 DOI: 10.1016/j.jsbmb.2014.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 11/25/2014] [Accepted: 12/03/2014] [Indexed: 01/10/2023]
Abstract
Endothelial dysfunction, common in chronic kidney disease (CKD), significantly increases cardiovascular disease risk in CKD patients. This study investigates whether different vitamin D receptor agonists exhibit different effects on endothelial function and on aortic gene expression in an animal CKD model. The 5/6 nephrectomized (NX) rat was treated with or without alfacalcidol (0.02, 0.04 and 0.08μg/kg), paricalcitol (0.04 and 0.08μg/kg), or VS-105 (0.004, 0.01 and 0.16μg/kg). All three compounds at the test doses suppressed serum parathyroid hormone effectively. Alfacalcidol at 0.08μg/kg raised serum calcium significantly. Endothelial function was assessed by pre-contracting thoracic aortic rings with phenylephrine, followed by treatment with acetylcholine or sodium nitroprusside. Uremia significantly affected endothelial-dependent aortic relaxation, which was improved by all three compounds in a dose-dependent manner with alfacalcidol and paricalcitol exhibiting a lesser effect. DNA microarray analysis of aorta samples revealed that uremia impacted the expression of numerous aortic genes, many of which were normalized by the vitamin D analogs. Real-time RT-PCR analysis confirmed that selected genes such as Abra, Apoa4, Fabp2, Hsd17b2, and Hspa1b affected by uremia were normalized by the vitamin D analogs with alfacalcidol exhibiting less of an effect. These results demonstrate that different vitamin D analogs exhibit different effects on endothelial function and aortic gene expression in 5/6 NX rats. This article is part of a Special Issue entitled '17th Vitamin D Workshop'.
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Affiliation(s)
| | - Xinmin Li
- Department of Pathology & Laboratory Medicine, University of California, Los Angeles, CA, United States
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Valente MAE, Voors AA, Damman K, Van Veldhuisen DJ, Massie BM, O'Connor CM, Metra M, Ponikowski P, Teerlink JR, Cotter G, Davison B, Cleland JGF, Givertz MM, Bloomfield DM, Fiuzat M, Dittrich HC, Hillege HL. Diuretic response in acute heart failure: clinical characteristics and prognostic significance. Eur Heart J 2014; 35:1284-93. [DOI: 10.1093/eurheartj/ehu065] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Wu-Wong JR, Kawai M, Chen YW, Wessale JL, Huang CJ, Wu MT, Nakane M. Two novel vitamin D receptor modulators with similar structures exhibit different hypercalcemic effects in 5/6 nephrectomized uremic rats. Am J Nephrol 2013; 37:310-9. [PMID: 23548814 DOI: 10.1159/000348755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/07/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Vitamin D receptor modulators (VDRMs) are indicated for secondary hyperparathyroidism in chronic kidney disease (CKD). Clinical observations demonstrate that VDRM therapy provides cardiovascular (CV) benefit in CKD. Current on-market VDRMs have a narrow therapeutic index at 1- to 4-fold [hypercalcemic toxicity vs. parathyroid hormone (PTH)-suppressing efficacy]. Hypercalcemia leads to the need for frequent drug dose titration and serum calcium (Ca) monitoring. A VDRM with a wider therapeutic index and beneficial CV effects will be clinically useful. METHODS Two structurally similar VDRMs were tested in the 5/6 nephrectomized (NX) rats with elevated PTH, endothelial dysfunction and left ventricular hypertrophy. RESULTS VS-110 and VS-411 at 0.01-1 μg/kg (i.p. 3 times/week for 2 weeks) suppressed serum PTH effectively. VS-411 raised serum Ca with an 11% increase at 0.01 μg/kg (therapeutic index = ~1-fold), while VS-110 did not raise serum Ca even at 1 μg/kg (therapeutic index >50-fold). VS-110 improved endothelium-dependent aortic relaxation in a dose-dependent manner and significantly reduced left ventricular fibrosis without affecting serum Ca. VS-411 also exhibited effects on the CV parameters, but was less potent at the high doses with severe hypercalcemia. VS-110 and VS-411 specifically activated the reporter gene via a chimeric receptor containing the VDR ligand binding domain with EC(50) <0.1 nM. CONCLUSIONS Structurally similar VDRMs can exhibit distinctly different hypercalcemic effects in 5/6 NX uremic rats. While differences exist for the Ca and CV effects of VS-110 and VS-411, the clinical implications are unclear. VS-110's results are promising but clinical outcome studies need to be performed.
