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The term 'cardiorenal syndrome' (CRS) has increasingly been used in recent years without a constant meaning and a well-accepted definition. To include the vast array of interrelated derangements, and to stress the bidirectional nature of the heart-kidney interactions, the classification of the CRS today includes 5 subtypes whose etymology reflects...
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... the same kidney would likely function relatively normally [9] . This concept, however, has recently been challenged and a more articulated definition for the CRS has been proposed [5,6] . Heart-kidney interactions include a variety of conditions, either acute or chronic, where the primary failing organ can be either the heart or the kidney ( fig. 1, 2 ) [10] . For this reason, we discuss the different heart-kidney interactions, which fall under the umbrella of the CRS, using the definition structure summarized in table 1 [5,6] . A major problem with previous terminology is that it does not allow clinicians or investigators to identify and fully characterize the relevant ...
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... Both these diseases can initiate and perpetuate each other leading to a phenomenon termed as "cardio-renal syndrome" (CRS) [60]. According to Ronco et al. [61] CRS is classified into five types. The different types of CRS result in either hypoperfusion, kidney ischemia, and necrosis or apoptosis of renal tubular cells. ...
Sechium edule, commonly known as chayote is known for its low glycemic index, high fiber content , and rich nutritional profile, which suggests it may be beneficial for individuals with diabetes. While research specifically examining the impact of chayote on diabetes is limited, this study screened its biological impacts by using different biomarkers on streptozotocin-induced diabetic (STZ-ID) rats. The ethanolic extract of the Sechium edule fruits was assessed for different phytochemical, biochemical, and anti-diabetic properties. In the results, chayote extract had high phenolic and flavonoid contents respectively (39.25 ± 0.65 mg/mL and 12.16 ± 0.50 mg/mL). These high phenolic and flavonoid contents showed high implications on STZ-ID rats. Altogether 200 and 400 mg/kg of the extract considerably reduced the blood sugar level and enhanced the lipid profile of the STZ-ID rats. Additionally, they have decreased blood urea and serum creatinine levels. Besides, the levels of SGOT, SGPT, LDH, sodium, and potassium ions were significantly lowered after the administration period. More importantly, the electrocardiogram (ECG) parameters such as QT, RR, and QTc which were prolonged in the diabetic rats were downregulated after 35 days of administration of S. edule extract (400 mg/ kg). And, the histological examination of the pancreas and kidney showed marked improvement in structural features of 200 and 400 mg/kg groups when compared to the diabetic control group. Where the increase in the glucose levels was positively correlated with QT, RR, and QTc (r 2 = 0.76, r 2 = 0.76, and r 2 = 0.43) which means that ECG could significantly reflect the diabetes glucose levels. In conclusion, our findings showed that the fruit extract exerts a
high potential to reduce artifacts secondary to diabetes which can be strongly suggested for diabetic candidates. However, there is a need to study the molecular mechanisms of the extract in combating artifacts secondary to diabetes in experimental animals.
... Chronic renal failure activates the RAA system, which plays a key role in regulating blood pressure and uid homeostasis. Chronic activation of this system can cause constriction of blood vessels and increase afterload of the heart, which can eventually lead to heart failure [30]. Patients with chronic kidney disease often have low production of red blood cells, which leads to anemia. ...
Background
Individuals with diabetes mellitus are at increased risk of developing heart failure due to the contributing influence of diabetes mellitus risk factors. But data on African literature are rare. The objective of this study is to evaluate the determinants of heart failure in patients with diabetes mellitus followed in Goma.
Methods
Asymptomatic diabetics in the city of Goma were cross-sectionally recruited at the Center of the Association of Diabetics in Congo (ADIC) in Goma, DRC during the period from February 5 to 19, 2023. The incidence of heart failure was determined using pulse pressure (PP). A PP value ≥ 65 mmHg was considered as an incidence of heart failure. The association between the incidence of HF and the independent variables was evaluated by two models using the logistic regression test at the threshold of p < 0.05.
