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Life
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Cardiorenal Disease: Pathogenesis, Diagnosis, and Treatments
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Cardiorenal Disease: Pathogenesis, Diagnosis, and Treatments

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: 28 April 2026 | Viewed by 1991

Special Issue Editors

Dr. Pedro Caravaca-Pérez

E-Mail Website
Guest Editor
1. Heart Failure and Heart Transplant Unit, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
2. Institut D́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Interests: heart failure; cardiorenal syndrome; heart transplantation
Dr. Jose Jesus Broseta

E-Mail Website
Guest Editor
Department of Nephrology and Renal Transplantation, Hospital Clínic Barcelona, 08036 Barcelona, Spain
Interests: dyalisis; heart failure; cardiorenal syndrome

Special Issue Information

Dear Colleagues,

Chronic kidney disease and heart failure are among the most prevalent comorbidities worldwide, significantly impacting patients' quality of life and survival. These conditions often coexist, creating a bidirectional and deleterious interplay referred to as cardiorenal syndrome (CRS), where one condition accelerates the development and progression of the other.

The diagnosis of CRS is associated with high rates of hospital readmissions, progressive clinical deterioration, and increased morbidity and mortality. This poses significant challenges for healthcare systems due to the high care burden and resource consumption. Despite recent therapeutic advancements, treatment implementation remains suboptimal, largely due to the lack of robust evidence and concerns about iatrogenic complications.

In this scenario, cardiorenal units have emerged as integrative, multidisciplinary models aimed at improving care delivery, education, and research for this complex patient population. Their implementation in recent years has demonstrated clear benefits, including reduced hospital readmissions, lower mortality rates, and more efficient resource utilization.

This Special Issue aims to advance the management of cardiorenal syndrome by promoting a multidisciplinary approach focused on developing new diagnostic tools to improve characterization and innovative therapeutic strategies to enhance patient outcomes.

Dr. Pedro Caravaca-Pérez
Dr. Jose Jesus Broseta
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • heart failure
  • kidney disease
  • cardiorenal syndrome
  • diagnosis
  • treatment

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Published Papers (3 papers)

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Research

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14 pages, 559 KB  
Article
Protocol Biopsies Reveal Progressive Arteriolar Thickening as a Predictor of Mortality in Kidney Transplant Recipients
by Diana Rodríguez-Espinosa, Evelyn Hermida, Agustín Leal-Cúpich, Adriana García, Ana Belén Larque, Elena Cuadrado-Payán, Elena Guillén-Olmos, Marina Moncada, Pedro Ventura-Aguiar, David Cucchiari, Nuria Esforzado, Ignacio Revuelta, Fritz Diekmann, José Vicente Torregrosa and José Jesús Broseta
Life 2025, 15(10), 1635; https://doi.org/10.3390/life15101635 - 20 Oct 2025
Viewed by 275
Abstract
Kidney transplant recipients remain at high risk of cardiovascular events and premature death. Whether chronic histological changes in protocol allograft biopsies provide prognostic information for patient outcomes beyond graft survival remains uncertain. In this prospective study of 458 kidney transplant recipients with biopsies [...] Read more.
Kidney transplant recipients remain at high risk of cardiovascular events and premature death. Whether chronic histological changes in protocol allograft biopsies provide prognostic information for patient outcomes beyond graft survival remains uncertain. In this prospective study of 458 kidney transplant recipients with biopsies performed at 3 and 12 months and followed up to 8 years, we assessed the association between vascular and interstitial lesions and major adverse cardiovascular events (MACEs) or all-cause mortality. Fifty-eight patients (12.7%) died and 49 (10.7%) experienced MACEs during follow-up. The most notable finding was that progression of hyaline arteriolar thickening (aah) between 3 and 12 months independently predicted all-cause mortality, even after adjustment for estimated glomerular filtration rate, diabetes, and previous cardiovascular disease. In addition, vascular fibrous intimal thickening at 12 months was also independently associated with mortality, while associations of baseline vascular or interstitial lesions were attenuated after full multivariable adjustment. These results suggest that progressive aah reflects an ongoing recipient-related vascular process rather than donor-derived injury. Monitoring this dynamic histological change in repeated biopsies performed for protocol or for cause may provide transplant nephrologists with an early signal of increased mortality risk. Full article
(This article belongs to the Special Issue Cardiorenal Disease: Pathogenesis, Diagnosis, and Treatments)
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13 pages, 933 KB  
Article
Relationship Between Subclinical Renal Damage and Maximum Rate of Blood Pressure Variation Assessed by Fourier Analysis of 24-h Blood Pressure Curve in Patients with Essential Hypertension
by Caterina Carollo, Alessandra Sorce, Maria Giovanna Vario, Emanuele Cirafici, Davide Bologna, Maria Elena Ciuppa, Salvatore Evola, Guseppe Mulè and Giulio Geraci
Life 2025, 15(7), 1149; https://doi.org/10.3390/life15071149 - 21 Jul 2025
Viewed by 602
Abstract
Background: Blood pressure (BP) variability has been increasingly recognized as a predictor of cardiovascular and renal outcomes. However, the relevance of specific dynamic indices such as the maximum slope of systolic blood pressure (max SBP slope), derived through partial Fourier series modeling, in [...] Read more.
Background: Blood pressure (BP) variability has been increasingly recognized as a predictor of cardiovascular and renal outcomes. However, the relevance of specific dynamic indices such as the maximum slope of systolic blood pressure (max SBP slope), derived through partial Fourier series modeling, in relation to early renal damage remains underexplored. Methods: A total of 389 patients with essential hypertension were enrolled and stratified according to the estimated glomerular filtration rate (eGFR) ≥ or <90 mL/min/1.73 m2 and the presence of subclinical renal damage, defined by elevated urinary albumin excretion (AER) and/or reduced eGFR. All participants underwent clinical and biochemical evaluation, as well as 24-h ambulatory blood pressure monitoring (ABPM), including advanced hemodynamic analysis using Fourier-based modeling. Results: Patients with eGFR < 90 mL/min/1.73 m2 were older and exhibited higher waist circumference, uricemia, albuminuria, and systolic BP values, including the elevated max SBP slope (12.8 vs. 10.8 mmHg/h, p = 0.028). Subclinical renal damage was associated with older age; male sex; smoking; and higher levels of uricemia, clinical, and ambulatory BP, and the max SBP slope (14.2 vs. 10.7 mmHg/h, p = 0.007). The max SBP slope positively correlated with AER (r = 0.215, p < 0.001) and inversely with eGFR (r = −0.153, p = 0.002). In multivariate linear regression, the max SBP slope remained independently associated with AER (β = 0.220, p < 0.001), along with mean 24-h SBP, male sex, and the day–night SBP percentage dip. Logistic regression confirmed these associations with subclinical renal damage (max SBP slope OR: 1.536; 95% CI: 1.241–2.004; p = 0.001). Conclusions: The max SBP slope, a dynamic index of BP derived via Fourier analysis, is independently associated with markers of subclinical renal damage in hypertensive patients. This suggests that incorporating such advanced metrics into ABPM evaluation may improve early risk stratification and help identify individuals at greater risk of renal impairment, even in the absence of overt kidney disease. Full article
(This article belongs to the Special Issue Cardiorenal Disease: Pathogenesis, Diagnosis, and Treatments)
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Review

