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This research letter presents findings on the variability of cardiac biomarkers, specifically NT-proBNP and high-sensitivity troponin T, in patients with chronic kidney disease (CKD). The study, which included 4615 individuals from the SPRINT trial, found that the levels of these biomarkers remained stable over time regardless of the level of kidney function. The results suggest that baseline values of these biomarkers can be used for comparison when CKD patients present with symptoms of acute heart failure or myocardial infarction. The study acknowledges its limitations, such as the exclusion of patients with lower kidney function or on dialysis, and the potential impact of acute kidney injury on biomarker concentrations. [Extracted from the article]

The article focuses on the role of cardiac troponin (cTn) as diagnostic and prognostic blood-based biomarkers in renal disease diagnosis. It mentions the emergence of a new consensus definition of acute myocardial infarction (AMI) which reflected an increased emphasis on a biochemical basis for the diagnosis of the disease as well as reports of the diagnostic accuracy for AMI with cTn assays in patients with renal disease.

Background and Aims: There is limited information on the risk of progression of chronic kidney disease (CKD) among individuals with CVD (cardiovascular disease). We studied the association between prevalent CVD and the risk of progression of CKD among persons enrolled in a long-term observational study. Methods: A prospective cohort study of 3,939 women and men with CKD enrolled in the chronic renal insufficiency cohort (CRIC) study between June 2003 and June 2008. Prevalent cardiovascular disease (myocardial infarction/revascularization, heart failure, stroke, and peripheral vascular disease) was determined by self-report at baseline. The primary outcome was a composite of either end-stage renal disease or a 50% decline in estimated glomerular filtration rate (eGFR) from baseline. Results: One-third (1,316 of 3,939, 33.4%) of the study participants reported a history of any cardiovascular disease, and 9.6% (n = 382) a history of heart failure at baseline. After a median follow up of 6.63 years, 1,028 patients experienced the primary outcome. The composite of any CVD at baseline was not independently associated with the primary outcome (Hazard Ratio 1.04 95% CI (0.91, 1.19)). However, a history of heart failure was independently associated with a 29% higher risk of the primary outcome (Hazard Ratio 1.29 95% CI (1.06, 1.57)). The relationship between heart failure and risk of CKD progression was consistent in subgroups defined by age, race, gender, baseline eGFR, and diabetes. Neither the composite measure of any CVD or heart failure was associated with the rate of decline in eGFR. Conclusions: Self-reported heart failure was an independent risk factor for the development of the endpoint of ESRD or 50% decline in GFR in a cohort of patients with chronic kidney disease. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Among older adults with chronic kidney disease (CKD), the comparative event rates of end-stage renal disease (ESRD) and cause-specific death are unknown.Objective: To compare the rates of ESRD, cardiovascular and non-cardiovascular death and examine risk factors for ESRD and all-cause mortality in Cardiovascular Health Study (CHS) participants.Design: The CHS is a longitudinal cohort study of community-dwelling adults aged 65 years and older.Participants: 1,268 participants with an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m(2) were followed until the time of first event (ESRD, cardiovascular or non-cardiovascular death) or until March 31, 2003.Main Measures: The outcomes were ESRD, cardiovascular- and non-cardiovascular death. Rates of each event were calculated, and a Cox Proportional Hazards Model with a competing risk framework was used to examine risk factors for ESRD as compared with death. Predictors included age, gender, race, BMI, hypertension, diabetes, cardiovascular disease, heart failure, tobacco use, eGFR, and total cholesterol.Key Results: During 9.7 years of follow-up, 5% of the cohort progressed to ESRD, and 61% of the cohort died. The rate (per 100 person-years) was 0.5 for ESRD and 6.8 for all-cause mortality (3.0 for cardiovascular and 3.8 for non-cardiovascular mortality). In the competing risk framework, lower eGFR, male gender, African-American race, and higher BMI were associated with an increased risk of ESRD.Conclusions: Older adults with CKD are 13-fold more likely to die from any cause than progress to ESRD and are 6-fold more likely to die from cardiovascular causes than develop ESRD. [ABSTRACT FROM AUTHOR]

