The Role of Endotoxin in the Setting of Cardiorenal Syndrome Type 5
Lipopolysaccharide or endotoxin, the major cell wall component of gram-negative bacteria, plays a pivotal role in the pathogenesis of sepsis. It is able to activate the host defense system through the interaction with Toll-like receptor 4, thus triggering pro-inflammatory mechanisms. When the production of inflammatory mediators becomes uncontrolled and excessive, septic shock develops with multiple organ dysfunction, such as myocardial and renal impairment, which are hallmarks of cardiorenal syndrome type 5. In this review, we will analyze the role of endotoxin in the pathogenesis of sepsis, its effects on cardiac and ren...
Source: Cardiorenal Medicine - June 23, 2017 Category: Urology & Nephrology Source Type: research
Urinary Liver-Type Fatty Acid-Binding Protein Level as a Predictive Biomarker of Acute Kidney Injury in Patients with Acute Decompensated Heart Failure
We examined 281 consecutive patients with ADHF. Serum creatinine (Cr) and L-FABP levels were measured at admission and 24 and 48 h after admission.Results: AKI developed in 104 patients (37%). Urinary L-FABP levels at admission were significantly higher in patients with AKI than in those without (33.0 vs. 5.2 μg/g Cr;p (Source: Cardiorenal Medicine)
Source: Cardiorenal Medicine - June 20, 2017 Category: Urology & Nephrology Source Type: research
Folic Acid and Homocysteine in Chronic Kidney Disease and Cardiovascular Disease Progression: Which Comes First?
Background: Hyperhomocysteinemia (Hhcy) occurs in about 85% of chronic kidney disease (CKD) patients because of impaired renal metabolism and reduced renal excretion. Folic acid (FA), the synthetic form of vitamin B9, is critical in the conversion of homocysteine (Hcy) to methionine. If there is not enough intake of FA, there is not enough conversion, and Hcy levels are raised.Summary: Hhcy is regarded as an independent predictor of cardiovascular morbidity and mortality in end-stage renal disease. Hhcy exerts its pathogenic action on the main processes involved in the progression of vascular damage. Research has shown Hhc...
Source: Cardiorenal Medicine - June 20, 2017 Category: Urology & Nephrology Source Type: research
Urinary Osteopontin Predicts Incident Chronic Kidney Disease, while Plasma Osteopontin Predicts Cardiovascular Death in Elderly Men
Background and Objectives: The matricellular protein osteopontin is involved in the pathogenesis of both kidney and cardiovascular disease. However, whether circulating and urinary osteopontin levels are associated with the risk of these diseases is less studied.Design, Setting, Participants, and Measurements: A community-based cohort of elderly men (Uppsala Longitudinal Study of Adult Men [ULSAM];n = 741; mean age: 77 years) was used to study the associations between plasma and urinary osteopontin, incident chronic kidney disease, and the risk of cardiovascular death during a median of 8 years of follow-up.Results: There ...
Source: Cardiorenal Medicine - May 24, 2017 Category: Urology & Nephrology Source Type: research
Characterization of an Animal Model to Study Risk Factors and New Therapies for the Cardiorenal Syndrome, a Major Health Issue in Our Aging Population
Conclusion: The animal model described in this article in many aspects mimics the human situation of the CRS type 4 and will be useful to concomitantly evaluate the effects of new treatment strategies on the various aspects of CRS.Cardiorenal Med 2017;7:234-244 (Source: Cardiorenal Medicine)
Source: Cardiorenal Medicine - May 23, 2017 Category: Urology & Nephrology Source Type: research
Estimated Glomerular Filtration Rate and 6-Minute Walk Distance in African Americans with Mild to Moderate Heart Failure
Conclusion: A decrease in eGFR significantly predicted a shorter 6MWD in AA patients with HF. Therefore, a reduction in eGFR may be used as an early marker to identify and manage declining functional capacity in these patients.Cardiorenal Med 2017;7:227-233 (Source: Cardiorenal Medicine)
Source: Cardiorenal Medicine - May 23, 2017 Category: Urology & Nephrology Source Type: research
Brain Natriuretic Peptide Is a Marker of Fluid Overload in Incident Hemodialysis Patients
We report the monthly BNP change in the first months of HD therapy in incident patients and its relationship with fluid removal and cardiac history (CH).Methods: All patients starting HD therapy in our unit from May 2008 to December 2012 were retrospectively analyzed. Every month (M1 to M6), BNP was assessed before a midweek dialysis session. CH, monthly pre- and postdialysis blood pressure, and postdialysis body weight were collected.Results: A total of 236 patients were included in the analysis. The median BNP at HD start was 593 (175-1,433) pg/mL, with a significant difference between CH- and CH+ patients (291 vs. 731 p...
