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Medicina
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Chronic Kidney Disease and Cardiovascular Disease
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Chronic Kidney Disease and Cardiovascular Disease

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Urology & Nephrology".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 7145

Special Issue Editors

Prof. Dr. Bang-Gee Hsu

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Guest Editor
1. Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
2. School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
Interests: uremic toxins; arterial stiffness; endothelial function; vascular calcification; uremic sarcopenia; acute kidney injury
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Jen-Pi Tsai

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Guest Editor
Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
Interests: nephrology

Special Issue Information

Dear Colleagues, 

Chronic kidney disease (CKD) is closely related to cardiovascular disease (CVD), presenting a major risk factor for the development of cardiovascular issues such as coronary artery disease, heart failure, and stroke.

One reason for this is the presence of traditional cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia, which are highly prevalent in patients with CKD. These risk factors contribute to the development of atherosclerosis, which is the underlying cause of most CVD.

CKD is also associated with several non-traditional risk factors that increase the risk of CVD. These include inflammation, oxidative stress, endothelial dysfunction, vascular calcification, anemia, malnutrition, uremic toxins, and mineral and bone disorder, all of which contribute to the development of artherosclerosis and other cardiovascular issues in patients with CKD.

Management of CKD and CVD involves addressing both traditional and non-traditional risk factors. Treatment of hypertension, diabetes, and dyslipidemia is essential to reduce the risk of CVD in patients with CKD. Lifestyle modifications such as regular exercise, healthy diet, and smoking cessation are also important. In some cases, medications to control non-traditional risk factors may be used to reduce the risk of CVD.

This Special Issue will offer a platform for clinicians and basic researchers to present and discuss novel issues in the association between CKD and CVD. The published papers will significantly contribute to a better understanding of CKD’s associations with CVD and will address both traditional and non-traditional risk factors, aiming to reduce the risk of CVD in patients with CKD.

Prof. Dr. Bang-Gee Hsu
Prof. Dr. Jen-Pi Tsai
Guest Editors

Manuscript Submission Information

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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. Medicina 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 2200 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

  • atherosclerosis
  • arteriosclerosis
  • inflammation
  • oxidative stress
  • endothelial dysfunction
  • vascular calcification
  • anemia
  • malnutrition
  • uremic toxins
  • mineral and bone disorder
  • chronic kidney disease
  • cardiovascular disease
  • arterial stiffness

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Published Papers (5 papers)

