The cardio-renal-metabolic connection: a review of the evidence

Cardiovascular Diabetology, Journal Year: 2023, Volume and Issue: 22(1)

Published: July 31, 2023

Abstract Type 2 diabetes (T2D), cardiovascular disease (CVD) and chronic kidney (CKD), are recognized among the most disruptive public health issues of current century. A large body evidence from epidemiological clinical research supports existence a strong interconnection between these conditions, such that unifying term cardio-metabolic-renal (CMR) has been defined. This coexistence remarkable epidemiological, pathophysiologic, prognostic implications. The mechanisms hyperglycemia-induced damage to cardio-renal system well validated, as those tie cardiac renal together. Yet, it remains controversial how what extent CVD CKD can promote metabolic dysregulation. aim this review is recapitulate epidemiology CMR connections; discuss well-established, putative emerging implicated in interplay three entities; provide pathophysiological background for an integrated therapeutic intervention aiming at interrupting vicious crosstalks.

Language: Английский

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Cardiovascular-Kidney-Metabolic (CKM) syndrome: A state-of-the-art review

Current Problems in Cardiology, Journal Year: 2023, Volume and Issue: 49(2), P. 102344 - 102344

Published: Dec. 14, 2023

Language: Английский

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Cardiac Fibrosis in heart failure: Focus on non-invasive diagnosis and emerging therapeutic strategies

Molecular Aspects of Medicine, Journal Year: 2023, Volume and Issue: 93, P. 101194 - 101194

Published: June 27, 2023

Heart failure is a leading cause of mortality and hospitalization worldwide. Cardiac fibrosis, resulting from the excessive deposition collagen fibers, common feature across spectrum conditions converging in heart failure. Eventually, either reparative or reactive nature, long-term cardiac fibrosis contributes to development progression associated with poor clinical outcomes. Despite this, specific antifibrotic therapies are lacking, making an urgent unmet medical need. In this context, better patient phenotyping needed characterize heterogenous features advance toward its personalized management. review, we will describe different phenotypes focus on potential usefulness imaging techniques circulating biomarkers for non-invasive characterization condition tracking impact. We also recapitulate effects existing non-heart drugs discuss strategies under preclinical targeting activation fibroblasts at levels, as well additional extracardiac processes.

Language: Английский

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Primordial Drivers of Diabetes Heart Disease: Comprehensive Insights into Insulin Resistance

Diabetes & Metabolism Journal, Journal Year: 2024, Volume and Issue: 48(1), P. 19 - 36

Published: Jan. 4, 2024

Insulin resistance has been regarded as a hallmark of diabetes heart disease (DHD). Numerous studies have shown that insulin can affect blood circulation and myocardium, which indirectly cause cardiac hypertrophy ventricular remodeling, participating in the pathogenesis DHD. Meanwhile, hyperinsulinemia, hyperglycemia, hyperlipidemia associated with directly impair metabolism function heart. Targeting is potential therapeutic strategy for prevention Currently, role pathogenic development DHD still under active research, pathological roles involved are complex not yet fully understood, related approaches well developed. In this review, we describe add recent advances major physiological changes underlying mechanisms by leads to myocardial remodeling dysfunction diabetic heart, including exosomal dysfunction, ferroptosis, epigenetic factors. addition, discuss improve accelerate cardiovascular protection drugs.

Language: Английский

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Pharmacological functions of salidroside in renal diseases: facts and perspectives

Frontiers in Pharmacology, Journal Year: 2024, Volume and Issue: 14

Published: Jan. 8, 2024

Rhodiola rosea is a valuable functional medicinal plant widely utilized in China and other Asian countries for its anti-fatigue, anti-aging, altitude sickness prevention properties. Salidroside, most active constituent derived from , exhibits potent antioxidative, hypoxia-resistant, anti-inflammatory, anticancer, anti-aging effects that have garnered significant attention. The appreciation of the pharmacological role salidroside has burgeoned over last decade, making it beneficial option treatment multiple diseases, including atherosclerosis, Alzheimer’s disease, Parkinson’s cardiovascular more. With renoprotective effects, parallel with inhibition oxidative stress inflammation, holds promise as potential therapeutic agent kidney damage. This article provides an overview microinflammatory state disease discuss current strategies, particular focus on highlighting recent advancements utilizing renal disease. mechanisms action are primarily associated regulation gene protein expression glomerular endothelial cells, podocytes, tubule mesangial cells cell carcinoma cell, TNF-α, TGF-β, IL-1β, IL-17A, IL-6, MCP-1, Bcl-2, VEGF, ECM protein, caspase-3, HIF-1α, BIM, well modulation AMPK/SIRT1, Nrf2/HO-1, Sirt1/PGC-1α, ROS/Src/Cav-1, Akt/GSK-3β, TXNIP-NLRP3, ERK1/2, TGF-β1/Smad2/3, PI3K/Akt, Wnt1/Wnt3a β-catenin, TLR4/NF-κB, MAPK, JAK2/STAT3, SIRT1/Nrf2 pathways. To best our knowledge, this review first to comprehensively cover protective diverse suggests great be developed drug metabolic syndrome, cerebrovascular diseases complications.

