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Albuminuria; Enfermedad renal crónica; Finerenona Albuminúria; Malaltia renal crònica; Finerenona Albuminuria; Chronic kidney disease; Finerenone Persons with diabetes and chronic kidney disease (CKD) have a high residual risk of developing cardiovascular (CV) complications despite treatment with renin-angiotensin system blockers and sodium-glucose cotransporter type 2 inhibitors. Overactivation of mineralocorticoid receptors plays a key role in the progression of renal and CV disease, mainly by promoting inflammation and fibrosis. Finerenone is a nonsteroidal selective mineralocorticoid antagonist. Recent clinical trials, such as FIDELIO-DKD and FIGARO-DKD and the combined analysis FIDELITY have demonstrated that finerenone decreases albuminuria, risk of CKD progression, and CV risk in subjects with type 2 diabetes (T2D) and CKD. As a result, finerenone should thus be considered as part of a holistic approach to kidney and CV risk in persons with T2D and CKD. In this narrative review, the impact of finerenone treatment on the CV system in persons with type 2 diabetes and CKD is analyzed from a practical point of view.

Worsening kidney function (WKF) is common in patients with acute heart failure (AHF) syndromes. Although WKF has traditionally been associated with worse outcomes on a population level, serum creatinine concentrations vary greatly during episodes of worsening heart failure, with substantial individual heterogeneity in terms of their clinical meaning. Consequently, interpreting such changes within the appropriate clinical context is essential to unravel the pathophysiology of kidney function changes and appropriately interpret their clinical meaning. This article aims to provide a critical overview of WKF in AHF aiming to provide physicians with some tips and tricks to appropiately interpret kidney function changes in the context of AHF.

Aims: Bendopnea is a clinical symptom of advanced heart failure with uncertain prognostic value. We aimed to evaluate whether bendopnea and the change in oxygen saturation when bending forward (bending oxygen saturation index [BOSI]) are associated with adverse outcomes in ambulatory chronic heart failure (CHF) patients.Methods and results: We prospectively evaluated 440 subjects with symptomatic CHF. BOSI was defined as the difference between sitting and bending oxygen saturation (SpO2). The endpoint was the total number of worsening heart failure (WHF) events (heart failure hospitalization or urgent heart failure visit requiring parenteral diuretic therapy). The mean age was 74 ± 10 years, 257 (58.6%) were male, and 226 (51.4%) had a left ventricular ejection fraction 2 when bending (BOSI 0%), those with BOSI ≥−3% showed an increased risk of WHF events (incidence rate ratio [IRR] 2.16, 95% confidence interval [CI] 1.67–2.79; p < 0.001). In contrast, bendopnea was not associated with the risk of total WHF episodes (IRR 1.04, 95% CI 0.83–1.31; p = 0.705).Conclusions: In ambulatory and stable CHF patients, BOSI ≥−3% and not bendopnea was independently associated with an increased risk of total (first and recurrent) WHF episodes. Awareness of SpO2 while assessing bendopnea may be a useful tool for predicting heart failure decompensations.

Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/2076-393X/10/2/299 En este artículo de investigación también participan: Maria Jesús Puchades, Mari Sargsyan, Irina Sanchís, Carmen Ribera, Ma. Inés Marco, Cristela Moncho Ferrá, Carmen María Pérez-Baylach, Begoña Bonilla, Francesc Moncho Francés, Elisa Perez-Bernat, Asunción Sancho y Jose Luis Górriz. Este artículo pertenece al número especial "Psychological Aspects of COVID-19 Vaccine Uptake: Principles and Empirical Strategies". The purpose of the study is to analyze the impact of vaccination against SARS-CoV-2 on anxiety and depression scores in patients with different modalities of chronic kidney disease. One hundred and seventeen renal patients (50 hemodialysis patients, 13 peritoneal dialysis patients, 32 kidney transplants, and 22 advanced chronic kidney disease patients at pre-dialysis care) were evaluated for depression, anxiety, health-related quality of life (HRQOL), and perceived fears and resources with standardized (Hospital Anxiety and Depression Scale (HADS)) and self-reported questionnaires. The measure points were before vaccination and 15 days after vaccination. The main finding of the study was that there was a decrease in the global mean of normal scores for anxiety and depression symptoms in chronic kidney disease patients post-vaccination. We did not find statistically significant differences in depression or anxiety scores, nor any HRQOL differences between the treatment groups. The three main fears reported by the participants at baseline were those of adverse effects, not getting the vaccine, and lack of information. These findings highlight the potential interest of assessing psychological variables related to the impact of vaccination against SARS-CoV-2. New studies will be required to assess the impact of comprehensive vaccine coverage and its psychological impact.

Resumen La afeccion renal en los pacientes con enfermedad cardiovascular confiere un caracter pronostico y un incremento del riesgo cardiovascular. La disfuncion renal es un marcador de lesiones en otras partes del arbol vascular. Su deteccion permite la identificacion precoz de individuos con riesgo elevado de acontecimientos cardiovasculares. La valoracion de la afeccion renal del paciente con enfermedad cardiovascular se llevara a cabo mediante la determinacion de albuminuria en una muestra aislada de orina y por la estimacion del filtrado glomerular a partir de formulas o ecuaciones predictivas derivadas de la creatinina. Se recomienda la formula de la Chronic Kidney Disease Epidemiology Collaboration o la de Modification of Diet in Renal Disease. Como alternativa, puede utilizarse la formula de Cockcroft-Gault. La administracion de farmacos que bloqueen el sistema renina-angiotensina puede asociarse en determinadas ocasiones a disfuncion renal aguda o hiperpotasemia. Es importante conocer las situaciones con riesgo de que se produzcan estas complicaciones para dar el mejor tratamiento posible: la prevencion. Dado el incremento progresivo de los procedimientos diagnosticos y terapeuticos con contraste intravenoso en el ambito de la cardiologia, la nefrotoxicidad por contraste supone un problema relevante. Es de interes detectar los factores de riesgo y a los pacientes con mayor probabilidad de sufrirla, asi como prevenir su aparicion.

An update on the referral pattern of patients with end-stage renal disease. This article first describes the epidemiology and reasons of late referal to the nephrologist of patients suffering from end-stage renal disease (ESRD). Depending on the definition, between 25 and 50% of worldwide ESRD patients are referred very late. Second, the relation of late referral to the quality of pre-ESRD care, its impact on the selection of dialysis modality, on the time of start of dialysis and on the use of an adequate vascular access, are discussed. Finally, the economic aspects of late referral are described and ways to improve the referral pattern are proposed.