Cardiorenal Syndrome: A Literature Review

Exploring Multimorbidity Patterns in older hospitalized Norwegian patients using Network Analysis modularity

BACKGROUND

Understanding Multimorbidity Patterns (MPs) is crucial for planning healthcare interventions, allocating resources, and improving patients' outcomes.

OBJECTIVE

We aim to demonstrate the use of Network Analysis (NA) to explore the MPs in hospitalized Norwegian older patients.

METHODS

We utilized data from the Norwegian Patient Registry (NPR) of all admissions between 2017 and 2019. The study population included patients ≥ 65 years old with two or more different conditions. Multimorbidity was defined as the co-occurrence of two or more associated chronic conditions. Chronic conditions were identified using the Chronic Condition Indicator Refined (CCIR) list. The association between chronic conditions was determined by calculating Relative Risk (RR) and Phi-correlation to detect pairs of conditions that co-occur beyond chance. A multimorbidity network was created, and MPs were detected using Louvain method for community detection. We suggested a clinical interpretation for these MPs.

RESULTS

A total of 539 chronic conditions were used to create a multimorbidity network revealing several MPs. These modules included patterns of vision and hearing disorders, cardiorenal syndrome, metabolic and cardiovascular disorders, respiratory disorders, endocrine and skin conditions, autoimmune and musculoskeletal disorders, as well as mental and behavioral disorders. Using NA centrality measures, we identified the most influential conditions in each module. An interactive network and sunburst graphs for each module are publicly available.

CONCLUSION

The study demonstrates the use of NA modularity detection in identifying MPs. The findings highlight the complex interaction of chronic conditions in the elderly and the potential of NA methodology in exploring these relationships.

Sodium-Glucose-Cotransporter-2 Inhibitor Therapy and Intermitted Fasting in Cardiorenal Syndrome: The Role of Glucose-Mediated Oxidative Stress

Cardiorenal syndrome (CRS) is a complex clinical disorder characterized by the interplay between heart and kidney dysfunction. This condition is exacerbated by comorbidities such as diabetes mellitus, which contribute to glucose-mediated oxidative stress, further complicating the management of CRS. The management of CRS has evolved with the discovery of sodium-glucose-cotransporter-2 (SGLT2) inhibitors, which have been established as effective agents in reducing hyperglycemia and demonstrated cardiorenal protective effects. Concurrently, intermittent fasting has gained attention as an intervention without pharmacological treatment for its metabolic benefits, including improved glucose metabolism and insulin regulation and sensitivity, both with a potential reduction in oxidative stress. This review provides a summary of current findings on the roles of SGLT2 inhibitors and intermittent fasting in managing CRS, with a particular focus on glucose-mediated oxidative stress. We evaluate the mechanisms by which these interventions exert their effects, identify gaps in current research, and offer recommendations for future studies. While both SGLT2 inhibitors and intermittent fasting demonstrate potential in managing CRS, more research is needed to elucidate their long-term efficacy, safety, and potential synergistic effects.

Cerebral, Splanchnic, and Renal Transit Time Measurement and Blood Volume Estimation Using Contrast-Enhanced Ultrasonography

ABSTRACT

We aimed to measure cerebral, splanchnic, and renal transit times and the associated blood volumes using contrast ultrasound. In healthy individuals, regional transit times were calculated from time-intensity curves generated as ultrasound contrast passed through the associated inflow and outflow vessels. These included the internal carotid artery and internal jugular vein (brain), the superior mesenteric artery and portal vein (intestines), and the renal artery and renal vein (kidney). An organ's blood volume relative to the stroke volume delivered to that organ with each cardiac cycle was calculated from the product of heart rate and transit time of contrast passage through the associated vascular bed. The fraction of systemic stroke volume received by each organ was calculated from the respective velocity-time integral and inflow vessel cross-sectional area and used to estimate absolute organ blood volume. The cohort consisted of 16 participants (age: 42 ± 13 years; 5 female) without known cerebrovascular, gastrointestinal, or renal disease. Cerebral, splanchnic, and renal transit times were obtained for 15, 14, and 8 individuals, respectively. Anatomic variability of the renal vessels confounded the acquisition of renal transit times. For all organs, transit times were reproducible and the associated blood volumes were generally comparable to reference values. Cerebral, gastrointestinal, and renal transit times/blood volumes can be reasonably acquired from contrast ultrasound, although the latter is less reliably available. Assessment of the impact on regional blood volumes of pharmacologic or other interventions is a next step toward clinical application of this technique.