Language: Английский

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Role of Uremic Toxins, Oxidative Stress, and Renal Fibrosis in Chronic Kidney Disease

Antioxidants, Journal Year: 2024, Volume and Issue: 13(6), P. 687 - 687

Published: June 3, 2024

Affecting millions of people worldwide, chronic kidney disease is a serious medical problem. It results in decrease glomerular filtration rate below 60 mL/min/1.73 m, albuminuria, abnormalities urine sediment and pathologies detected by imaging studies lasting minimum 3 months. Patients with CKD develop uremia, as result the accumulation uremic toxins body, patients can be expected to suffer from number consequences such progression renal fibrosis, development atherosclerosis or increased incidence cardiovascular events. Another key element pathogenesis oxidative stress, resulting an imbalance between production antioxidants reactive oxygen species. Oxidative stress contributes damage cellular proteins, lipids DNA increases inflammation, perpetuating dysfunction. Additionally, fibrogenesis involving fibrous tissue kidneys occurs. In our review, we also included examples forms therapy for CKD. To improve condition patients, pharmacotherapy used, described review. Among drugs that prognosis CKD, include: GLP-1 analogues, SGLT2 inhibitors, Finerenone monoclonal antibody—Canakinumab Sacubitril/Valsartan.

Language: Английский

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The Pillars for Renal Disease Treatment in Patients with Type 2 Diabetes

Pharmaceutics, Journal Year: 2023, Volume and Issue: 15(5), P. 1343 - 1343

Published: April 27, 2023

The diabetes epidemic and the increasing number of patients with diabetic chronic vascular complications poses a significant challenge to health care providers. Diabetic kidney disease is serious diabetes-mediated complication represents burden for both society in general. not only major cause end stage renal but also paralleled by an increase cardiovascular morbidity mortality. Any interventions delay development progression are important reduce associated burden. In this review we will discuss five therapeutic tools prevention treatment disease: drugs inhibiting renin–angiotensin–aldosterone system, statins, more recently recognized sodium-glucose co-transporter-2 inhibitors, glucagon-like peptide 1 agonists, novel non-steroidal selective mineralocorticoid receptor antagonist.

Language: Английский

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Epigenetic modification in diabetic kidney disease

Frontiers in Endocrinology, Journal Year: 2023, Volume and Issue: 14

Published: June 30, 2023

Diabetic kidney disease (DKD) is a common microangiopathy in diabetic patients and the main cause of death patients. The manifestations DKD are proteinuria decreased renal filtration capacity. glomerular rate urinary albumin level two most important hallmarks progression DKD. classical treatment controlling blood glucose pressure. However, commonly used clinical therapeutic strategies existing biomarkers only partially slow roughly predict progression. Therefore, novel methods, targets urgently needed to meet requirements. In recent years, increasing attention has been given role epigenetic modification pathogenesis Epigenetic variation mainly includes DNA methylation, histone changes noncoding RNA expression profile, which deeply involved DKD-related inflammation, oxidative stress, hemodynamics, activation abnormal signaling pathways. Since reversible at certain stages, it valuable identify modifications as early diagnosis prevent end-stage (ESRD). Because current understanding mechanism not comprehensive, purpose this review summarize occurrence development evaluate value therapies

Language: Английский

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Nonsteroidal Mineralocorticoid Receptor Antagonist Finerenone Improves Diastolic Dysfunction in Preclinical Nondiabetic Chronic Kidney Disease

Journal of the American Heart Association, Journal Year: 2024, Volume and Issue: 13(12)

Published: June 6, 2024

The mineralocorticoid receptor plays a significant role in the development of chronic kidney disease (CKD) and associated cardiovascular complications. Classic steroidal antagonists are therapeutic option, but their use clinic is limited due to risk hyperkalemia patients with CKD. Finerenone nonsteroidal antagonist that has been recently investigated 2 large phase III clinical trials (FIDELIO-DKD [Finerenone Reducing Kidney Failure Disease Progression Diabetic Disease] FIGARO-DKD Cardiovascular Mortality Morbidity Disease]), showing reductions outcomes.

Language: Английский

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Treatment Patterns, Adverse Events, and Clinical Outcomes with Steroidal Mineralocorticoid Receptor Antagonists: A Retrospective Analysis of Administrative Claims Data (RELICS)

Pragmatic and Observational Research, Journal Year: 2025, Volume and Issue: Volume 16, P. 27 - 37

Published: Feb. 1, 2025

This study aimed to describe the characteristics, treatment patterns, adverse events (AEs), and clinical outcomes of patients starting steroidal mineralocorticoid receptor antagonists (sMRAs) in real-world settings. The RELICS study, complementing survey-based RELICS-PS was a retrospective cohort conducted using Healthcare Integrated Research Database (HIRD®), single-payer healthcare database with medical pharmacy claims from health insurance plans across United States. A adults initiating sMRAs January 2016 June 2021 divided into six subgroups: three mutually exclusive heart failure (HF) subgroups, two chronic kidney disease (CKD) "all other patients" subgroup, which included those without documented HF or CKD. Outcomes assessed first sMRA fill until death, health-plan disenrollment, 2022 (whichever came first) analysis AEs, outcomes. Factors associated discontinuation were evaluated multivariate logistic regression. Of 224,100 initiators identified, 76.4% did not have CKD (ie, subgroup). subgroup younger primarily female. Across all initiators, 72.3% nonadherent, 73.0% discontinued within median 90 days initiation. these discontinuers, 44.2% restarted 91 discontinuation. decreasing odds most subgroups higher comorbidity burden, use cardiovascular medications, cardiologist prescribing. These findings consistent subgroups. AEs varied line baseline profiles. Patients such as both T2D rather than alone, experienced worse High rates subsequent restart observed implying fluctuating use. However, heightened risk may decrease

Language: Английский

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