Cardiovascular Complications in Renal Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (25 July 2022) | Viewed by 13972

Special Issue Editors

1. Nephrology Clinic, Dialysis and Renal Transplant Center, "C.I. Parhon" University Hospital, Iasi, Romania
2. Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
3. Academy of Romanian Scientists (AOSR), Iasi, Romania
Interests: nephrology; dialysis; atherosclerosis; cardiovascular diseases; blood pressure; endothelial function; arrhythmia
Special Issues, Collections and Topics in MDPI journals
1. Head of Department of Interventional Cardiology—Cardiovascular Diseases Institute, 700503 Iasi, Romania
2. Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
3. Romanian Academy of Medical Sciences, 030167 Bucharest, Romania
Interests: antithrombotics; dialysis; cardiovascular therapies; anticoagulants; thrombosis; machine learning; artificial intelligence; atrial fibrillation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is well-known that the heart–kidney interrelation is complex, problematic, and leads to multiple pathogenic and clinical consequences and complications that require considerable human and financial resources.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease. The clustering of traditional atherosclerotic and non-traditional risk factors drives the excess rates of coronary and non-coronary CVD in this population. The incidence, severity, and mortality of coronary artery disease as well as the number of complications arising from its therapy are higher in dialysis patients than in non-chronic kidney disease patients.

The emergence of new methods of diagnosis and new treatment techniques and molecules has inevitably led to the initiation of many clinical trials to prevent, detect early, or treat as soon as possible any complications (acute or chronic) induced by renal pathology (chronic kidney disease or other renal diseases). Whether it is the early stages of chronic kidney disease or the advanced stages (e.g., G5D, G5T), various aspects of cardiovascular functionality are impacted and require close attention.

The focus of this Special Issue is to review various cardiovascular implications of (acute or chronic) renal diseases and different aspects of diagnosis and various novel/updated therapeutic strategies.

Prof. Dr. Adrian Covic
Dr. Alexandru Burlacu
Guest Editors

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Keywords

  • renal diseases
  • cardiovascular diseases
  • diagnostic strategies
  • guidelines
  • biomarkers
  • artificial intelligence
  • treatment algorithms
  • antithrombotics

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Published Papers (8 papers)

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Editorial

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3 pages, 180 KiB  
Editorial
Special Issue: “Cardiovascular Complications in Renal Diseases”
by Alexandru Burlacu and Adrian Covic
J. Clin. Med. 2023, 12(16), 5307; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12165307 - 15 Aug 2023
Cited by 1 | Viewed by 523
Abstract
The intricate interplay between cardiovascular (CV) pathology and chronic kidney disease (CKD) encompasses diagnostic protocols (both clinical and paraclinical), outcome assessments (such as mortality, morbidity, and costs), as well as advancements in new therapeutic approaches (including pharmacological, interventional, and surgical modalities) [...] Full article
(This article belongs to the Special Issue Cardiovascular Complications in Renal Diseases)