Results
The incidence frequency of heart failure was 29.9%. In multivariate analysis, adjusted for all these variables in multivariate in the two whose menopause and sex were collinear, the following variables emerged as determinants of incidence of HF in diabetics: hypertension (aOR: 5.93 IC95%: 2.42–14.51), DS type 2 (aOR: 3.60 95% CI: 1.63–4.25), menopause (aOR: 5.48 95% CI: 3.03-9, 72) and eGFR < 60 ml/min/1.73m² (aOR: 348 95% CI: 1.94–5.30), female sex (aOR: 2.80 95% CI: 1.06–3.80) and pathological fundus (aOR: 2.04, 95% CI: 1.77–5.35).
Conclusion
The frequency of HF is high in asymptomatic diabetics in Goma. It is determined by gender, menopause, dS type 2, pathological fundus and altered eGFR.
... Cardiorenal syndrome is a clinical vicious cycle that involves both heart and renal dysfunction. This syndrome has high morbidity and mortality [6,7]. CS-AKI is usually caused independently or interactively by multiple factors, such as inflammation, ischemia and nephrotoxicity. ...
Objective
We retrospectively analyzed risk factors on in-hospital mortality in CRRT-therapy patients with open cardiac surgery (CS)-induced acute kidney injury (AKI), to provide the clinical basis for predicting and lowering the in-hospital mortality after CS.
Methods
84 CS-AKI patients with CRRT were divided into survival and death groups according to discharge status, and the perioperative data were analyzed with R version 4.0.2.
Results
There were significant differences between the two groups, including: urea nitrogen, Sequential Organ Failure Assessment (SOFA) score and vasoactive-inotropic score (VIS) on the first day after operation; VIS just before CRRT; SOFA score and negative balance of blood volume 24 h after CRRT; the incidence rate of bleeding, severe infection and MODS after operation; and the interval between AKI and CRRT. Univariate logistic regression analysis showed that SOFA score and VIS on the first day after operation; VIS just before CRRT; VIS and negative balance of blood volume 24 h after CRRT; the incidence rate of bleeding, infection and multiple organ dysfunction syndrome (MODS) after operation; bootstrap resampling analysis showed that SOFA score and VIS 24 h after CRRT, as well as the incidence of bleeding after operation were the independent risk factors.
Conclusion
Maintaining stable hemodynamics and active prevention of bleeding are expected to decrease the in-hospital mortality.
... CKD also implies a reduction in erythropoietin production over time, leading to anemia, which will increase the risk of ischemic events in the heart. Moreover, CKD induces a decrease in vitamin D production and parathormone stimulation, leading to an increase in calcium and phosphate levels and thus, increased risk of coronary and vessel calcification, augmenting the high risk of ischemic events [91]. Electrolyte imbalances are also observed in CKD patients, more precisely, hyperkalemia, which can increase the risk of cardiovascular complications [87]. ...
Since the prevalence of heart failure (HF) increases with age, HF is now one of the most common reasons for the hospitalization of elderly people. Although the treatment strategies and overall outcomes of HF patients have improved over time, hospitalization and mortality rates remain elevated, especially in developed countries where populations are aging. Therefore, this paper is intended to be a valuable multidisciplinary source of information for both doctors (cardiologists and general physicians) and pharmacists in order to decrease the morbidity and mortality of heart failure patients. We address several aspects regarding pharmacological treatment (including new approaches in HF treatment strategies [sacubitril/valsartan combination and sodium glucose co-transporter-2 inhibitors]), as well as the particularities of patients (age-induced changes and sex differences) and treatment (pharmacokinetic and pharmacodynamic changes in drugs; cardiorenal syndrome). The article also highlights several drugs and food supplements that may worsen the prognosis of HF patients and discusses some potential drug–drug interactions, their consequences and recommendations for health care providers, as well as the risks of adverse drug reactions and treatment discontinuation, as an interdisciplinary approach to treatment is essential for HF patients.