Biomarkers in cardiorenal syndrome, a potential use in precision medicine

Cardiorenal syndrome refers to the interrelated dysfunction of the heart or kidney resulting in a cascade of feedback mechanisms, hemodynamic, neurohormonal, and immunological and/or biochemical feedback pathways causing damage in the other organ. Cardiorenal syndrome is categorized into five clinical subtypes depending on the perceived primary precipitant of organ injury and is associated with high morbidity and mortality. Therefore, the development of tools for the earliest identification of cardiorenal syndrome in hospitalized patients is of extremely high significance to ameliorate the prognosis and outcome of these patients. There is increasing interest in identifying molecules serving as biomarkers, reflecting hemodynamic changes, heart and kidney damage and/or dysfunction and oxidative stress-induced cell damage or changes in the extracellular matrix of both the heart and kidneys. Biomarkers provide important insights into the pathophysiology of cardiorenal syndrome and are invaluable tools to predict the decrease in renal function during cardiac dysfunction and vice versa. Based on the pathophysiological mechanisms of cardiorenal syndrome, we reviewed and evaluated the available literature on serum and urinary biomarkers as predictors of kidney and/or heart injury. In addition, heart- and kidney-specific biomarkers were also evaluated based on their reference to kidney and cardiac (dys)function respectively, and whether they would provide any prediction and prognostication of cardiorenal syndrome. In this article, we discuss the current knowledge on the pathophysiology of different types of cardiorenal syndrome, examine the clinical utility of candidate biomarkers in the early diagnosis of cardiorenal syndrome, and guide treatment by evaluating the respective roles of the involved pathophysiological pathways.

Does cardiac impairment develop in ischemic renal surgery in rats depending on the reperfusion time?

Background

Renal dysfunction is known to cause heart failure. However, renal dysfunction associated with kidney surgeries (mediated by reperfusion injury) that affects the cardiac physiological function, especially during the recovery and repair phase of renal surgery is unknown.

Method

Male Wistar rats (238 ± 18 g) were subjected to renal sham and ischemia-reperfusion (IR-bilateral clamping for 15 min/45 min and reperfusion for 24 h/48 h/7 days) surgeries. At the end of the experiment, the heart was isolated from the animal (to exclude neurohormonal influence) and perfused for 60 min with Krebs-Hanseleit buffer to study the physiological changes.

Result

Renal artery bilateral occlusion for 45 min that creates ischemia, followed by 24 h of reperfusion did not impart any significant cardiac physiological functional decline but 48 h of reperfusion exhibited a significant decline in cardiac hemodynamic indices (Rate pressure product in x104 mmHg*beats/min: Sham- 3.53 ± 0.19, I45_R48-2.82 ± 0.21) with mild tissue injury. However, 7 days of reperfusion inflict significant physiological decline (Rate pressure product in x104 mmHg*beats/min - 2.5 ± 0.14) and tissue injury (Injury score- 4 ± 1.5) in isolated rat hearts. Interestingly, when the renal artery bilateral occlusion time was reduced to 15 min the changes in the hearts were negligible after 7 days. Cellular level exploration reveals a positive relation between functional deterioration of mitochondria and elevated mitochondrial oxidative stress and inflammation with cardiac physiological decline and injury linked with renal ischemia-reperfusion surgery.