Research

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13 pages, 841 KiB  
Article
Connection between Cardiac Fibrosis Biomarkers and Echocardiography Parameters in Advanced Chronic Kidney Disease Patients
by Carina Ureche, Gianina Dodi, Alexandra Covic, Alina Nedelcu, Simona R. Volovăț, Radu A. Sascău, Cristian Stătescu and Adrian Covic
J. Clin. Med. 2023, 12(8), 3003; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12083003 - 20 Apr 2023
Cited by 4 | Viewed by 1354
Abstract
Background: Myocardial fibrosis represents a mainstay pathway in the pathophysiology of uremic cardiomyopathy. This process leads to structural and functional changes in the heart, which can be detected by echocardiography. The purpose of our study was to determine the association between four echocardiographic [...] Read more.
Background: Myocardial fibrosis represents a mainstay pathway in the pathophysiology of uremic cardiomyopathy. This process leads to structural and functional changes in the heart, which can be detected by echocardiography. The purpose of our study was to determine the association between four echocardiographic parameters (ejection fraction (EF), global longitudinal strain (GLS), mean E/e’ ratio, and left atrial volume indexed) and biomarkers associated with cardiac fibrosis, such as procollagen type I carboxy-terminal propeptide (PICP), procollagen type III N-terminal peptide (P3NP), and galectin-3 (Gal-3) in patients with end-stage renal disease (ESRD). Methods: 140 patients with ESRD were enrolled and investigated by echocardiography and the serum levels of the aforementioned biomarkers were determined at baseline. Results: The mean EF was 53.63 ± 8%, the mean GLS was −10.2 ± 5.3%, the mean E/e’ ratio was 9.8 ± 4.3, and the mean left atrial volume indexed (LAVI) was 45.8 ± 14.2 mL/m2. The average levels for PICP, P3NP, and Gal-3 were 457.2 ± 240 µg/L, 242 ± 199.9 µg/L, and 10.7 ± 3.7 ng/mL, respectively. In regression analysis, PICP was strongly associated with all four echocardiographic parameters (EF: p = 0.0002, R2 = 0.69; GLS: p = 0.00001, R2 = 0.81; mean E/e’: p = 0.00002; R2 = 0.89; LAVI: p = 0.003; R2 = 0.73). P3NP and Gal-3 were only associated with the EF (p = 0.01, R2 = 0.31 and p = 0.02; R2 = 0.35, respectively). Conclusion: Our study evidenced that PICP, a collagen-derived biomarker, is associated with important echocardiography parameters, suggesting that it can serve as an indicator of the presence of subclinical systolic and diastolic dysfunction in patients with advanced CKD. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Renal Diseases)
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11 pages, 1094 KiB  
Article
A Prognostic Merit of Statins in Patients with Chronic Hemodialysis after Percutaneous Coronary Intervention—A 10-Year Follow-Up Study
by Takehiro Funamizu, Hiroshi Iwata, Yuichi Chikata, Shinichiro Doi, Hirohisa Endo, Hideki Wada, Ryo Naito, Manabu Ogita, Yoshiteru Kato, Iwao Okai, Tomotaka Dohi, Takatoshi Kasai, Kikuo Isoda, Shinya Okazaki, Katsumi Miyauchi and Tohru Minamino
J. Clin. Med. 2022, 11(2), 390; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11020390 - 13 Jan 2022
Cited by 4 | Viewed by 1535
Abstract
Background: Patients with end-stage renal disease (ESRD) on chronic hemodialysis who are complicated by coronary artery disease (CAD) are at very high risk of cardiovascular (CV) events and mortality. However, the prognostic benefit of statins, which is firmly established in the general population, [...] Read more.
Background: Patients with end-stage renal disease (ESRD) on chronic hemodialysis who are complicated by coronary artery disease (CAD) are at very high risk of cardiovascular (CV) events and mortality. However, the prognostic benefit of statins, which is firmly established in the general population, is still under debate in this particular population. Methods: As a part of a prospective single-center percutaneous coronary intervention (PCI) registry database, this study included consecutive patients on chronic hemodialysis who underwent PCI for the first time between 2000 and 2016 (n = 201). Participants were divided into 2 groups by following 2 factors, such as (1) with or without statin, and (2) with or without high LDL-C (> and ≤LDL-C = 93 mg/dL, median) at the time of PCI. The primary endpoint was defined as CV death, and the secondary endpoints included all-cause and non-CV death, and 3 point major cardiovascular adverse events (3P-MACE) which is the composite of CV death, non-fatal myocardial infarction and stroke. The median and range of the follow-up period were 2.8, 0–15.2 years, respectively. Results: Kaplan–Meier analyses showed significantly lower cumulative incidences of primary and secondary endpoints other than non-CV deaths in patients receiving statins. Conversely, no difference was observed when patients were divided by the median LDL-C at the time of PCI (p = 0.11). Multivariate Cox proportional hazard analysis identified statins as an independent predictor of reduced risk of CV death (Hazard ratio of statin use: 0.43, 95% confidence interval 0.18–0.88, p = 0.02), all-cause death (HR: 0.50, 95%CI 0.29–0.84, p = 0.007) and 3P-MACE (HR: 0.50, 95%CI 0.25–0.93, p = 0.03). Conclusions: Statins were associated with reduced risk of adverse outcomes in patients with ESRD following PCI. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Renal Diseases)
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14 pages, 808 KiB  
Article
Atrial Fibrillation and Clinical Outcomes in a Cohort of Hospitalized Patients with Sars-Cov-2 Infection and Chronic Kidney Disease
by Simonetta Genovesi, Paola Rebora, Giuseppe Occhino, Emanuela Rossi, Alessandro Maloberti, Michele Belli, Paolo Bonfanti, Cristina Giannattasio, Claudio Rossetti, Oscar Massimiliano Epis, Nicola Ughi and Maria Grazia Valsecchi
J. Clin. Med. 2021, 10(18), 4108; https://doi.org/10.3390/jcm10184108 - 11 Sep 2021
Cited by 14 | Viewed by 1782
Abstract
The aim of the study was to investigate the role of chronic kidney disease (CKD) on in-hospital mortality and on incident atrial fibrillation (AF) in patients infected with SARS-CoV-2. The incidence of acute kidney injury (AKI) was also investigated. Multivariable regression models were [...] Read more.
The aim of the study was to investigate the role of chronic kidney disease (CKD) on in-hospital mortality and on incident atrial fibrillation (AF) in patients infected with SARS-CoV-2. The incidence of acute kidney injury (AKI) was also investigated. Multivariable regression models were used to assess the association between renal function groups (estimated Glomerular Filtration Rate, eGFR, >60 mL/min, 30–59 mL/min, <30 mL/min) and in-hospital all-cause mortality and incident AF and AKI. A cohort of 2816 patients admitted in one year for COVID-19 disease in two large hospitals was analyzed. The independent predictors of mortality were severe CKD [HR 1.732 (95%CI 1.264–2.373)], older age [HR 1.054 (95%CI 1.044–1.065)], cerebrovascular disease [HR 1.335 (95%CI (1.016–1.754)], lower platelet count [HR 0.997 (95%CI 0.996–0.999)], higher C-reactive protein [HR 1.047 (95%CI 1.035–1.058)], and higher plasma potassium value 1.374 (95%CI 1.139–1.658). When incident AKI was added to the final survival model, it was associated with higher mortality [HR 2.202 (1.728–2.807)]. Incident AF was more frequent in patients with CKD, but in the multivariable model only older age was significantly related with a higher incidence of AF [OR 1.036 (95%CI 1.022–1.050)]. Incident AF was strongly associated with the onset of AKI [HR 2.619 (95%CI 1.711–4.009)]. In this large population of COVID-19 patients, the presence of severe CKD was an independent predictor of in-hospital mortality. In addition, patients who underwent AKI during hospitalization had a doubled risk of death. Incident AF became more frequent as eGFR decreased and it was significantly associated with the onset of AKI. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Renal Diseases)
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Review

