Toward Precision Medicine in the Cardiorenal Syndrome

Publication date: September 2018Source: Advances in Chronic Kidney Disease, Volume 25, Issue 5Author(s): Nicholas Wettersten, Alan S. Maisel, Dinna N. CruzAlthough the field of oncology has made significant steps toward individualized precision medicine, cardiology and nephrology still often use a “one size fits all” approach. This applies to the intersection of the heart-kidney interaction and the cardiorenal syndrome as well. Recent studies have shown that the prognostic implications of worsening renal function (WRF) in acute heart failure are variable; thus, there is a need to differentiate the implications of WRF to better guide precise care. This may best be performed with biomarkers that can give the clinician a real-time evaluation of the physiologic state at the time of developing WRF. This review will summarize current cardiac and renal biomarkers and their status in the evaluation of cardiorenal syndrome. Although we have made progress in our understanding of this syndrome, further investigation is needed to bring precision medicine into routine clinical practice for the care of patients with cardiorenal syndrome.
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research

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This study comprised 2,516 hypertensive patients who had had at least two serum creatinine measurements over a four-year period. An eGFR reduction of ≥10% per year has been deemed as high-eGFR and a reduction in eGFR of less than 10% per year as a low decline. The end-points were: coronary artery disease, stroke, transitory ischemic accident, peripheral arterial disease, heart failure, atrial fibrillation, death from any cause. Cox regression analyses adjusted for potentially confounding factors were conducted. RESULTS: 2,354 patients with low rate of eGFR decline and 149 with high-rate of eGFR decline were analyze...
Source: American Journal of Hypertension - Category: Cardiology Authors: Tags: Am J Hypertens Source Type: research
The same underlying molecular and cellular damage of aging contributes to both calcification of blood vessel walls and the development of atherosclerosis, but researchers here argue that calcification can be considered on its own, an independent risk factor for cardiovascular dysfunction and mortality in later life. The presence of senescent cells is one of the common underlying factors that accelerates the progression of both atherosclerosis and calcification of blood vessels. This is due to the inflammatory signaling produced by these cells. That signaling distorts the behavior of macrophages trying to clear up deposits ...
Source: Fight Aging! - Category: Research Authors: Tags: Daily News Source Type: blogs
CONCLUSIONS: CVOTs and other studies confirm that the SGLT-2 inhibitors, mostly used in combination with other glucose-lowering drugs, offer several clinical benefits beyond improved glycemic control. These include reducing HHF risk and improving renal outcomes. HF and renal benefits are observed in individuals with and without established CVD, which may simplify therapeutic selection. Ongoing SGLT-2 inhibitor CVOTs will help clarify the potential of these drugs to treat T2D comorbid with different forms of HF (HF with preserved vs reduced ejection fraction) and different degrees of renal dysfunction, and in individuals wi...
Source: Current Medical Research and Opinion - Category: Research Tags: Curr Med Res Opin Source Type: research
Hypertension is a major risk factor and precursor of myocardial infarction, chronic kidney disease, heart failure and premature death. These vascular events increased costs of hypertension management. Self-car...
Source: BMC Research Notes - Category: Research Authors: Tags: Research note Source Type: research
The (pro)renin receptor [(P)RR)] is involved in the activation of local renin-angiotensin system and subsequent development of cardiovascular disease. We investigated the therapeutic effect of a (P)RR blocker, handle region peptide (HRP), on chronic kidney disease (CKD)-associated heart failure.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: Basic Science and Experimental Studies Source Type: research
In type 2 cardiorenal syndrome, chronic heart failure is thought to cause or promote chronic kidney disease; however, the underlying mechanisms remain poorly understood. We investigated the role of Wnt signaling in heart and kidney injury in a mouse model of cardiac hypertrophy and heart failure induced by transverse aortic constriction (TAC). At 8 weeks after TAC, cardiac hypertrophy, inflammation, and fibrosis were prominent, and echocardiography confirmed impaired cardiac function. The cardiac lesions were accompanied by upregulation of multiple Wnt ligands and activation of β-catenin, as well as activation of the ...
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Basic Research Source Type: research
ConclusionsThese findings question a “one-size-fits-all” approach to fluid administration and performance measures for patients with sepsis.
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research
Cardiovascular disease is prevalent in patients with chronic kidney disease (CKD) and responsible for approximately half of all CKD-related deaths. Unfortunately, the presence of CKD can lead to a challenging interpretation of cardiac biomarkers essential in accurate diagnosis and prompt management of heart failure and acute coronary syndrome. There is growing interest in novel cardiac biomarkers that may improve diagnostic accuracy reflecting myocardial injury, inflammation, and remodeling. Interpretation of these biomarkers in CKD can be complicated, since elevated levels may not reflect myocardial injury or wall tension...
Source: Nephron - Category: Urology & Nephrology Source Type: research
Abstract PURPOSE: Although guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) should be treated with renin-angiotensin system (RAS) inhibitors, the long-term efficacy of RAS inhibitors in HFrEF patients with moderate-to-severe chronic kidney disease (CKD) remains unclear. METHODS: The present study included consecutive patients hospitalized for acute heart failure across five Japanese teaching hospitals. The impact of RAS inhibitors on 2-year all-cause mortality was evaluated in patients with an ejection fraction ≤40% and CKD, defined as an estimated glomerular filtration rate (eGFR)
Source: European Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Eur J Intern Med Source Type: research
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Source: Acta Diabetologica - Category: Endocrinology Source Type: research
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