Performance of the American Heart Association's PREVENT risk score for cardiovascular risk prediction in a multiethnic population.

The Predicting Risk of Cardiovascular EVENTS (PREVENT) equations, created and endorsed by the American Heart Association, provide cardiovascular risk estimates for the general population, but have not yet been tested in multiethnic populations. In the present study, in a large nationwide multiethnic sample of US veterans, the utility of PREVENT to predict the risk of total cardiovascular disease (CVD: fatal and nonfatal myocardial infarction, stroke or heart failure; PREVENT-CVD), atherosclerotic cardiovascular disease (ASCVD: fatal and nonfatal myocardial infarction or stroke; PREVENT ASCVD) and heart failure was evaluated. We assessed the discrimination and calibration performance of ASCVD prediction with PREVENT ASCVD compared with a previous risk-prediction score, pooled cohort equations (PCEs).

Interconnected pathways and emerging therapies in chronic kidney disease and heart failure: A comprehensive review.

Chronic kidney disease (CKD) and chronic heart failure (HF) frequently coexist and, when comorbid, are associated with poorer outcomes. These two diseases have common risk factors, such as diabetes, obesity and hypertension, and common pathophysiological connected mechanisms, including inflammation, endothelial dysfunction, neurohormonal activation and fibrosis. Early diagnosis and intervention are important to slow CKD progression and reduce HF events.

Changes in Renal Venous Flow and Liberation from Renal Replacement Therapy in Patients with Acute Heart Failure.

Introduction: In acute heart failure (AHF), the factors associated with successful renal replacement therapy (RRT) discontinuation are largely undefined. We hypothesized that improvements in Doppler-derived renal venous flow (RVF) waveforms may serve as indicators of recovering cardiorenal function associated with successful liberation from RRT.

Methods: We performed a post hoc analysis of a prospective cohort study involving inpatients with AHF undergoing serial renal Doppler evaluations.

Higher Risk of Kidney Failure Associated With Angiotensin Receptor Blockers vs ACE Inhibitors in Patients With Heart Failure.

Background: Renin-angiotensin system (RAS) inhibition with high-dose (versus low-dose) angiotensin-converting inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) is associated with a lower risk of kidney failure in patients with heart failure. We examined whether this association varies between ACEIs and ARBs.

Methods: From 300,361 Veterans with heart failure without baseline kidney failure initiated on ACEIs (n = 256,224) or ARBs (n = 44,137), we assembled a propensity score-matched cohort of 88,178 patients while remaining blinded to study outcomes.

Kidney Dysfunction in Heart Failure: Core Curriculum 2025.

The pathophysiology of heart failure (HF) with kidney dysfunction is represented by several maladaptive bidirectional pathways wherein acute or chronic dysfunction of one organ drives acute or chronic dysfunction in the other organ. Suboptimal decongestion, diuretic resistance, and low use rates of guideline-directed medical therapy in individuals with kidney dysfunction and HF contribute to poor cardiovascular and kidney outcomes. Recent developments with the early identification and treatment of diuretic resistance may help mitigate the harmful effects of persistent congestion in individuals with HF.

Rapid and Simultaneous Initiation of Guideline-Directed Kidney Therapies in Patients with CKD and Type 2 Diabetes.

The global incidence of CKD continues to rise, with type 2 diabetes as a major contributor. At any stage of CKD, patients with concurrent CKD and type 2 diabetes are at heightened cardiovascular risk and have a greater likelihood of dying from cardiovascular causes than progressing to kidney failure. Consequently, the use of "four pillars" of CKD therapy, including renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitor, nonsteroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, has been advocated to reduce cardiovascular-kidney risk.

Risk and management of cardiac disease in kidney and liver transplant recipients.

Organ transplantation is the treatment of choice for individuals with kidney failure requiring kidney replacement therapy, as well as for those with end-stage liver disease. Despite the significant reduction in long-term morbidity and mortality with transplantation, kidney and liver allograft recipients remain at high risk for cardiovascular disease (CVD) and premature death from cardiovascular causes. This heightened risk is represented across all phenotypes of CVD, including coronary heart disease, heart failure, arrhythmias, valvulopathies and pulmonary hypertension.

The Cardiovascular-Kidney-Metabolic Health Framework: Implications for Nephrology.