... CKD also implies a reduction in erythropoietin production over time, leading to anemia, which will increase the risk of ischemic events in the heart. Moreover, CKD induces a decrease in vitamin D production and parathormone stimulation, leading to an increase in calcium and phosphate levels and thus, increased risk of coronary and vessel calcification, augmenting the high risk of ischemic events [91]. Electrolyte imbalances are also observed in CKD patients, more precisely, hyperkalemia, which can increase the risk of cardiovascular complications [87]. ...
... An abundance of mitochondria and ATP production is therefore required for normal kidney function. Cardiac and renal dysfunctions are interconnected, with cardiovascular disorders contributing to the pathogenesis of chronic kidney disease (CKD) and accounting for ~50% of mortality in patients with CKD [12][13][14]. Conversely, kidney dysfunction and even relatively minor reduction in estimated glomerular filtration rate increase the risk for cardiac failure and death [15]. ...
The kinetics and efficiency of mitochondrial oxidative phosphorylation (OxPhos) can depend on the choice of respiratory substrates. Furthermore, potential differences in this substrate dependency among different tissues are not well-understood. Here, we determined the effects of different substrates on the kinetics and efficiency of OxPhos in isolated mitochondria from the heart and kidney cortex and outer medulla (OM) of Sprague-Dawley rats. The substrates were pyruvate+malate, glutamate+malate, palmitoyl-carnitine+malate, alpha-ketoglutarate+malate, and succinate±rotenone at saturating concentrations. The kinetics of OxPhos were interrogated by measuring mitochondrial bioenergetics under different ADP perturbations. Results show that the kinetics and efficiency of OxPhos are highly dependent on the substrates used, and this dependency is distinctly different between heart and kidney. Heart mitochondria showed higher respiratory rates and OxPhos efficiencies for all substrates in comparison to kidney mitochondria. Cortex mitochondria respiratory rates were higher than OM mitochondria, but OM mitochondria OxPhos efficiencies were higher than cortex mitochondria. State 3 respiration was low in heart mitochondria with succinate but increased significantly in the presence of rotenone, unlike kidney mitochondria. Similar differences were observed in mitochondrial membrane potential. Differences in H2O2 emission in the presence of succinate±rotenone were observed in heart mitochondria and to a lesser extent in OM mitochondria, but not in cortex mitochondria. Bioenergetics and H2O2 emission data with succinate±rotenone indicate that oxaloacetate accumulation and reverse electron transfer may play a more prominent regulatory role in heart mitochondria than kidney mitochondria. These studies provide novel quantitative data demonstrating that the choice of respiratory substrates affects mitochondrial responses in a tissue-specific manner.
... These mechanisms cause resistance to diuretic therapy and circulatory overload, which further decreases cardiac output and exacerbates patients' symptoms. 2 Kidney disease occurs very often in end-stage congestive HF. 3 The underlying mechanisms are decreased renal perfusion due to systolic HF, activation of the neurohormonal system, right-sided congestion, and renal venous hypertension, which all lead to the development of glomerulosclerosis, tubulointerstitial fibrosis, and reduction of GFR. 4,5 In this setting, removal of excess sodium and water is a vital component in the management of patients with end-stage congestive HF. 6 Peritoneal dialysis (PD) has been part of the management of patients with refractory HF either as intermittent peritoneal dialysis (IPD) or as continuous ambulatory PD. ...
Background
Patients with refractory to optimal pharmacological treatment heart failure (HF) require frequent hospitalization. Peritoneal dialysis (PD) has been part of the management of such patients mainly for promoting ultrafiltration and management of overhydration independently of kidney function. The aim of this study was to evaluate the efficacy of PD, especially the use of icodextrin solutions and intermittent PD, in the hospitalization rate and cardiac functional status of patients with HF.
Methods
We conducted a retrospective study involving patients with New York Heart Association (NYHA) class IV HF and preserved renal function (estimated glomerular filtration rate (eGFR) > 25 ml/min), who were refractory to conservative treatment. Clinical data on weight loss, hospitalization rate before and after PD initiation, cardiac functional status, and technique complications during a 6-month observational period were analyzed.