Background/aims: Cardiovascular reactivity (CVR), defined as an exaggerated hemodynamic response to mental stress, is a putative vascular risk factor and may reflect sympathetic hyperactivity. Chronic kidney disease (CKD) is also associated with sympathetic hyperactivity and vascular risk, but its relationship with CVR is unknown.Methods: CVR was assessed in 107 individuals without overt cardiovascular disease or diabetes. Blood pressure and heart rate responses were elicited by three experimental tasks designed to evoke mental stress. Glomerular filtration rate (eGFR) was estimated using the MDRD formula. General linear models estimated the association between renal function and CVR, adjusting for potential confounders.Results: Mean age was 66 years and 11% had eGFR of <60 ml/min/1.73 m2. After multivariate adjustment, a low eGFR was associated with a greater stress response of systolic blood pressure, heart rate, and pulse pressure. Associations were only partially attenuated after adjustment for lipids and glucose tolerance. When considered as a continuous variable, lower eGFR was associated with a greater blood pressure response after adjustment for glycemia.Conclusion: Although there were relatively few participants with CKD, these results suggest a relationship between CKD and greater CVR. Further investigation is warranted into factors that mediate this relationship and potential clinical consequences of this exaggerated response to stress in CKD. [ABSTRACT FROM AUTHOR]

Background. Results of cross-sectional analyses of the association of kidney function with bone mineral density (BMD) have been conflicting. We examined the association of cystatin-C, a new marker of kidney function that is unrelated to lean mass, with initial and follow-up BMD, in an ancillary study of the Cardiovascular Health Study, a population-based cohort of individuals ≥65 years old. Methods. Two years after measurement of cystatin-C and other covariates, the first BMD was measured in Pittsburgh, Pennsylvania and Davis, California, by using dual energy x-ray absorptiometry. Follow-up BMD was measured in Pittsburgh 4 years later. Associations of cystatin-C with initial BMD and the change in BMD (%/y) at the hip were examined with linear regression. Analyses were conducted separately for men and women. Results. In 1519 participants who had cystatin-C and initial BMD assessed, 614 had follow-up BMD. The percent annual change in BMD at the total hip by cystatin-C quartiles was -0.24, -0.13, -0.40, and -.66%/y (first to fourth quartile) in women and -0.02, -0.30, -0.18, and -0.94%/y in men. After adjusting for potential confounders, cystatin-C was marginally associated with initial BMD in men but not women. Cystatin-C was associated with bone loss in men; after adjustment for weight loss, cystatin-C was not associated with bone loss in women. Conclusion. Kidney dysfunction, as assessed by cystatin-C, is associated with a more rapid loss of BMD at the hip, especially in men. Further studies are needed to confirm these findings and to determine whether this loss leads to an elevated risk of fracture. [ABSTRACT FROM AUTHOR]

This article looks at several correctional programs believed to decrease the recidivism rate. While the studies on recidivism indicate that there is a relationship between the existence of therapy programs within the prison and the reduction of post-release recidivism, more research must be conducted to determine what types of programs will accomplish the best results. What is now known is that therapy does affect the recidivism rate. What will have to be determined is how these programs can most significantly reduce recidivism. While a limited program of therapy is developed in the prisons, efforts should be made to arouse public support so more money can be made available from the state legislatures for more effective and expensive programs. Private organizations, The American Bar Association for one, should conduct an extensive public relations campaign. Groups should also lobby in attempts to persuade the legislators themselves that improved conditions in the prisons will in the long run benefit society with a reduction in the recidivism rate. A positive approach to rehabilitation, while certainly ineffective by itself, is essential to the establishment of a therapeutic regime in the U.S. prisons.

Purpose of Review: To characterize and interpret recent studies of biomarkers of cardiorenal syndrome. Recent Findings: Recent studies have questioned the mechanisms and significance of moderate worsening renal function (WRF) in patients with acute heart failure. In the setting of successful decongestion, WRF may not predict cardiorenal morbidity. Cardiac-specific biomarkers including cardiac troponins and natriuretic peptides are highly prognostic in acute and chronic HF patients with kidney impairment, and serial changes in these markers during hospitalization are also predictive of longer-term adverse outcomes. These markers also predict new HF in patients with established chronic kidney disease (CKD). The role of kidney tubular injury markers in acute HF remains controversial, with inconsistent associations with short- and long-term cardiorenal outcomes. Many cases of WRF in acute HF are not characterized by a clear pattern of renal tubular injury. Summary: Cardiac-specific and renal-specific biomarkers may provide mechanistic and prognostic information in cardiorenal syndromes. [ABSTRACT FROM AUTHOR]

Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) have an increased risk of cardiovascular morbidity and mortality. Impaired left ventricular (LV) global longitudinal strain (GLS) can be a sign of subclinical cardiac dysfunction even in patients with otherwise preserved ejection fraction (EF). Transmitral early filling velocity to early diastolic strain rate (E/SRe) is a novel measure of LV filling pressure, which is often affected early in cardiac disease.Methods: A total of 110 ADPKD patients not on dialysis were included in this prospective study. All patients underwent an extensive echocardiographic examination including two-dimensional speckle tracking. GLS and strain rates were measured. The distribution of GLS and E/SRe was determined and patient characteristics were compared by median levels of GLS (- 17.8%) and E/SRe (91.4 cm). Twenty healthy participants were included as control group.Results: There was a significantly worse GLS in the ADPKD patients (mean: - 17.8 ± 2.5%) compared to the healthy controls (mean: - 21.9 ± 1.9%), p < 0.001. The same was true for E/SRe (mean: 10.0 ± 0.3 cm) compared to the control group (mean: 6.5 ± 0.3 cm), p < 0.001. In simple logistic regression, male gender (OR: 4.74 [2.10-10.71], p < 0.001), fasting glucose (odds ratio (OR) 1.05 [1.01-1.10], p = 0.024), htTKV (OR: 1.07 [1.01-1.13], p = 0.013), HDL cholesterol (OR: 0.97 [0.94, 0.996], p = 0.025), triglycerides (OR: 1.01 [1.00-1.02], p = 0.039), hemoglobin (OR: 1.50 [1.11-2.04], p = 0.009), and β-blocker use (OR: 1.07 [1.01, 1.13], p = 0.013) were all associated with higher GLS. After multivariate logistic regression with backward model selection, only male gender (OR: 5.78 [2.27-14.71], p < 0.001) and β-blocker use (OR: 14.00 [1.60, 122.51], p = 0.017) remained significant. In simple logistic regression models, BMI (OR: 1.11 [1.02-1.20], p = 0.015), systolic blood pressure (OR: 1.03 [1.00-1.06], p = 0.027) and β-blocker use (OR: 17.12 [2.15-136.20], p = 0.007) were associated with higher E/SRe - a novel measure of left ventricular filling pressure. After backward elimination, only β-blocker use (OR: 17.22 [2.16, 137.14], p = 0.007) remained significant.Conclusion: Higher GLS and E/SRe are common in ADPKD patients, even in patients with preserved eGFR and normal left ventricular EF. GLS and E/SRe may aid in cardiovascular risk stratification in patients with ADPKD as they represent early markers of cardiac dysfunction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Limited data are available on the continuation of outpatient sodium glucose cotransporter 2 inhibitors (SGLT2is) during hospitalization. The objective was to evaluate associations of SGLT2i continuation in the inpatient setting with hospital outcomes. RESEARCH DESIGN AND METHODS: This nationwide cohort study used Veterans Affairs health care system data of acute care hospitalizations between 1 April 2013 and 31 August 2021. A total of 36,505 admissions of patients with diabetes with an outpatient prescription for an SGLT2i prior to hospitalization were included. The exposure was defined as SGLT2i continuation during hospitalization. Admissions where SGLT2i was continued were compared with admissions where it was discontinued. The primary outcome was in-hospital mortality. Secondary outcomes were acute kidney injury (AKI) and length of stay (LOS). Negative binomial propensity score–weighted and zero-truncated analyses were used to compare outcomes and adjusted for multiple covariates, including demographics and comorbidities. RESULTS: Mean (SE) age was 67.2 (0.1) and 67.5 (0.1) years (P = 0.03), 97.0% and 96.6% were male (P = 0.1), 71.3% and 72.1% were White, and 20.8% and 20.5% were Black (P = 0.52) for the SGLT2i continued and discontinued groups, respectively. After adjustment for covariates (age, sex, race, BMI, Elixhauser comorbidity index, procedures/surgeries, and insulin use), the SGLT2i continued group had a 45% lower mortality rate (incidence rate ratio [IRR] 0.55, 95% CI 0.42–0.73, P < 0.01), no difference in AKI (IRR 0.96, 95% CI 0.90–1.02, P = 0.17), and decreased LOS (4.7 vs. 4.9 days) (IRR 0.95, 95% CI 0.93–0.98, P < 0.01) versus the SGLT2i discontinued group. Similar associations were observed across multiple sensitivity analyses. CONCLUSIONS: Continued SGLT2i during hospitalization among patients with diabetes was associated with lower mortality, no increased AKI, and shorter LOS. [ABSTRACT FROM AUTHOR]