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Lupa M, Pardała A, Bednarek A, Mrochem-Kwarciak J, Deja R, Mizia-Stec K, Kolonko A. The Association between Echocardiographic Parameters of Heart Failure with Preserved Ejection Fraction and Fluid Status Biomarkers in Hemodialysis Patients. Diagnostics (Basel) 2024; 14:1310. [PMID: 38928725 PMCID: PMC11202598 DOI: 10.3390/diagnostics14121310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Overhydration and cardiac function abnormalities are common in hemodialysis patients. The association of N-terminal prohormone for brain natriuretic peptide (NT-proBNP) and other fluid status biomarkers with echocardiographic parameters of heart failure with preserved ejection fraction (HFpEF) is scarcely investigated in this population. A total of 100 separate measurements performed in 50 dialysis patients (29 male, aged 60 ± 17 years) in NYHA class II/II and preserved left ventricle ejection fraction were analyzed. Plasma levels of NT-proBNP, mid-regional prohormone for atrial natriuretic peptide (MR-proANP) and copeptin (CPP) were measured. The E/e' ratio as an index of HFpEF and other echocardiographic parameters were calculated. An E/e' ratio >9 was associated with higher median right ventricular systolic pressure (RVSP) and LVMI values. Left atrium volume index (LAVI) as well as NT-proBNP and MR-proANP, but not CPP levels were significantly higher in this group. In a stepwise multivariate analysis, only CPP and IL-6 levels were found to be independently associated with the E/e' ratio in the study group, whereas NT-proBNP and MR-proANP were associated only with left heart structure parameters and LVEF. Of the analyzed biomarkers, only the CPP level was found to be independently associated with the E/e' ratio in maintenance hemodialysis patients.
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Affiliation(s)
- Mariusz Lupa
- Department of Internal Medicine, District Hospital, 34-600 Limanowa, Poland;
| | | | - Anna Bednarek
- First Department of Cardiology, Medical University of Silesia, 40-635 Katowice, Poland; (A.B.); (K.M.-S.)
| | - Jolanta Mrochem-Kwarciak
- Analytics and Clinical Biochemistry Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (J.M.-K.); (R.D.)
| | - Regina Deja
- Analytics and Clinical Biochemistry Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (J.M.-K.); (R.D.)
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, Medical University of Silesia, 40-635 Katowice, Poland; (A.B.); (K.M.-S.)
| | - Aureliusz Kolonko
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, 40-027 Katowice, Poland
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2
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Ito T, Akamatsu K. Echocardiographic manifestations in end-stage renal disease. Heart Fail Rev 2024; 29:465-478. [PMID: 38071738 DOI: 10.1007/s10741-023-10376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 03/16/2024]
Abstract
End-stage renal disease (ESRD) is a common but profound clinical condition, and it is associated with extremely increased morbidity and mortality. ESRD can represent four major echocardiographic findings-myocardial hypertrophy, heart failure, valvular calcification, and pericardial effusion. Multiple factors interplay leading to these abnormalities, including pressure/volume overload, oxidative stress, and neurohormonal imbalances. Uremic cardiomyopathy is characterized by left ventricular (LV) hypertrophy and marked diastolic dysfunction. In ESRD patients on hemodialysis, LV geometry is changeable bidirectionally between concentric and eccentric hypertrophy, depending upon changes in corporal fluid volume and arterial pressure, which eventually results in a characteristic of LV systolic dysfunction. Speckle tracking echocardiography enabling to detect subclinical disease might help prevent future advancement to heart failure. Heart valve calcification also is common in ESRD, keeping in mind which progresses faster than expected. In a modern era, pericardial effusion observed in ESRD patients tends to result from volume overload, rather than pericarditis. In this review, we introduce and discuss those four echocardiography-assessed findings of ESRD, with which known and conceivable pathophysiologies for each are incorporated.
