Cardiovascular, kidney, and metabolic health: an actionable vision for heart failure prevention.

The substantial and growing prevalence of heart failure, which remains the leading cause of preventable hospitalisation worldwide, has brought heart failure prevention into sharp focus. Although this condition has historically been characterised by impaired cardiac function, mounting evidence has underscored its complex and multisystem pathobiology. Epidemiological studies have indicated that other forms of cardiovascular disease, along with kidney and metabolic dysfunction, frequently and increasingly contribute to heart failure onset.

Dietary Advanced Glycation End Products and Cardiovascular-Kidney-Metabolic Complications.

Cardiovascular-kidney-metabolic (CKM) syndrome is a new term indicating a health condition that emphasizes the interconnection of diabetes (type 2 diabetes [T2D]), insulin resistance (IR), CKD, and cardiovascular disease; the pathogenic links between these conditions seem to start with IR/T2D. The incidence and prevalence of this condition are increasing in parallel with the contemporary Western culture consumption of ultra-processed foods. Thermic processing of food increases the formation of pro-oxidant and proinflammatory advanced glycation end products (AGEs), which are partially absorbed into the body increasing the body pool of AGEs, which eventually produces chronic tissue injury, including IR.

Effects of Semaglutide With or Without Concomitant Mineralocorticoid Receptor Antagonist Use in Participants With Type 2 Diabetes and Chronic Kidney Disease: A FLOW Trial Prespecified Secondary Analysis.

Objective: In the Evaluate Renal Function With Semaglutide Once Weekly (FLOW) trial, semaglutide reduced the risk of major kidney and cardiovascular (CV) outcomes and all-cause mortality in people with type 2 diabetes (T2D) and chronic kidney disease (CKD). This prespecified analysis assessed the effects of semaglutide on kidney, CV, and mortality outcomes by baseline mineralocorticoid receptor antagonist (MRA) use.

Research Design And Methods: Participants were randomized to once-weekly subcutaneous semaglutide 1.

Longitudinal Impacts of Bariatric Surgery on eGFR in CKD Patients.

Introduction: Obesity is associated with chronic kidney disease (CKD) incidence and progression. We examined whether bariatric surgery is associated with change in eGFR trajectory among patients with and without CKD.

Methods: Patients who underwent bariatric surgery at two health systems were identified using ICD-9/ICD-10 and CPT codes.

Clinical characteristics and CKD care delivery in African American and American Indian or Alaska Native patients: A real-world cohort study.

Background: Racially minoritized populations in the United States (US), notably African American (AA) and American Indian/Alaska Native (AI/AN), experience disproportionately higher rates of chronic kidney disease (CKD), diabetes, and hypertension compared to their White peers but are understudied. This real-world cohort study examines the standards of CKD care provided to these groups in two US health systems.

Methods: Using electronic health record data from the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) Registry (N = 381,011) collected between 2015 and 2020, adjusted binary logistic regression models were used to identify predictors of two CKD care outcomes: 1) prescriptions for CKD-related guideline-directed medical therapy (CKD-GDMT) in the form of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and 2) testing for urine albumin-creatinine/urine protein-creatinine ratio (UACR/UPCR) among adult patients of AA and AI/AN race compared to the reference group (White, non-Hispanic).

Effects of empagliflozin on quality of life and healthcare use and costs in chronic kidney disease: a health economic analysis of the EMPA-KIDNEY trial.

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) slow progression of chronic kidney disease (CKD) but there is no randomised evidence of their effects on health-related quality of life (QoL) and healthcare use. We explored the effects of empagliflozin on health-related QoL, healthcare use and UK healthcare costs in the EMPA-KIDNEY trial.

Methods: EMPA-KIDNEY, a randomised, double blind, placebo-controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included participants aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to <45 mL/min/1.

Population risk predictors of major adverse kidney events attributed to focal segmental glomerulosclerosis from the CURE-CKD registry.

Background: Predictors of major adverse kidney events (MAKE) in focal segmental glomerulosclerosis (FSGS) have not been previously explored within large, real-world populations. The study aim was to evaluate population-level predictors of MAKE attributed to FSGS from health system data.

Methods: The study population was derived from electronic health records from Providence and University of California Los Angeles Health Systems.

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).

Rationale, design and baseline characteristics of REMODEL, a mechanism-of-action trial with semaglutide in people with type 2 diabetes and chronic kidney disease.

Background: Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD) and kidney failure globally. Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, reduces the risk of major kidney, cardiovascular, and mortality outcomes in people with T2D and CKD, but the mechanism-of-action (MoA) remains unclear.

Methods: REMODEL (NCT04865770) is a 52-week placebo-controlled, double-blind, parallel-group, randomized trial in adults with T2D and CKD.

Preventing chronic kidney disease and maintaining kidney health: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

To date, the primary focus of chronic kidney disease (CKD) care has been on managing disease progression, complications, and kidney failure. In contrast, maintaining kidney health and preventing CKD have received limited attention, despite their potential to save millions of lives, reduce health care costs, and lessen environmental burdens. The cardiovascular-kidney-metabolic (CKM) concept frames CKD as part of a complex, high-risk syndrome requiring global risk assessment and multifactorial intervention.

Prevalence and severity of chronic kidney disease in a population with type 1 diabetes from a United States health system: a real-world cohort study.