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Hou ZQ, Sun ZX, Su CY, Tan H, Zhong X, Hu B, Zhou Y, Shang DY. Effect of lipo-prostaglandin E1 on cystatin C, β2-microglobulin, and estimated glomerular filtration rate in patients with decompensated heart failure and renal dysfunction: a single-center, nonrandomized controlled study. Heart Vessels 2012; 28:589-95. [PMID: 23000961 DOI: 10.1007/s00380-012-0286-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/24/2012] [Indexed: 11/29/2022]
Abstract
A nonrandomized controlled study was conducted to evaluate the effect of lipo-prostaglandin E1 (lipo-PGE1) on cystatin C (CysC), β2-microglobulin (B2MG), and estimated glomerular filtration rate (eGFR) in patients with decompensated heart failure (DHF) and renal dysfunction. A total of 286 enrolled patients with DHF and renal dysfunction were nonrandomly assigned a 7-day standard treatment without (n = 146) or with (n = 140) lipo-PGE1 intervention. According to the baseline eGFR, patients were further classified into mild, moderate, and severe renal dysfunction subgroups. By the end of study period, there was no evidence of an immense improvement in B2MG, CysC, and eGFR in response to standard treatment (all P > 0.05). On the contrary, a noticeable decrease of B2MG and CysC was observed in patients receiving lipo-PGE1 intervention, as well as an increase in eGFR (all P < 0.05). Moreover, lipo-PGE1 intervention led to greater changes in renal function variables from baseline than with standard management (all P < 0.05). Most important, the favorable renal protective effects of lipo-PGE1 were maintained in three subgroups. Lipo-PGE1 intervention brought a substantial renoprotective benefit to hospitalized DHF patients as compared with standard therapy, suggesting it might offer a promising therapeutic option for the management of renal dysfunction associated with DHF.
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Affiliation(s)
- Zhi-Qiang Hou
- Emergency Department, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing Wu Road, Jinan, 250021, Shandong, China
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Dini FL, Demmer RT, Simioniuc A, Morrone D, Donati F, Guarini G, Orsini E, Caravelli P, Marzilli M, Colombo PC. Right ventricular dysfunction is associated with chronic kidney disease and predicts survival in patients with chronic systolic heart failure. Eur J Heart Fail 2012; 14:287-94. [PMID: 22357576 DOI: 10.1093/eurjhf/hfr176] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
AIMS Chronic kidney disease (CKD) and right ventricular (RV) dysfunction are important predictors of prognosis in heart failure (HF). We investigated the relationship between RV dysfunction and CKD in outpatients with chronic systolic HF, an association which remains poorly defined. METHODS AND RESULTS Outpatients (n = 373) with chronic HF and left ventricular ejection fraction (LVEF) ≤45% underwent clinical and echo-Doppler evaluations and were followed up for 31 ± 24 months. Tricuspid annular plane systolic excursion (TAPSE) assessed RV dysfunction. The estimated glomerular filtration rate (GFR) was measured by the simplified Modification of Diet in Renal Disease (MDRD) formula. Correlation analysis was used to characterize the association between TAPSE and estimated GFR. Odds ratios (ORs) for CKD and hazard ratios (HRs) for all-cause mortality were assessed using multivariable logistic or proportional hazards regression models. TAPSE and estimated GFR were significantly correlated (r = 0.38, P < 0.0001). TAPSE ≤14 mm was associated with elevated estimated right atrial pressure and N-terminal pro brain natriuretic peptide levels. TAPSE ≤14 mm increased the odds of estimated GFR <60 mL/min/1.73 m(2), OR [95% confidence interval (CI)] = 2.51(1.44-4.39), P < 0.0001 and predicted all-cause mortality, HR (95% CI) = 1.80 (1.20-2.71) after multivariable adjustment. CONCLUSIONS Right ventricular dysfunction is cross-sectionally associated with CKD and prospectively predicts survival in outpatients with chronic systolic HF. These data suggest RV dysfunction to be one of the possible mechanistic links between HF and CKD.