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Affiliation(s)
- Takahide Ito
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Kanako Akamatsu
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
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Dobre MA, Ahlawat S, Schelling JR. Chronic kidney disease associated cardiomyopathy: recent advances and future perspectives. Curr Opin Nephrol Hypertens 2024; 33:203-211. [PMID: 38193308 PMCID: PMC10872957 DOI: 10.1097/mnh.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW Cardiomyopathy in chronic kidney disease (CKD) is a complex condition with multiple triggers and poor prognosis. This review provides an overview of recent advances in CKD-associated cardiomyopathy, with a focus on pathophysiology, newly discovered biomarkers and potential therapeutic targets. RECENT FINDINGS CKD is associated with a specific pattern of myocardial hypertrophy and fibrosis, resulting in diastolic and systolic dysfunction, and often triggered by nonatherosclerotic processes. Novel biomarkers, including amino-terminal type III procollagen peptide (PIIINP), carboxy-terminal type I procollagen peptide (PICP), FGF23, marinobufagenin, and several miRNAs, show promise for early detection and risk stratification. Treatment options for CKD-associated cardiomyopathy are limited. Sodium glucose cotransporter-2 inhibitors have been shown to reduce left ventricle hypertrophy and improve ejection fraction in individuals with diabetes and mild CKD, and are currently under investigation for more advanced stages of CKD. In hemodialysis patients calcimimetic etelcalcetide resulted in a significant reduction in left ventricular mass. SUMMARY CKD-associated cardiomyopathy is a common and severe complication in CKD. The identification of novel biomarkers may lead to future therapeutic targets. Randomized clinical trials in individuals with more advanced CKD would be well posed to expand treatment options for this debilitating condition.
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Affiliation(s)
- Mirela A Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center
- School of Medicine
| | - Shruti Ahlawat
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center
| | - Jeffrey R Schelling
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center
- School of Medicine
- Department of Physiology & Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
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Bolignano D, Greco M, D’Agostino M, Cianfrone P, Tripodi L, Misiti R, Zicarelli M, Ganino L, Foti DP, Andreucci M, Coppolino G. Urinary Marinobufagenin in Patients with Non-Advanced Chronic Kidney Disease: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1392. [PMID: 37629682 PMCID: PMC10456778 DOI: 10.3390/medicina59081392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The global prevalence of chronic kidney disease (CKD) is on the rise, posing important challenges for healthcare systems. Thus, the search for new factors potentially involved in the pathogenesis, progression and complications of early CKD remains urgent. Marinobufagenin (MBG) is a natriuretic endogenous cardiotonic steroid, and increased circulating levels of it may accelerate kidney damage. In this study, we explored the possible clinical significance of measuring urinary marinobufagenin (uMBG) in patients with non-advanced CKD. Materials and Methods: One hundred and eight adult CKD patients (mean age 71.6 ± 10 years, 70.4% male; mean eGFR 40.54 ± 17 mL/min/1.73 m2) were enrolled in this cross-sectional study. uMBG was measured together with a series of clinical, anthropometric, laboratory and instrumental analyses. Twenty-five healthy matched subjects served as controls for the uMBG measurement. Results: The uMBG values were lower in the patients with CKD as compared to those of the controls (0.37 [IQR: 0.25-0.45] vs. 0.64 [0.46-0.78] nmol/L. p = 0.004), and a significant trend in eGFR levels was noticed across the decreasing uMBG tertiles (p = 0.03). Regarding the correlation analyses, the uMBG values remained robustly associated with the eGFR in multivariate models employing either uMBG or eGFR as the dependent variable (β = 0.248; p = 0.01 and β = 0.139; p = 0.04, respectively). Besides the eGFR, the independent predictors of uMBG values in this population were the use of statins (β = -0.326; p = 0.001), the presence of diabetes (β = 0.243; p = 0.009) and urine sodium (β = 0.204; p = 0.01). Conclusions: Reduced uMBG excretion may reflect impaired renal clearance, which may contribute to the detrimental effects attributed to this hormone due to systemic accumulation. Future studies are needed to clarify the biological mechanisms placing uMBG at the crossroad of sodium intake and the presence of diabetes in CKD-suffering individuals and to verify whether a statin treatment may somewhat limit the detrimental effects of MBG in the presence of impaired renal function.
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Affiliation(s)
- Davide Bolignano
- Nephrology and Dialysis Unit, Magna-Graecia University Hospital, 88100 Catanzaro, Italy (L.T.)