Background: A contemporary description and estimates for rates of chronic kidney disease (CKD) in type 1 diabetes are needed to inform risk reduction strategies. The study aim was to assess prevalence and severity of CKD based on a population with type 1 diabetes receiving care at a large United States health system.

Methods: Type 1 diabetes was identified through the Providence health system electronic health records during 2013-2022.

Systemic Inflammation and the Risks of Adverse Kidney Outcomes in Adults With Atherosclerotic Cardiovascular Disease.

Rationale & Objective: Inflammasome activation is involved in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD). This study investigated whether systemic inflammation, measured by C-reactive protein (CRP), is associated with adverse kidney outcomes in adults with ASCVD.

Study Design: Retrospective cohort study.

Trends in Pharmacological Treatment of Patients With New Onset Type 2 Diabetes: Usage Patterns in an Evolving Guideline Landscape.

Aims: In patients with new onset type 2 diabetes, this study aimed to analyze glucose-lowering medication use patterns between 2014 and 2022.

Materials And Methods: This retrospective study included adults with incident type 2 diabetes in the University of California Health System between 2014 and 2022. We determined medications used within 1 year of diagnosis and evaluated statistical evidence of use pattern changes via Mann-Kendall trend tests.

Population Risk Predictors of Major Adverse Kidney Events in Patients with Focal Segmental Glomerulosclerosis from the CURE-CKD Registry.

Background: Predictors of major adverse kidney events (MAKE) in focal segmental glomerulosclerosis (FSGS) have not been previously explored within large, real-world populations. The study aim was to evaluate population-level predictors of MAKE for patients with FSGS from health system data.

Methods: The study population was derived from electronic health records from Providence and University of California Los Angeles Health.

Clinical staging to guide management of metabolic disorders and their sequelae: a European Atherosclerosis Society consensus statement.

Obesity rates have surged since 1990 worldwide. This rise is paralleled by increases in pathological processes affecting organs such as the heart, liver, and kidneys, here termed systemic metabolic disorders (SMDs). For clinical management of SMD, the European Atherosclerosis Society proposes a pathophysiology-based system comprising three stages: Stage 1, where metabolic abnormalities such as dysfunctional adiposity and dyslipidaemia occur without detectable organ damage; Stage 2, which involves early organ damage manifested as Type 2 diabetes, asymptomatic diastolic dysfunction, metabolic-associated steatohepatitis (MASH), and chronic kidney disease (CKD); and Stage 3, characterized by more advanced organ damage affecting multiple organs.

Effects of anti-inflammatory agents on clinical outcomes in people with chronic kidney disease: a systematic review and meta-analysis of randomized control trials.

Background: Chronic kidney disease (CKD) is characterized by chronic inflammation, which is strongly linked to risk of cardiovascular disease. Anti-inflammatory agents present a novel strategy to reduce the burden of cardiovascular disease in people with CKD, but their effects on clinical outcomes are uncertain.

Methods: A systematic review and meta-analysis was performed to assess the efficacy and safety of anti-inflammatory agents in CKD (PROSPERO CRD42021238755).

Population-Level Risk Factors for Kidney Outcomes in IgA Nephropathy: The CURE-CKD Registry.

Rationale & Objective: Although IgA nephropathy (IgAN) therapies are advancing quickly, therapeutic interventions are hampered by a lack of kidney disease identification and risk assessment. The study aim was to use population-level data from health systems to identify IgAN and assess risks.

Study Design: A longitudinal and real-world cohort study.

Using guideline-directed medical therapies to improve kidney and cardiovascular outcomes in patients with chronic kidney disease.

Purpose: An estimated 37 million people currently live with chronic kidney disease in the US, which places them at increased risk for kidney disease progression, cardiovascular disease, and mortality. This review discusses current standard-of-care management of patients with chronic kidney disease, identifies key gaps in care, and briefly highlights how pharmacists can address gaps in care as members of the multidisciplinary care team.

Summary: Recent advances in guideline-directed medical therapies for patients with chronic kidney disease, including agents from the sodium-glucose cotransporter, glucagon-like peptide-1 receptor agonist, and nonsteroidal mineralocorticoid receptor antagonist classes, can dramatically improve cardiovascular-kidney-metabolic care and outcomes.

Frailty, Multimorbidity, and Polypharmacy: Exploratory Analyses of the Effects of Empagliflozin from the EMPA-KIDNEY Trial.

Background: Sodium-glucose cotransporter-2 inhibitors are recommended treatment for adults with CKD, but uncertainty exists regarding their use in patients with frailty and/or multimorbidity, among whom polypharmacy is common. We derived a multivariable logistic regression model to predict hospitalization (reflecting frailty) and assessed empagliflozin's risk–benefit profile in a post hoc analysis of the double-blind, placebo-controlled EMPA-KIDNEY trial.

Methods: The EMPA-KIDNEY trial randomized 6609 patients with CKD (eGFR ≥20 to <45 ml/min per 1.

Continuous glucose monitoring improves detection of glycemic excursions in hemodialysis patients with type 2 diabetes.

Background: Optimal glucose management in individuals with type 2 diabetes (T2D) and end-stage kidney disease (ESKD) on hemodialysis is challenging. We compared the detection of glycemic excursions with continuous glucose monitoring (CGM) and capillary glucose testing (CBG) in this population.

Methods: In this prospective observational study, insulin-treated adults with T2D on hemodialysis for ≥90 days wore a Dexcom G6-Pro CGM.