1
|
Chandramohan D, Simhadri PK, Jena N, Palleti SK. Strategies for the Management of Cardiorenal Syndrome in the Acute Hospital Setting. HEARTS 2024; 5:329-348. [DOI: 10.3390/hearts5030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Cardiorenal syndrome (CRS) is a life-threatening disorder that involves a complex interplay between the two organs. Managing this multifaceted syndrome is challenging in the hospital and requires a multidisciplinary approach to tackle the many manifestations and complications. There is no universally accepted algorithm to treat patients, and therapeutic options vary from one patient to another. The mainstays of therapy involve the stabilization of hemodynamics, decongestion using diuretics or renal replacement therapy, improvement of cardiac output with inotropes, and goal-directed medical treatment with renin–angiotensin–aldosterone system inhibitors, beta-blockers, and other medications. Mechanical circulatory support is another viable option in the armamentarium of agents that improve symptoms in select patients.
Collapse
Affiliation(s)
- Deepak Chandramohan
- Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Prathap Kumar Simhadri
- Department of Nephrology, Advent Health/FSU College of Medicine, Daytona Beach, FL 32117, USA
| | - Nihar Jena
- Department of Internal Medicine/Cardiovascular Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, USA
| | - Sujith Kumar Palleti
- Department of Internal Medicine/Nephrology, LSU Health Shreveport, Shreveport, LA 71103, USA
| |
Collapse
|
2
|
Maisons V, Halimi JM, Fauchier G, de Fréminville JB, Goin N, Gueguen J, Gatault P, Sautenet B, Angoulvant D, Herbert J, Bisson A, Ducluzeau PH, Fauchier L. Type 2 diabetes and cardiorenal syndromes. A nationwide French hospital cohort study. DIABETES & METABOLISM 2023; 49:101441. [PMID: 36931430 DOI: 10.1016/j.diabet.2023.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
AIM Type 2 diabetes mellitus (T2DM) is a risk factor for cardiac and renal complications; its effect on cardiorenal syndromes is unknown. METHODS In a French nationwide cohort of 5,123,193 patients hospitalized in 2012 with ≥5 years of follow-up, we assessed the effect of T2DM on cardiorenal syndrome (CRS) (using cardiorenal, renocardiac, and simultaneous subtypes) incidence and outcomes using 1:1 propensity matching. RESULTS Among 4,605,236 adults without cardiorenal syndrome, 380,581 (8.5%) with T2DM were matched to 380,581 adults without T2DM. During follow-up, CRS occurred in 104,788 patients: simultaneous n = 25,225 (24.0%); cardiorenal n = 51,745 (49.4%); renocardiac n = 27,818 (26.5%). T2DM doubled the risk of incident CRS (1.30% versus 0.65%/year; adjusted hazard ratio (HR) for any cardiorenal syndrome: 2.14 [95% confidence interval 2.10;2.19]; renocardiac: 2.43 [2.34;2.53]; cardiorenal: 2.09 [2.03;2.15]; simultaneous: 1.94 [1.86;2.03]. Among the 26,396 adults with CRS in 2012, 11,355 (43.0%) had T2DM and were younger than non-diabetic adults (77.4 ± 9.5 versus 82.3 ± 10.0); 8,314 patients with T2DM were matched to 8,314 patients without. T2DM increased risk of: end-stage kidney disease, adjusted HR 1.50 [1.39;1.62]; myocardial infarction 1.35 [1.19;1.53]; cardiovascular death 1.20 [1.13;1.27]; heart failure 1.17 [1.12;1.21]; and all-cause death 1.09 [1.06;1.13], but not ischemic stroke. CONCLUSION Patients with T2DM represent almost half of patients with CRS and are younger than their non-diabetic counterparts. T2DM doubles the risk of CRS and increases the risk of death, cardiovascular outcome, and end-stage kidney disease but not ischemic stroke after CRS.
Collapse
Affiliation(s)
- Valentin Maisons
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Jean-Michel Halimi
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France; EA4245, T2I, Université de Tours, Tours, France; INI-CRCT, France.
| | - Grégoire Fauchier
- Service de Service d'endocrinologie, diabétologie et métabolisme, Hôpital Bretonneau, CHU Tours, Tours, France
| | | | - Nicolas Goin
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Juliette Gueguen
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Philippe Gatault
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France; EA4245, T2I, Université de Tours, Tours, France
| | - Bénédicte Sautenet
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France; INI-CRCT, France; INSERM U1246 SPHERE, Université de Tours-Université de Nantes, Tours, France
| | - Denis Angoulvant
- EA4245, T2I, Université de Tours, Tours, France; Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| | - Julien Herbert
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| | - Pierre-Henri Ducluzeau
- Service de Service d'endocrinologie, diabétologie et métabolisme, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| |
Collapse
|
3
|
Adeghate EA, Kalász H, Al Jaberi S, Adeghate J, Tekes K. Tackling type 2 diabetes-associated cardiovascular and renal comorbidities: a key challenge for drug development. Expert Opin Investig Drugs 2020; 30:85-93. [PMID: 33327794 DOI: 10.1080/13543784.2021.1865914] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Ernest A Adeghate
- Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University , Al Ain, United Arab Emirates
| | - Huba Kalász
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Semmelweis University , Budapest, Hungary
| | - Saeeda Al Jaberi
- Department of Anatomy, College of Medicine & Health Sciences, United Arab Emirates University , Al Ain, United Arab Emirates
| | - Jennifer Adeghate
- Department of Ophthalmology, University of Pittsburgh School of Medicine , Pittsburgh, USA
| | - Kornelia Tekes
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University , Budapest, Hungary
| |
Collapse
|