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35 pages, 1106 KB  
Review
Integrating Novel Biomarkers into Clinical Practice: A Practical Framework for Diagnosis and Management of Cardiorenal Syndrome
by Georgios Aletras, Maria Bachlitzanaki, Maria Stratinaki, Emmanuel Lamprogiannakis, Ioannis Petrakis, Emmanuel Foukarakis, Yannis Pantazis, Michael Hamilos and Kostas Stylianou
Life 2025, 15(10), 1540; https://doi.org/10.3390/life15101540 - 1 Oct 2025
Viewed by 677
Abstract
Cardiorenal syndrome (CRS) reflects the intricate and bidirectional interplay between cardiac and renal dysfunction, commonly resulting in diagnostic uncertainty, therapeutic dilemmas and poor outcomes. While traditional biomarkers like serum creatinine (Cr) and natriuretic peptides remain widely used, their limitations in specificity, timing and [...] Read more.
Cardiorenal syndrome (CRS) reflects the intricate and bidirectional interplay between cardiac and renal dysfunction, commonly resulting in diagnostic uncertainty, therapeutic dilemmas and poor outcomes. While traditional biomarkers like serum creatinine (Cr) and natriuretic peptides remain widely used, their limitations in specificity, timing and contextual interpretation often hinder optimal management. This narrative review synthesizes the current evidence on established and emerging biomarkers in CRS, with emphasis on their clinical relevance, integration into real-world practice, and potential to inform precision therapy. Markers of glomerular filtration rate beyond creatinine—such as cystatin C—offer more accurate assessment in frail or sarcopenic patients, while tubular injury markers such as NGAL, KIM-1, and urinary L-FABP (uL-FABP) provide early signals of structural renal damage. The FDA-approved NephroCheck® test—based on TIMP-2 and IGFBP7— enables risk stratification for imminent AKI up to 24 h before functional decline. Congestion-related markers such as CA125 and bio-adrenomedullin outperform natriuretic peptides in certain CRS phenotypes, particularly in right-sided heart failure or renally impaired patients. Fibrosis and inflammation markers (galectin-3, sST2, GDF-15) add prognostic insights, especially when combined with NT-proBNP or troponin. Rather than presenting biomarkers in isolation, this review proposes a framework that links them to specific clinical contexts—such as suspected decongestion-related renal worsening or persistent congestion despite therapy—to support actionable interpretation. A tailored, scenario-based, multi-marker strategy may enhance diagnostic precision and treatment safety in CRS. Future research should prioritize prospective biomarker-guided trials and standardized pathways for clinical integration. Full article
(This article belongs to the Special Issue Cardiorenal Disease: Pathogenesis, Diagnosis, and Treatments)
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