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Affiliation(s)
- Frank L Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Via Paradisa 2, Pisa, Italy.
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Wu-Wong JR, Kawai M, Chen YW, Nakane M. VS-105: a novel vitamin D receptor modulator with cardiovascular protective effects. Br J Pharmacol 2012; 164:551-60. [PMID: 21557735 DOI: 10.1111/j.1476-5381.2011.01473.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Vitamin D receptor (VDR) modulators (VDRMs) such as calcitriol, paricalcitol and doxercalciferol are commonly used to manage hyperparathyroidism secondary to chronic kidney disease (CKD). CKD patients experience extremely high risks of cardiovascular morbidity and mortality. Clinical observations show that VDRM therapy may be associated with cardio-renal protective and survival benefits for CKD patients. However, hypercalcaemia remains a serious side effect for current VDRMs, which leads to the need for frequent dose titration and serum Ca (calcium) monitoring. Significant clinical benefits can be derived from a VDRM with cardiovascular protective effects without the hypercalcaemic liability. EXPERIMENTAL APPROACH Male Sprague-Dawley rats were 5/6 nephrectomized and 6 weeks later, after they had established uraemia, elevated parathyroid hormone levels, endothelial dysfunction and left ventricular hypertrophy, the rats were treated with VS-105, a novel VDRM. The effects of VS-105 were also tested in cultured HL-60 cells. KEY RESULTS VS-105 induced HL-60 cell differentiation with an EC₅₀ value at 11.8 nM. Treatment (i.p., 3× a week over a period of 2 weeks) of the 5/6 nephrectomized rats by VS-105 (0.004-0.64 µg·kg⁻¹) effectively suppressed serum parathyroid hormone without raising serum Ca or phosphate levels. Furthermore, 2 weeks of treatment with VS-105 improved endothelium-dependent aortic relaxation and attenuated left ventricular abnormalities in a dose range that did not affect serum Ca levels. Similar results were obtained when VS-105 was administered i.p. or by oral gavage. CONCLUSIONS AND IMPLICATIONS VS-105 exhibits an overall therapeutic product profile that supports expanded use in CKD to realize the cardiovascular protective effects of VDR activation.
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Campbell E, Kalra P. Cardiorenal medicine: partners in practice? J Ren Care 2011; 37:68-71. [PMID: 21561540 DOI: 10.1111/j.1755-6686.2011.00226.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiorenal medicine is an exciting and evolving area of medicine. There is still much to learn about the complex pathophysiological process of the cardiorenal syndrome. The latest ideas and research were discussed at the 5th Annual Cardiorenal Forum on 15th October 2010.
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Affiliation(s)
- Ellen Campbell
- Department of Cardiology, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK
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Viswanathan G, Gilbert S. The cardiorenal syndrome: making the connection. Int J Nephrol 2010; 2011:283137. [PMID: 21151533 PMCID: PMC2989717 DOI: 10.4061/2011/283137] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/17/2010] [Indexed: 01/13/2023] Open
Abstract
The heart and the kidneys share responsibility for maintaining hemodynamic stability and end-organ perfusion. Connections between these organs ensure that subtle physiologic changes in one system are tempered by compensation in the other through a variety of pathways and mediators. In the setting of underlying heart disease or chronic kidney disease, the capacity of each organ to respond to perturbation caused by the other may become compromised. This has recently led to the characterization of the cardiorenal syndrome (CRS). This review will primarily focus on CRS type 1 where acute decompensated heart failure (ADHF) results in activation of hemodynamic and neurohormonal factors leading to an acute drop in the glomerular filtration rate and the development of acute kidney injury. We will examine the scope and impact of this problem, the pathophysiology associated with this relationship, including underperfuson and venous congestion, diagnostic tools for earlier detection, and therapeutic interventions to prevent and treat this complication.
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Affiliation(s)
- Gautham Viswanathan
- Division of Nephrology, Tufts Medical Center, 800 Washington Street, P.O. 391, Boston, MA 02111, USA
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