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14 pages, 1379 KiB  
Review
Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis
by Crischentian Brinza, Adrian Covic, Anca Elena Stefan, Mariana Floria, Iolanda Valentina Popa, Dragos-Viorel Scripcariu and Alexandru Burlacu
J. Clin. Med. 2022, 11(7), 1944; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11071944 - 31 Mar 2022
Cited by 7 | Viewed by 1923
Abstract
Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to systematically review and calculate the pooled effect size of the literature evaluating the association between pre-existing PH documented by transthoracic [...] Read more.
Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to systematically review and calculate the pooled effect size of the literature evaluating the association between pre-existing PH documented by transthoracic echocardiography (TTE) or invasively and adverse outcomes following KT. The primary composite outcome extracted from the included studies was represented by the mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure. The secondary outcomes were represented by individual components of the primary composite outcome. Twelve studies meeting the inclusion criteria were selected. The main finding is that pre-existing PH was associated with increased mortality and a higher rate of DGF, kidney graft dysfunction, or failure in KT recipients. The effect remained significant for all outcomes irrespective of PH evaluation, invasively or using TTE. Consequently, patients with PH defined only by TTE were at higher risk of death, DGF, or graft failure. Our findings support the routine assessment of PH in patients on the KT waitlist. PH might represent an extensively available and valuable tool for risk stratification in KT patients. These data should be confirmed in large prospective clinical trials. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Renal Diseases)
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12 pages, 2892 KiB  
Review
Arterial Remodelling in Chronic Kidney Disease: Impact of Uraemic Toxins and New Pharmacological Approaches
by Nabil Foudi, Maeva Palayer, Marie Briet and Anne-Sophie Garnier
J. Clin. Med. 2021, 10(17), 3803; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10173803 - 25 Aug 2021
Cited by 8 | Viewed by 2028
Abstract
Chronic kidney disease (CKD) is a major public health concern that affects around 10 percent of the world’s population. The severity of CKD is mainly due to the high prevalence of cardiovascular (CV) complications in this population. The aim of this review is [...] Read more.
Chronic kidney disease (CKD) is a major public health concern that affects around 10 percent of the world’s population. The severity of CKD is mainly due to the high prevalence of cardiovascular (CV) complications in this population. The aim of this review is to describe the arterial remodelling associated with CKD, to provide a quick overview of the mechanisms involved and to review the recent pharmacological approaches aimed at improving vascular health in CKD. CKD patients are exposed to metabolic and haemodynamic disorders that may affect the CV system. Large artery functional and geometric abnormalities have been well documented in CKD patients and are associated with an increase in arterial stiffness and a maladaptive remodelling. Uraemic toxins, such as indoxyl sulphate, p-cresyl sulphate, protein carbamylation and advanced glycation products, exert various effects on vascular smooth muscle cell functions. The low-grade inflammation associated with CKD may also affect arterial wall composition and remodelling. It is worth noting that the CV risk for CKD patients remains high despite the pharmacological control of traditional CV risk factors, suggesting the need for innovative therapeutic strategies. An interventional study targeting the NLRP3 inflammasome has provided some interesting preliminary results that need to be confirmed, especially in terms of safety. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Renal Diseases)
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11 pages, 657 KiB  
Review
Safety and Efficacy of Minimum- or Zero-Contrast IVUS–Guided Percutaneous Coronary Interventions in Chronic Kidney Disease Patients: A Systematic Review
by Alexandru Burlacu, Grigore Tinica, Crischentian Brinza, Radu Crisan-Dabija, Iolanda Valentina Popa and Adrian Covic
J. Clin. Med. 2021, 10(9), 1996; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10091996 - 06 May 2021
Cited by 5 | Viewed by 2196
Abstract
Conventional percutaneous coronary interventions (PCIs) frequently cause severe complications in chronic kidney disease (CKD) patients. Low-to-zero contrast intravascular ultrasound (IVUS) guided PCIs are promising alternatives in the CKD setting. We aim to systematically review up-to-date literature that have reported data and outcomes of [...] Read more.
Conventional percutaneous coronary interventions (PCIs) frequently cause severe complications in chronic kidney disease (CKD) patients. Low-to-zero contrast intravascular ultrasound (IVUS) guided PCIs are promising alternatives in the CKD setting. We aim to systematically review up-to-date literature that have reported data and outcomes of low-to-zero contrast PCIs performed in CKD patients. We searched Embase, PubMed, and Cochrane databases for full-text articles that reported original data regarding efficacy and/or safety outcomes of IVUS-guided PCIs in patients with CKD. The quality of non-randomized trials included was assessed using the Newcastle–Ottawa scale. Six papers were included in the present systematic review: One non-randomized trial, two case series, and three case reports. Given the literature reported so far, contrast-free and IVUS-guided PCI procedures in patients with CKD appear to be safe (both in cardiac and renal outcomes) with a comparable efficacy to the conventional procedure, even in complex atherosclerotic lesions. No patient included in the mentioned studies showed renal function deterioration and did not need renal replacement therapy after the zero-contrast IVUS-guided percutaneous procedures. From a cardiovascular point of view, this technique proved to be safe in terms of cardiovascular outcomes. The undesirable consequences of conventional PCI in the CKD population might soon be effectively hampered by safer low-to-zero contrast IVUS-guided PCI procedures after a mandatory and rigorous evidence-based validation in long-awaited randomized controlled trials. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Renal Diseases)
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Other