Conclusion

Cardiac functional decline associated with renal surgery is manifested during renal repair or recovery. This decline depends on cardiac mitochondrial health, which is negatively influenced by the renal IR mediators and kidney function.

Clinical characteristics and outcomes in COVID-19 in kidney transplant recipients: a propensity score matched cohort study

Patients with chronic kidney disease (CKD), especially those on dialysis or who have received a kidney transplant (KT), are considered more vulnerable to severe COVID-19. This susceptibility is attributed to advanced age, a higher frequency of comorbidities, and the chronic immunosuppressed state, which may exacerbate their susceptibility to severe outcomes. Therefore, our study aimed to compare the clinical characteristics and outcomes of COVID-19 in KT patients with those on chronic dialysis and non-CKD patients in a propensity score-matched cohort study. This multicentric retrospective cohort included adult COVID-19 laboratory-confirmed patients admitted from March/2020 to July/2022, from 43 Brazilian hospitals. The primary outcome was in-hospital mortality. Propensity score analysis matched KT recipients with controls - patients on chronic dialysis and those without CKD (within 0.25 standard deviations of the logit of the propensity score) - according to age, sex, number of comorbidities, and admission year. This study included 555 patients: 163 KT, 146 on chronic dialysis, and 249 non-CKD patients (median age 57 years, 55.2% women). With regards to clinical outcomes, chronic dialysis patients had a higher prevalence of acute heart failure, compared to KT recipients, furthermore, both groups presented high in-hospital mortality, 34.0 and 28.1%, for KT and chronic dialysis patients, respectively. When comparing KT and non-CKD patients, the first group had a higher incidence of in-hospital dialysis (26.4% vs. 8.8%, p < 0.001), septic shock (24.1% vs. 12.0%, p = 0.002), and mortality (32.5% vs. 23.3%, p = 0.039), in addition to longer time spent in the intensive care unit (ICU). In this study, chronic dialysis patients presented a higher prevalence of acute heart failure, compared to KT recipients, whereas KT patients had a higher frequency of complications than those without CKD, including septic shock, dialysis during hospitalization, and in-hospital mortality as well as longer time spent in the ICU.

Cardiac damage following renal ischemia reperfusion injury increased with excessive consumption of high fat diet but enhanced the cardiac resistance to reperfusion stress in rat

Renal ischemia-reperfusion (IR) injury inflicts remote cardiac dysfunction. Studies on rats fed with a high-fat diet (HD) showed contradictory results: some demonstrated increased sensitivity of the heart and kidney to IR injury, while others reported resistance. In this study, we examined cardiac dysfunction and compromised cardiac tolerance associated with renal IR in HD and standard diet (SD) fed rats. Male Wistar rats fed with HD or SD diet for 16 weeks were subjected to either renal sham or IR protocol (bilateral clamping for 45 min and reperfusion for 24 h). The hearts isolated from these rats were further subjected to normal perfusion or IR procedure to study cardiac response. Renal IR surgery negatively affected cardiac function with substantial changes in the cardiac tissues, like mitochondrial dysfunction, elevated oxidative stress, and inflammation. HD-fed rat hearts exhibited hypertrophy at the end of 16 weeks, and the consequential impact on the heart was higher in the animals underwent renal IR surgery than with sham surgery. However, the IR induction in the isolated heart from renal sham or renal IR operation showed significant tissue injury resistance and better physiological recovery in HD-fed rats. However, in SD-fed rats, only hearts from renal IR-operated rats showed resistance to cardiac IR, whereas hearts from renal sham-operated rats were more susceptible to IR damage. The augmented IR resistance in the heart with prior renal surgery was due to preserved mitochondrial bioenergetics function, reduced oxidative stress, and activation of the PI3K/AKT signaling axis.