Results
PD treatment was performed in 32 patients with a mean age of 63.8 ± 11.9 years and a follow-up of 20.78 ± 14.24 months. Hospitalizations were significantly reduced from 20.7 ± 13.7 to 7.7 ± 8.9 days/patients at 6 months. All patients showed improvement in NYHA class as well as in left ventricular ejection fraction. Overall, eGFR showed a significant decrease but only six patients reached end-stage renal disease. Complications included 18 cases of peritonitis. PD was well tolerated and no patient dropped out of the method. Survival rate reached 72% at 12 months but mortality rate was high with 23 patients dying at 16.65 ± 12.3 months after the initiation of treatment. Patients survival was not influenced by the type of PD modality or weight reduction achieved.
Conclusions
PD showed to be a viable option for the treatment of patients with refractory HF leading to a better cardiac functional status and diminishing the number of hospital admissions.
... Moreover, by deepening the analysis, after homogeneity method, we observed a positive interaction between the variable Pro BNP and its co-variable Clearance of creatinine. This interaction is explained by the development at this stage of a cardio-renal syndrome [14]. ...
... Acute kidney injury is probably a reflection of pre-ECMO injury but could also be due to insufficient ECMO flow. Fluid overload, with or without renal failure, may impact on respiratory mechanics and myocardial recovery (49,50). Renal replacement therapy during ECMO is therefore advocated by ELSO, and has been shown to improve fluid balance and electrolytes (51)(52)(53)(54). ...
Worldwide, the use of Extracorporeal Membrane Oxygenation (ECMO) for cardiac failure has been steadily increasing in the neonatal population and has become a widely accepted modality. Especially in centers caring for children with (congenital) heart disease, ECMO is now an essential part of care available for those with severe heart failure as a bridge to recovery, long term mechanical support, or transplantation. Short-term outcomes depend very much on indication. Hospital survival is ~40% for all neonatal cardiac ECMO patients combined. ECMO is being used for pre- and/or post-operative stabilization in neonates with congenital heart disease and in neonates with medical heart disease such as myocarditis, cardiomyopathy or refractory arrhythmias. ECMO use during resuscitation (ECPR) or for sepsis is summarized elsewhere in this special edition of Frontiers in Pediatrics. In this review article, we will discuss the indications for neonatal cardiac ECMO, the difficult process of patients' selection and identifying the right timing to initiate ECMO, as well as outline pros and cons for peripheral vs. central cannulation. We will present predictors of mortality and, very importantly, predictors of survival: what can be done to improve the outcomes for your patients. Furthermore, an overview of current insights regarding supportive care in neonatal cardiac ECMO is given. Additionally, we will address issues specific to neonates with single ventricle physiology on ECMO, for example cannulation strategies and the influence of shunt type (Blalock-Taussig shunt vs. “right ventricle to pulmonary artery” shunt). We will not only focus on short term outcomes, such as hospital survival, but also on the importance of long-term neuro-developmental outcomes, and we will end this review with suggestions for future research.
... of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other" [2][3][4][5]. ...
This study tested the hypothesis that early administration of empagliflozin (Empa), an inhibitor of glucose recycling in renal tubules, could preserve heart function in cardiorenal syndrome (CRS) in rat. Chronic kidney disease (CKD) was caused by 5/6 subtotal nephrectomy and dilated cardiomyopathy (DCM) by doxorubicin (DOX) treatment. In vitro results showed that protein expressions of cleaved-caspase3 and autophagy activity at 24 h/48 h in NRK-52P cells were significantly upregulated by para-Creso treatment; these were significantly downregulated by Empa treatment. Flow cytometric analysis showed that annexin-V (i.e., early/late apoptosis) in NRK-52P cells expressed an identical pattern to cleaved-caspase3 between the two groups (all p