14 pages, 998 KiB  
Systematic Review
Predicting Renal Denervation Response in Resistant High Blood Pressure by Arterial Stiffness Assessment: A Systematic Review
by Alexandru Burlacu, Crischentian Brinza, Mariana Floria, Anca Elena Stefan, Andreea Covic and Adrian Covic
J. Clin. Med. 2022, 11(16), 4837; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11164837 - 18 Aug 2022
Cited by 3 | Viewed by 1518
Abstract
Background: Accurately selecting hypertensive candidates for renal denervation (RDN) therapy is required, as one-third of patients who undergo RDN are non-responders. We aimed to systematically review the literature on RDN response prediction using arterial stiffness assessment, optimizing the selection of patients referred for [...] Read more.
Background: Accurately selecting hypertensive candidates for renal denervation (RDN) therapy is required, as one-third of patients who undergo RDN are non-responders. We aimed to systematically review the literature on RDN response prediction using arterial stiffness assessment, optimizing the selection of patients referred for interventional blood pressure lowering procedures. Methods: A literature search was performed in MEDLINE, Embase, Scopus, and Cochrane databases to retrieve potential eligible studies from the inception to 30 June 2022. Results: Ten studies were finally included in this systematic review. Studies consistently documented that invasive pulse wave velocity (PWV) was correlated with RDN’s significant success. Nevertheless, non-invasive ambulatory arterial stiffness index and PWV derived from ambulatory blood pressure monitoring were independent predictors of blood pressure response (p = 0.04 and p < 0.0001). In some studies, magnetic resonance imaging parameters of arterial stiffness (ascending aortic distensibility, total arterial compliance) were correlated with blood pressure reduction (AUC = 0.828, p = 0.006). Conclusions: Assessing arterial stiffness prior to RDN predicted procedural success, since stiffness parameters were strongly correlated with a significant blood pressure response. Our endeavor should be tackled as a step forward in selecting appropriate hypertensive patients scheduled for RDN therapy. Non-invasive measurements could be an alternative to invasive parameters for response prediction. Full article
(This article belongs to the Special Issue Cardiovascular Complications in Renal Diseases)
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