Epidemiological Trends and Factors Associated With the Morbidity Rate of Gonorrhea: A CDC-WONDER Database Analysis

BACKGROUND AND OBJECTIVE

Gonorrhea is a prevalent sexually transmitted illness caused by the bacteria Neisseria gonorrhoeae, leading to serious health consequences such as pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and increased susceptibility to HIV infection. Despite advancements in prevention and treatment, gonorrhea remains a significant public health problem in the United States (US) due to its widespread incidence, potential consequences, and the growth of antibiotic resistance. This study investigates the epidemiological trends and morbidity rates of gonorrhea using the Centers for Disease Control and Prevention's (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database. The aim is to identify temporal patterns, demographic characteristics, and notable changes in gonorrhea epidemiology to inform targeted therapies and interventions.

METHODS

The CDC WONDER database, which provides extensive national and state-level data on reported causes of death in the United States, was utilized for this study. We examined the developments in gonorrhea morbidity rates over time, identified demographic differences based on age, gender, and race/ethnicity, and analyzed the disease's regional distribution through a systematic analysis of the database. Aggregate data for selected time periods (1996-2014) were summarized using the morbidity rate per 100,000 people and the total number of cases across the years.

RESULTS

This database analysis identified a total of 6,454,097 individuals diagnosed with gonorrhea between 1996 and 2014. The calculated total morbidity rate during this period was 115.4 per 100,000 individuals. The highest morbidity rates were observed in the years 1999 (129.2 per 100,000 people), 1998 (129.1 per 100,000 people), and 2001 (126.8 per 100,000 people), respectively. The District of Columbia reported the highest morbidity rate (478.25 per 100,000 people). In males, the overall morbidity rate over the years was reported to be comparable to females (114 per 100,000 people and 116.3 per 100,000 people, respectively). The analysis revealed consistently higher morbidity rates among individuals aged between 19 and 24 years (525.2 per 100,000 people). Moreover, black or African American individuals consistently exhibited higher morbidity rates (506.1 per 100,000 people) compared to white individuals (16.1 per 100,000 people).

CONCLUSION

The analysis of gonorrhea cases between 1996 and 2014 revealed that the highest rates occurred during specific years, with a particular concentration observed in the District of Columbia. Additionally, certain demographic groups, such as individuals aged 19-24 and the black or African American population, consistently exhibited higher morbidity rates compared to others. These findings emphasize the importance of targeted interventions to address the observed temporal patterns and demographic disparities, in order to effectively combat the spread of gonorrhea.

Heartache in a Bottle: Understanding Alcoholic Cardiomyopathy

Alcoholic cardiomyopathy (ACM) is a cardiac ailment marked by impaired contraction and dilation of one or both ventricles of the heart. The extent of daily alcohol intake and duration of alcohol abuse are linked to the development of ACM, although the exact thresholds and timeline for alcohol misuse to induce heart dysfunction remain uncertain. Thus, the objective of this systematic review is to comprehensively evaluate the existing knowledge on the specific disease entity, particularly in light of the ongoing issue of alcohol misuse, with the intention of determining if recent advancements and discoveries have significantly altered the understanding of this condition compared to the past century. This systematic review involved a literature search that was conducted on PubMed to identify suitable and appropriate literature for the study. The inclusion criteria encompassed articles that focused on ACM or the relationship between alcohol abuse and cardiac dysfunction, involved human subjects or relevant animal models, were written in the English language, and were published within the last 10 years. The exclusion criteria included duplicates, case reports, letters, editorials, and reviews not specifically addressing ACM. As a result, a total of 18 articles were included in this systematic review. The risk of bias was assessed through the use of the Cochrane risk-of-bias tool for clinical trials. The findings of this systematic review indicated that the likelihood of ACM occurrence significantly rose when the consumption of over 80 g of alcohol per day occurred for at least five years. The systematic review further revealed that ACM is associated with various detrimental changes in the cellular, structural, and histological aspects of the heart muscles, even though the specific clinical and histological characteristics of ACM have yet to be established. In individuals with an extensive history of excessive alcohol abuse, the diagnosis of ACM was reached through the exclusion of other potential causes of the condition. The fundamental approach to treatment lies in abstaining from alcohol. It is crucial to manage symptoms in individuals with secondary heart failure and address any related complications.