Metabolic risk factors, CKD, and cardiovascular disease are highly prevalent, frequently coexist, and adversely affect lifespan and health span globally. The American Heart Association (AHA) recently defined Cardiovascular-Kidney-Metabolic (CKM) syndrome to highlight the interconnectedness between these conditions, across biological and socioecological domains. The CKM health initiative of the AHA seeks to improve cardiovascular and kidney health at a population level by providing a holistic approach to the management of individuals with CKM syndrome, emphasizing CKM health across the lifespan with priority for primordial/primary prevention, improving short and long-term cardiovascular risk prediction, and presenting an implementation framework for multidisciplinary health care models across diverse health care settings.

Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Case-Based Narrative Review.

These 4 hypothetical cases highlight new features of the American Heart Association cardiovascular-kidney-metabolic (CKM) health construct. The cases incorporate the CKM staging system, estimates from the PREVENT risk calculator, and clinical approaches related to CKM stages and individual risk profiles. Topics include management considerations for (1) a patient with stage 1 obesity and impaired glucose tolerance, (2) a patient with metabolic risk factors and moderate-risk chronic kidney disease (CKD), (3) a patient with subclinical atherosclerotic cardiovascular disease and multiple comorbid conditions, and (4) a patient with metabolic risk factors, prior myocardial infarction, new-onset heart failure, atrial fibrillation, and CKD.

Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF.

Background: Chronic kidney disease (CKD) is defined by the KDIGO (Kidney Disease: Improving Global Outcomes) guideline as abnormal kidney structure or function, present for >3 months, with implications for health. KDIGO-defined CKD is associated with poor outcomes in patients with heart failure (HF). Less is known about whether these associations vary by left ventricular ejection fraction.

Torsemide vs. furosemide in congestive heart failure: a systematic-review and meta-analysis on mortality and rehospitalization.

Background: Current guidelines suggest the use of loop diuretics as the preferred agent for decongestion in patients with heart failure. However, there is no clear evidence as to superiority of one loop diuretic over the other. The understanding of pharmacokinetic and pharmacodynamic superiority of torsemide over furosemide has generated the hypothesis that these features could result in better clinical outcomes.

Combination therapy as a new standard of care in diabetic and non-diabetic chronic kidney disease.

Unlabelled: Combination therapy, involving the use of multiple medications together, is becoming a new standard of care for chronic kidney disease (CKD). For people with CKD, combination therapy offers the promise of preventing kidney failure and reducing the risk of heart problems. This approach is appealing because different drugs target distinct mechanisms involved in CKD progression.

Evaluation and Management of Kidney Dysfunction in Advanced Heart Failure: A Scientific Statement From the American Heart Association.

Early identification of kidney dysfunction in patients with advanced heart failure is crucial for timely interventions. In addition to elevations in serum creatinine, kidney dysfunction encompasses inadequate maintenance of sodium and volume homeostasis, retention of uremic solutes, and disrupted endocrine functions. Hemodynamic derangements and maladaptive neurohormonal upregulations contribute to fluctuations in kidney indices and electrolytes that may recover with guideline-directed medical therapy.

Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Kidney Outcomes across Baseline Cardiovascular-Kidney-Metabolic Conditions: A Systematic Review and Meta-Analyses.

Key Points: Sodium-glucose cotransporter-2 (SGLT2) inhibitors slowed the rate of eGFR slope decline in patients with heart failure, CKD, and type 2 diabetes mellitus and in all combinations of multimorbid conditions among these diseases. SGLT2 inhibitors decreased kidney composite outcomes among all disease states and different combinations of multimorbidity, except in patients with heart failure with preserved ejection fraction and heart failure without type 2 diabetes mellitus. SGLT2 inhibitors were found to decrease the risk of kidney failure in patients with type 2 diabetes mellitus and also in those with CKD.

Association of arteriovenous fistulae with precapillary pulmonary hypertension - A single center retrospective analysis of invasive hemodynamic parameters.

Background: Pulmonary hypertension (pH) is a well-known complication among patients with chronic kidney disease (CKD). Arteriovenous fistulae (AVF) have been associated with pH mainly by increasing cardiac output. However, the burden of precapillary pH in individuals with CKD and an AVF is unclear.

Outcomes with inpatient use of midodrine in patients with heart failure and kidney failure on maintenance dialysis.

Background: Midodrine, an FDA-approved medication for orthostatic hypotension, is also used off-label to manage hypotension in dialysis patients, including those with heart failure. However, in patients with reduced ejection fraction (HFrEF) and/or right heart failure, midodrine is potentially harmful. No known studies examine the safety of midodrine in hospitalised kidney failure patients with HF.

Identification and outcomes of KDIGO-defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure.

Aims: According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined using this definition, and less is known about the true health implications of CKD in these patients. The objective of the current study was to identify patients with HF who met KDIGO criteria for CKD and examine their outcomes.