1,721,143 research outputs found
The role of urate-lowering treatment on cardiovascular and renal disease: evidence from CARES, FAST, ALL-HEART, and FEATHER studies
No full textHyperuricemia has long been known to cause gout, and has recently been correlated with cardiovascular disease, hypertension, and renal disease. In the last few years, several large clinical studies have confirmed that hyperuricemia is a significant and independent risk factor for hypertension, ischemic heart disease, and heart failure, after an extensive adjustment for almost all the possible confounding conditions. This article reviews published literature on the subject, and describes ongoing studies on the use of urate-lowering therapy for cardiovascular and renal diseases
Expanding the therapy options for diabetic kidney disease
No full textNew DAPA-CKD trial analyses have confirmed the outstanding renoprotective benefits of sodium-glucose co-transporter 2 inhibitors, independently of the presence of diabetes or the stage of kidney disease. Moreover, the non-steroidal mineralocorticoid receptor antagonist finerenone provides renal and cardiovascular protection in diabetic kidney disease when combined with renin-angiotensin-aldosterone system inhibitors.Key advances The kidney benefits of dapagliflozin are independent of the presence of diabetes and have been demonstrated in non-diabetic kidney disease; these benefits are greatest in patients with rapid disease progression but extend to patients with slower progression. The magnitude of the observed drop in estimated glomerular filtration rate (eGFR) after initiating treatment with a sodium-glucose co-transporter 2 (SGLT2) inhibitor is associated with early reductions in albuminuria, which in turn correlate with a slower rate of eGFR decline. The highly selective mineralocorticoid receptor antagonist finerenone improves kidney and cardiovascular outcomes in patients with diabetic kidney disease (DKD); the cardiovascular benefit is mainly driven by reduced hospitalization for heart failure. Combining SGLT2 inhibitors and finerenone, in addition to standard of care (including the use of renin-angiotensin-aldosterone system inhibitors) might slow the progressive loss of eGFR in DKD to values similar to those considered to be physiologically associated with ageing
Antihypertensive treatment with calcium channel blockers and renal protection: focus on lercanidipine and lercanidipine/enalapril
Full text linkOBJECTIVE: The aim of the study was to review the literature on clinical pharmacology of lercanidipine and experimental and clinical evidence and evaluate its ability to reduce proteinuria and preserve renal function when used as monotherapy or in combination with the angiotensin-converting enzyme (ACE) inhibitor enalapril. MATERIALS AND METHODS: MEDLINE/PubMed was searched for appropriate keyword. RESULTS: Lercanidipine, a third-generation calcium channel blocker, has been shown to have a unique pharmacological and clinical profile, which translates into favorable renal hemodynamic changes. The fixed-dose combination lercanidipine/enalapril has been proposed to overcome unmet therapeutic needs, often as the initial treatment in the high-risk patient. CONCLUSIONS: Lercanidipine may be regarded as an ideal antihypertensive drug for patients at renal risk and possibly the preferred choice among calcium channel blocker drugs
SGLT-2 inhibitors for treatment of heart failure in patients with and without type 2 diabetes: A practical approach for routine clinical practice
Full text linkSodium-glucose cotransporter-2 inhibitors (SGLT-2i), initially studied and approved for the treatment of diabetes, are now becoming a promising class of agents to treat heart failure (HF) and chronic kidney disease (CKD), even in patients without diabetes. While the potential benefits in several diseases (usually treated by different medical specialties) is amplifying the interest in these drugs, their use in frail patients with multiple pathologies and on polypharmacy can be complex, requiring a composite multidisciplinary approach. Following a brief overview of the evidence supporting the benefits of SGLT-2i in patients with HF or CKD, we herein provide guidance for prescribing SGLT-2i in daily practice using a multidisciplinary approach. A shared treatment algorithm is presented for initiating an SGLT-2i in patients already being treated for diabetes and HF. Tools to prevent hypoglycemia, blood pressure drop, genital infections, euglycemic diabetic ketoacidosis and eGFR dip are also provided. It is hoped that this practical, multidisciplinary guidance for initiating SGLT-2i in patients with HF and/or CKD, whatever therapy they are currently on, can help to offer SGLT-2i to the largest population of patients possible to provide the most therapeutic benefit
Possible Advantages Deriving from Patiromer Use in Hypertensive Patients Made Hyperkalemic by Renin–Angiotensin–Aldosterone Blocking Agents
No full textHyperkalemia is an elevated level of serum potassium (K+) and does represent a life-threatening condition. In clinical practice, hyperkalemia mainly derives from an impaired renal K+ excretion which, in turn, is usually caused by either acute or chronic renal failure. In concordance with this, hyperkalemia is very common in several chronic conditions, such as kidney disease, diabetes mellitus, heart failure, hypertension, and coronary heart disease. In all of these conditions the use of Renin–Angiotensin–Aldosterone System inhibitors (RAASIs), such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonist is widely recommended and further increases the risk of hyperkalemia. As hypertension is concerned, clinical trials suggest that the risk of hyperkalemia associated with RAASIs ranges from 2 to 10%. This often leads to a reduction or complete cessation of RAASIs, leaving patients without protective medications. Patiromer, a new oral potassium-binding agent, has been approved for clinical use in several countries, including Europe and US. Clinical studies have demonstrated that patiromer is effective in inducing a rapid and sustained K+ reduction in various patient settings, including those where RAASIs are a fundamental component of cardiorenal protection. Patiromer is generally well tolerated and characterised by a good safety profile. Most importantly, patiromer use might allow the continuation of ACEIs and ARBs in hypertensive patients developing hyperkalemia during treatment and thereby favour a more effective and long-lasting cardiorenal protection
Uric acid in CKD: has the jury come to the verdict?
No full textEpidemiological studies show that hyperuricemia independently predicts the development of chronic kidney disease (CKD) in individuals with normal kidney function both in the general population and in subjects with diabetes. As a matter of fact, an unfavorable role of uric acid may somewhat be harder to identify in the context of multiple risk factors and pathogenetic mechanisms typical of overt CKD such as proteinuria and high blood pressure. Although the discrepancy in clinical results could mean that urate lowering treatment does not provide a constant benefit in all patients with hyperuricemia and CKD, we believe that the inconsistency in the results from available meta-analysis is mainly due to inadequate sample size, short follow-up times and heterogeneity in study design characterizing the randomized controlled trials included in the analyses. Therefore, available data support the view that hyperuricemia has a damaging impact on kidney function, while preliminary evidence suggests that treatment of so-called asymptomatic hyperuricemia may be helpful to slow or delay the progression of chronic kidney
FAD Cristal. Il paziente con ipeuricemia cronica con e senza deposito di urato. Dal danno nefro-articolare al rischiocardiometabolico.
No full textDescrizione delle principali evidenze della letteratura scientifica relative alla associazione tra iperuricemia cronica con e senza depositi di urato e malattie cardiovascolari e renali e della possibilità che il trattamento ipouricemizzante possa esercitare effetti benefici in termini di protezione cardio-nefro-metabolica
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