- Department of Medical and Surgical Sciences, Magna-Graecia University, 88100 Catanzaro, Italy
| | - Marta Greco
- Clinical Pathology Lab., Magna-Graecia University Hospital, 88100 Catanzaro, Italy
- Department of Health Sciences, Magna-Graecia University, 88100 Catanzaro, Italy
| | - Mario D’Agostino
- Nephrology and Dialysis Unit, Magna-Graecia University Hospital, 88100 Catanzaro, Italy (L.T.)
| | - Paola Cianfrone
- Nephrology and Dialysis Unit, Magna-Graecia University Hospital, 88100 Catanzaro, Italy (L.T.)
| | - Loredana Tripodi
- Nephrology and Dialysis Unit, Magna-Graecia University Hospital, 88100 Catanzaro, Italy (L.T.)
| | - Roberta Misiti
- Clinical Pathology Lab., Magna-Graecia University Hospital, 88100 Catanzaro, Italy
| | - Mariateresa Zicarelli
- Department of Medical and Surgical Sciences, Magna-Graecia University, 88100 Catanzaro, Italy
| | - Ludovica Ganino
- Clinical Pathology Lab., Magna-Graecia University Hospital, 88100 Catanzaro, Italy
| | - Daniela Patrizia Foti
- Clinical Pathology Lab., Magna-Graecia University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna-Graecia University, 88100 Catanzaro, Italy
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Magna-Graecia University Hospital, 88100 Catanzaro, Italy (L.T.)
- Department of Health Sciences, Magna-Graecia University, 88100 Catanzaro, Italy
| | - Giuseppe Coppolino
- Nephrology and Dialysis Unit, Magna-Graecia University Hospital, 88100 Catanzaro, Italy (L.T.)
- Department of Health Sciences, Magna-Graecia University, 88100 Catanzaro, Italy
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Carullo N, Fabiano G, D'Agostino M, Zicarelli MT, Musolino M, Presta P, Michael A, Andreucci M, Bolignano D, Coppolino G. New Insights on the Role of Marinobufagenin from Bench to Bedside in Cardiovascular and Kidney Diseases. Int J Mol Sci 2023; 24:11186. [PMID: 37446363 DOI: 10.3390/ijms241311186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Marinobufagenin (MBG) is a member of the bufadienolide family of compounds, which are natural cardiac glycosides found in a variety of animal species, including man, which have different physiological and biochemical functions but have a common action on the inhibition of the adenosine triphosphatase sodium-potassium pump (Na+/K+-ATPase). MBG acts as an endogenous cardiotonic steroid, and in the last decade, its role as a pathogenic factor in various human diseases has emerged. In this paper, we have collated major evidence regarding the biological characteristics and functions of MBG and its implications in human pathology. This review focused on MBG involvement in chronic kidney disease, including end-stage renal disease, cardiovascular diseases, sex and gender medicine, and its actions on the nervous and immune systems. The role of MBG in pathogenesis and the development of a wide range of pathological conditions indicate that this endogenous peptide could be used in the future as a diagnostic biomarker and/or therapeutic target, opening important avenues of scientific research.
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Affiliation(s)
- Nazareno Carullo
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Giuseppe Fabiano
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Mario D'Agostino
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | | | - Michela Musolino
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Pierangela Presta
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Ashour Michael
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Michele Andreucci
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Davide Bolignano
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
| | - Giuseppe Coppolino
- Renal Unit, "Magna Graecia" University of Catanzaro, 88100 Catanzaro, Italy
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Bolignano D, Greco M, Presta P, Caglioti A, Carullo N, Zicarelli M, Foti DP, Dragone F, Andreucci M, Coppolino G. Marinobufagenin, Left Ventricular Hypertrophy and Residual Renal Function in Kidney Transplant Recipients. J Clin Med 2023; 12:jcm12093072. [PMID: 37176512 PMCID: PMC10179363 DOI: 10.3390/jcm12093072] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH), which is a pervasive complication of end-stage kidney disease (ESKD), persists in some uremic individuals even after kidney transplantation (Ktx), contributing to worsening CV outcomes. Marinobufagenin (MBG), an endogenous steroid cardiotonic hormone endowed with natriuretic and vasoconstrictive properties, is an acknowledged trigger of uremic cardiomyopathy. However, its clinical significance in the setting of Ktx remains undefined. METHODS In a cohort of chronic Ktx recipients (n = 40), we assessed circulating MBG together with a thorough clinical and echocardiographic examination. Forty matched haemodialysis (HD) patients and thirty healthy subjects served as controls for MBG measurements. Patients were then prospectively followed up to 12 months and the occurrence of an established cardio-renal endpoint (death, CV events, renal events, graft rejection) was recorded. RESULTS Median MBG plasma levels were lower in Ktx as compared with HD patients (p = 0.02), but higher as compared with healthy controls (p = 0.0005). Urinary sodium (β = 0.423; p = 0.01) and eGFR (β = -0.324; p = 0.02) were the sole independent predictors of MBG in this cohort, while a strong correlation with left ventricular mass index (LVMi), found in univariate analyses (R = 0.543; p = 0.0007), gained significance only in multivariate models not including eGFR. Logistic regression analyses indicated MBG as a significant predictor of the combined endpoint (OR 2.38 [1.10-5.12] per each 1 nmoL/L increase; p = 0.01), as well as eGFR, LVMi, serum phosphate and proteinuria. CONCLUSIONS Ktx recipients display altered MBG levels which are influenced by sodium balance, renal impairment and the severity of LVH. Thus, MBG might represent an important missing link between reduced graft function and pathological cardiac remodelling and may hold important prognostic value for improving cardio-renal risk assessment.