An Analysis of the Effect of Stroke on Health-Related Quality of Life of Older Adults With Coronary Heart Disease Who Take Aspirin

OBJECTIVE

The aim of this study was to examine the impact of coronary heart disease (CHD) on health-related quality of life (HRQoL) among individuals taking aspirin, as well as to explore the potential association between stroke and CHD on HRQoL.

METHOD

A total of 17,106 respondents aged 50 years and above who reported using aspirin on "some days" or "daily" were included in the analysis. Among them, 4,036 individuals had a history of coronary heart disease. We utilized the Chi-square test to assess the proportion of individuals with CHD who reported poor self-rated health and experienced poor HRQoL in four domains: physical health, mental health, physical and mental health combined, and the number of days limited by poor health. Logistic regression was employed to investigate the interaction between stroke and CHD concerning the quality of life.

RESULT

Among adults aged 50 years and above using aspirin, those with CHD tended to be older (68.7 years ± 0.37 vs 66.6 ± 0.24), had a higher proportion of male respondents (60.0% vs 45.1%), and were mostly of white ethnicity (77.4% vs 76.2%). The group with CHD reported significantly poorer self-rated health compared to those without CHD (52.1% vs 25.6%, p<0.001), along with a higher prevalence of poor physical health (55.3% vs 42.7%, p<0.001) and poor mental health (50.2% vs 40.4%, p = 0.033) in comparison to aspirin users without CHD. However, there was no statistically significant association between stroke and CHD concerning the impact on all domains of quality of life (p>0.05).

CONCLUSION

Our findings indicate that individuals aged 50 years and above with CHD who are using aspirin experience a lower quality of life in both the physical and mental health domains when compared to their counterparts without CHD. Furthermore, there was no significant interaction between stroke and CHD in relation to the impact on HRQoL in this study.

Association Between Depression and Anxiety Status With Uptake of Colorectal Cancer Screening Among US Adults: A Population-Level Study

BACKGROUND

Individuals with different mental disorders tend to experience higher rates of colorectal cancer (CRC)-related mortality compared to the general population. Discrepancies in CRC screening behaviors have been suggested as a potential contributing factor to this difference in mortality. However, existing evidence on this topic has been inconclusive and conflicting.

OBJECTIVE

This study aims to explore the relationship between mental health status (specifically, depression and/or anxiety) and the uptake of CRC screening. To achieve this, a larger and nationally representative sample from the adult population of the United States was utilized.

METHODS

We employed a cross-sectional approach using data from the 2019-2020 edition of the Health Information National Trends Survey (HINTS). The study examined disparities in CRC screening between individuals with self-reported history of depression diagnosis and the general population. Chi-square tests were used for analysis. Multivariable logistic regression models were applied to adjust for variables such as gender, age, education level, race, comorbidities, healthcare access, smoking status, household income, geographical residence, and insurance status. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

RESULTS

The findings of the study indicated that out of 5,398 eligible individuals, approximately 1,220 (weighted percentage: 22.8%) reported experiencing depression and/or anxiety, and approximately 4,154 (weighted percentage: 68.9%) reported adherence to colorectal cancer screening. In the bivariate analysis, there was no significant difference in participation in colorectal cancer screening between individuals with and without depression and/or anxiety (72.0% vs. 68.0%). Similarly, after adjusting for sociodemographic and health-related factors, the study found that the odds of participating in colorectal cancer screening did not vary based on an individual's depression status (OR 1.34, 95% CI 0.94-1.91, P = 0.05).

CONCLUSION

Individuals with depression participate in colorectal cancer screening at comparable rates to the general population. The findings of this study suggest that factors beyond CRC screening may play significant roles in the higher CRC-associated mortality rate. Therefore, further research is needed to uncover the various mechanisms contributing to the increased cancer-related mortality rates among susceptible populations.