Dear Colleagues,

Chronic renal failure (CRF) and cardiovascular disease (CVD) are intricately linked, with a complex interplay of molecular mechanisms contributing to their association. Understanding these connections is crucial for both preventing and managing these conditions in clinical practice.

At the molecular level, several factors contribute to the heightened risk of cardiovascular disease in individuals with chronic renal failure. One key player is endothelial dysfunction, where the inner lining of blood vessels fails to function optimally. In CRF, there is a dysregulation of endothelial nitric oxide synthase (eNOS), leading to reduced nitric oxide production, a vasodilator that helps maintain blood vessel health. This dysfunction promotes atherosclerosis, i.e., the buildup of plaques in arterial walls, which is a hallmark of cardiovascular disease.

Another molecular aspect involves the renin–angiotensin–aldosterone system (RAAS), a hormonal system that regulates blood pressure and fluid balance. In chronic renal failure, there is an overactivation of the RAAS, contributing to hypertension and fostering cardiovascular complications. The excessive release of aldosterone, a hormone that regulates sodium and potassium balance, further promotes inflammation, oxidative stress, and fibrosis, all of which contribute to cardiovascular pathology.

Furthermore, chronic inflammation is a common denominator in both chronic renal failure and cardiovascular disease. In CRF, the persistent inflammation is driven by factors such as uremic toxins and the activation of immune cells. This chronic inflammatory state extends its detrimental effects to the cardiovascular system, promoting atherosclerosis and increasing the risk of adverse cardiovascular events.

Moving from molecular mechanisms to clinical practice, the intersection of chronic renal failure and cardiovascular disease necessitates a comprehensive approach to patient care. The early detection and management of risk factors play a pivotal role. Furthermore, the regular monitoring of blood pressure, lipid levels, and renal function is essential for identifying individuals at risk. Lifestyle modifications, including a heart-healthy diet, regular exercise, and smoking cessation, are crucial in preventing the progression of both conditions.

Pharmacological interventions targeting specific molecular pathways are also integral components of clinical management. Medications that inhibit the RAAS, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), have shown efficacy in reducing cardiovascular events in individuals with chronic renal failure. Additionally, statins, which lower cholesterol levels, and antiplatelet agents may be prescribed to mitigate the risk of atherosclerotic events.

The management of chronic renal failure and cardiovascular disease is a collaborative effort between nephrologists and cardiologists. A multidisciplinary approach ensures that interventions are tailored to address the unique challenges posed by the coexistence of these conditions. Renal replacement therapies, including dialysis or kidney transplantation, may be considered in the advanced cases of chronic renal failure, with close attention to cardiovascular considerations in the selection of appropriate interventions.

In conclusion, the intricate relationship between chronic renal failure and cardiovascular disease extends from molecular intricacies to clinical implications. Understanding the molecular aspects provides insights into the shared pathways that drive these conditions, enabling clinicians to adopt a targeted and holistic approach to patient care. From the early detection to the implementation of lifestyle modifications and pharmacological interventions, the management of CRF and CVD requires a comprehensive strategy to improve patient outcomes and enhance their overall quality of life.

On this basis, we invite investigators to contribute original research as well as review articles.

Potential topics include but are not limited to the following:

- The identification of novel molecules and mechanisms involved in the onset and progression of chronic renal failure and cardiovascular diseases;
- Novel potential therapeutic approaches to reduce the onset of chronic renal failure and cardiovascular diseases;
- The identification of novel management strategies to prevent chronic renal failure and cardiovascular diseases;
- The discovery of novel clinical and pharmacological approaches to slow down chronic renal failure and cardiovascular disease progression.

Dr. Albino Carrizzo
Dr. Paola Di Pietro
Dr. Carmine Izzo
Guest Editors

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• cardiovascular disease (CVD)
• chronic kidney disease (CKD)
• ESKD
• heart
• vascular calcification