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Affiliation(s)
- Davide Bolignano
- Nephrology and Dialysis Unit, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
- Department of Medical and Surgical Sciences, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Marta Greco
- Clinical Pathology Lab, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
- Department of Health Sciences, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Pierangela Presta
- Nephrology and Dialysis Unit, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Alfredo Caglioti
- Nephrology and Dialysis Unit, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Nazareno Carullo
- Nephrology and Dialysis Unit, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Mariateresa Zicarelli
- Nephrology and Dialysis Unit, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Daniela Patrizia Foti
- Clinical Pathology Lab, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
- Department of Clinical and Experimental Medicine, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Francesco Dragone
- Clinical Pathology Lab, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Michele Andreucci
- Nephrology and Dialysis Unit, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
- Department of Health Sciences, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
| | - Giuseppe Coppolino
- Nephrology and Dialysis Unit, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
- Department of Health Sciences, University "Magna-Graecia" of Catanzaro, 88100 Catanzaro, Italy
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7
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D’Agostino M, Mauro D, Zicarelli M, Carullo N, Greco M, Andreucci M, Coppolino G, Bolignano D. miRNAs in Uremic Cardiomyopathy: A Comprehensive Review. Int J Mol Sci 2023; 24:5425. [PMID: 36982497 PMCID: PMC10049249 DOI: 10.3390/ijms24065425] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/14/2023] Open
Abstract
Uremic Cardiomyopathy (UCM) is an irreversible cardiovascular complication that is highly pervasive among chronic kidney disease (CKD) patients, particularly in End-Stage Kidney Disease (ESKD) individuals undergoing chronic dialysis. Features of UCM are an abnormal myocardial fibrosis, an asymmetric ventricular hypertrophy with subsequent diastolic dysfunction and a complex and multifactorial pathogenesis where underlying biological mechanisms remain partly undefined. In this paper, we reviewed the key evidence available on the biological and clinical significance of micro-RNAs (miRNAs) in UCM. miRNAs are short, noncoding RNA molecules with regulatory functions that play a pivotal role in myriad basic cellular processes, such as cell growth and differentiation. Deranged miRNAs expression has already been observed in various diseases, and their capacity to modulate cardiac remodeling and fibrosis under either physiological or pathological conditions is well acknowledged. In the context of UCM, robust experimental evidence confirms a close involvement of some miRNAs in the key pathways that are known to trigger or worsen ventricular hypertrophy or fibrosis. Moreover, very preliminary findings may set the stage for therapeutic interventions targeting specific miRNAs for ameliorating heart damage. Finally, scant but promising clinical evidence may suggest a potential future application of circulating miRNAs as diagnostic or prognostic biomarkers for improving risk stratification in UCM as well.
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Affiliation(s)
| | | | | | | | | | | | | | - Davide Bolignano
- Nephrology and Dialysis Unit, Department of Medical and Surgical Sciences, University “Magna-Graecia” of Catanzaro, Viale Europa SNC, 88100 Catanzaro, Italy
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