Source: Cardiorenal Medicine - April 28, 2017 Category: Urology & Nephrology Source Type: research
Recent Advances in Stroke Prevention in Patients with Atrial Fibrillation and End-Stage Renal Disease
Background: Chronic kidney disease (CKD) is associated with a high prevalence of atrial fibrillation (AF), but in this population the risk/benefit ratio of anticoagulant therapy with vitamin K antagonists (VKA) for thromboprophylaxis is uncertain.Summary: In end-stage renal disease (ESRD) patients undergoing hemodialysis, VKA seem less effective in stroke prevention than in the general population, with an increased risk of major bleeding. Recently, novel oral anticoagulant agents (NOACs) have proven to be effective for stroke prevention in AF and have demonstrated an improved safety profile compared to VKA. Limited data fr...
Source: Cardiorenal Medicine - April 26, 2017 Category: Urology & Nephrology Source Type: research
Nonparallel Progression of Left Ventricular Structure and Function in Long-Term Peritoneal Dialysis Patients
Background/Aims: Left ventricular hypertrophy and dysfunction are key cardiovascular risk factors of patients on peritoneal dialysis (PD). The purpose of this study was to investigate the dynamic changes of left ventricular (LV) structure and function in patients on long-term PD.Methods: Patients who underwent PD catheter insertions from January 2010 to December 2012 in our PD center were enrolled into this study. Cardiac structure and function of those patients were determined by echocardiography (4 times) at 12-month intervals. Patients' biochemical parameters, body mass index, blood pressure, urine output, ultrafiltrati...
Source: Cardiorenal Medicine - April 21, 2017 Category: Urology & Nephrology Source Type: research
Levocarnitine Injections Decrease the Need for Erythropoiesis-Stimulating Agents in Hemodialysis Patients with Renal Anemia
Conclusion: Our results suggest that levocarnitine administration can reduce the dose of ESAs required in patients with renal anemia on hemodialysis and improve the response to ESA therapy.Cardiorenal Med 2017;7:188-197 (Source: Cardiorenal Medicine)
Source: Cardiorenal Medicine - April 19, 2017 Category: Urology & Nephrology Source Type: research
Evaluation of the CRUSADE Risk Score for Predicting Major Bleeding in Patients with Concomitant Kidney Dysfunction and Acute Coronary Syndromes
Conclusions: The CRUSADE risk score shows a lower accuracy for predicting in-hospital MB in KD patients compared to those without KD.Cardiorenal Med 2017;7:179-187 (Source: Cardiorenal Medicine)
Source: Cardiorenal Medicine - February 16, 2017 Category: Urology & Nephrology Source Type: research
The Effect of Admission Renal Function on the Treatment and Outcome of Patients with Acute Coronary Syndrome
Background: Chronic kidney disease is a frequent comorbidity among patients with acute coronary syndrome (ACS). We aimed to evaluate treatment characteristics in ACS patients according to their renal function and to assess the effect of differences in therapy on clinical outcomes.Methods: Included were patients with ACS enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) during 2000-2013. Excluded were patients with cardiogenic shock at presentation. The estimated glomerular filtration rate (eGFR) was calculated using the simplified Modification of Diet in Renal Disease (MDRD) formula. The distribution...
Source: Cardiorenal Medicine - February 16, 2017 Category: Urology & Nephrology Source Type: research
Association of Growth Differentiation Factor 15 with Mortality in a Prospective Hemodialysis Cohort
Background/Aims: Cardiovascular disease and protein-energy wasting are among the strongest predictors of the high mortality of dialysis patients. In the general population, the novel cardiovascular and wasting biomarker, growth differentiation factor 15 (GDF15), is associated with decreased survival. However, little is known about GDF15 in dialysis patients.Methods: Among prevalent hemodialysis patients participating in a prospective study (October 2011 to August 2015), we examined the association of baseline GDF15 levels with all-cause mortality using unadjusted and case mix-adjusted death hazard ratios (HRs) that control...
Source: Cardiorenal Medicine - February 1, 2017 Category: Urology & Nephrology Source Type: research
Prognostic Implications of Chronic Kidney Disease on Patients Presenting with ST-Segment Elevation Myocardial Infarction with versus without Stent Thrombosis
Background: Limited data is present regarding long-term outcomes in chronic kidney disease (CKD) patients presenting with stent thrombosis (ST). We evaluated the possible implications of CKD on long-term mortality in patients presenting with ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PCI), and its interaction with the presence of ST.Methods: We retrospectively studied 1,722 STEMI patients treated with primary PCI. Baseline CKD was categorized as an estimated glomerular filtration rate (Source: Cardiorenal Medicine)
Source: Cardiorenal Medicine - January 27, 2017 Category: Urology & Nephrology Source Type: research
Lack of Diuretic Efficiency (but Not Low Diuresis) Early in An Acutely Decompensated Heart Failure Episode Is Associated with Increased 180-Day Mortality
Conclusion: A low DE ( ≤140 mL/40 mg of furosemide) in the first 3 h after an ADHF episode was associated with increased mid-term mortality rates.Cardiorenal Med 2017;7:137-149 (Source: Cardiorenal Medicine)
Source: Cardiorenal Medicine - January 20, 2017 Category: Urology & Nephrology Source Type: research