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Research

12 pages, 946 KiB  
Article
Left Ventricular Geometry and Inferior Vena Cava Diameter Co-Modify the Risk of Cardiovascular Outcomes in Chronic Hemodialysis Patients
by Chung-Kuan Wu, Ming Wang, Zih-Kai Kao, Noi Yar, Ming-Tsang Chuang and Tzu-Hao Chang
Medicina 2024, 60(7), 1140; https://doi.org/10.3390/medicina60071140 - 15 Jul 2024
Viewed by 1310
Abstract
Background and Objectives: Left ventricular hypertrophy (LVH) represents a significant cardiovascular risk in patients undergoing chronic hemodialysis (CHD). A large inferior vena cava diameter (IVCD), potentially indicative of fluid overload and a contributing factor to elevated cardiovascular risk, has not been sufficiently [...] Read more.
Background and Objectives: Left ventricular hypertrophy (LVH) represents a significant cardiovascular risk in patients undergoing chronic hemodialysis (CHD). A large inferior vena cava diameter (IVCD), potentially indicative of fluid overload and a contributing factor to elevated cardiovascular risk, has not been sufficiently explored. Therefore, our study aims to gain further insights into this aspect. Materials and Methods: A retrospective cohort study enrolled patients receiving CHD in a single medical center with available echocardiography from October to December 2018. They were categorized into four groups based on LVH geometry and IVCD. Cox proportional hazard models assessed the risk of major adverse cardiovascular effects (MACEs) and cardiovascular and overall mortality after multivariate adjustments. Kaplan–Meier analysis depicted MACE-free events and survival during the follow-up time. Results: Of the 175 CHD patients, 38, 42, 45, and 50 exhibited small IVCD with eccentric and concentric LVH and large IVCD with eccentric and concentric LVH, respectively. Compared to small IVCD and eccentric LVH, large IVCD and eccentric LVH had the highest risk of MACEs, followed by large IVCD and concentric LVH (aHR: 4.40, 3.60; 95% CI: 1.58–12.23, 1.28–10.12, respectively). As for cardiovascular mortality, large IVCD and concentric LVH had the highest risk, followed by large IVCD and eccentric LVH, and small IVCD and concentric LVH. (aHR: 14.34, 10.23, 8.87; 95% CI: 1.99–103.35, 1.41–74.33; 1.01–77.87). The trend in overall mortality risk among the groups was similar to that of cardiovascular mortality. Conclusions: LVH geometry and IVCD co-modify the risk of MACEs and cardiovascular and overall mortality in CHD patients. The highest risk of MACEs is associated with large IVCD and eccentric LVH, while the highest risk of cardiovascular and overall mortality is linked with large IVCD and concentric LVH. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Cardiovascular Disease)
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12 pages, 984 KiB  
Article
Serum Malondialdehyde-Modified Low-Density Lipoprotein as a Risk Marker for Peripheral Arterial Stiffness in Maintenance Hemodialysis Patients
by Wei-Nung Liu, Yi-Chiung Hsu, Chia-Wen Lu, Ssu-Chin Lin, Tsung-Jui Wu and Gen-Min Lin
Medicina 2024, 60(5), 697; https://doi.org/10.3390/medicina60050697 - 24 Apr 2024
Viewed by 1198
Abstract
Background and Objectives: Peripheral arterial stiffness (PAS), assessed by brachial-ankle pulse wave velocity (baPWV), is an independent biomarker of cardiovascular diseases (CVD) in patients on maintenance hemodialysis (HD). Malondialdehyde-modified low-density lipoprotein (MDA-LDL), an oxidative stress marker, has been linked to atherosclerosis and [...] Read more.
Background and Objectives: Peripheral arterial stiffness (PAS), assessed by brachial-ankle pulse wave velocity (baPWV), is an independent biomarker of cardiovascular diseases (CVD) in patients on maintenance hemodialysis (HD). Malondialdehyde-modified low-density lipoprotein (MDA-LDL), an oxidative stress marker, has been linked to atherosclerosis and CVD. However, the association between serum MDA-LDL and PAS among HD patients has not been fully elucidated. This study aimed to examine the association of serum MDA-LDL with PAS in HD patients and to identify the optimal cutoff value of serum MDA-LDL for predicting PAS. Materials and Methods: A cross-sectional study was conducted in 100 HD patients. Serum MDA-LDL was quantified using an enzyme-linked immunosorbent assay (ELISA), and baPWV was measured using a volume plethysmographic device. Patients were divided into the PAS group (baPWV > 18.0 m/s) and the non-PAS group (baPWV ≤ 18.0 m/s). The associations of baPWV and other clinical and biochemical parameters with serum MDA-LDL were assessed by multivariable logistic regression analyses. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff value of serum MDA-LDL for predicting PAS. Results: In multivariable logistic regression analysis, higher serum MDA-LDL, older age, and higher serum C-reactive protein [odds ratios (ORs) and 95% confidence intervals: 1.014 (1.004–1.025), 1.044 (1.004–1.085) and 3.697 (1.149–11.893)] were significantly associated with PAS. In the ROC curve analysis, the optimal cutoff value of MDA-LDL for predicting PAS was 80.91 mg/dL, with a sensitivity of 79.25% and a specificity of 59.57%. Conclusions: Greater serum MDA-LDL levels, particularly ≥80.91 mg/dL, were independently associated with PAS in HD patients. The findings suggest that oxidative stress plays a crucial role in the pathogenesis of PAS, and targeting MDA-LDL may be a potential therapeutic strategy for reducing cardiovascular risk in HD patients. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Cardiovascular Disease)
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17 pages, 2744 KiB  
Article
Gut Microbiota’s Oxalate-Degrading Activity and Its Implications on Cardiovascular Health in Patients with Kidney Failure: A Pilot Prospective Study
by Natalia Stepanova, Ganna Tolstanova, Iryna Aleksandrova, Lesya Korol, Taisa Dovbynchuk, Victoria Driianska and Svitlana Savchenko
Medicina 2023, 59(12), 2189; https://doi.org/10.3390/medicina59122189 - 17 Dec 2023
Viewed by 1371
Abstract
Background and Objectives: The present study aims to investigate the association between gut microbiota’s oxalate-degrading activity (ODA) and the risk of developing cardiovascular disease (CVD) over a three-year follow-up period in a cohort of patients undergoing kidney replacement therapy (KRT). Additionally, various [...] Read more.
Background and Objectives: The present study aims to investigate the association between gut microbiota’s oxalate-degrading activity (ODA) and the risk of developing cardiovascular disease (CVD) over a three-year follow-up period in a cohort of patients undergoing kidney replacement therapy (KRT). Additionally, various factors were examined to gain insight into the potential mechanisms underlying the ODA–CVD link. Materials and Methods: A cohort of 32 KRT patients and 18 healthy volunteers was enrolled in this prospective observational pilot study. Total fecal ODA, routine clinical data, plasma oxalic acid (POx), serum indoxyl sulfate, lipid profile, oxidative stress, and proinflammatory markers were measured, and the patients were followed up for three years to assess CVD events. Results: The results revealed that patients with kidney failure exhibited significantly lower total fecal ODA levels compared to the healthy control group (p = 0.017), with a higher proportion showing negative ODA status (≤−1% per 0.01 g) (p = 0.01). Negative total fecal ODA status was associated with a significantly higher risk of CVD events during the three-year follow-up period (HR = 4.1, 95% CI 1.4–16.3, p = 0.003), even after adjusting for potential confounders. Negative total fecal ODA status was significantly associated with elevated POx and indoxyl sulfate levels and linked to dyslipidemia, increased oxidative stress, and inflammation, which are critical contributors to CVD. Conclusions: The findings contribute novel insights into the relationship between gut microbiota’s ODA and cardiovascular health in patients undergoing KRT, emphasizing the need for further research to elucidate underlying mechanisms and explore potential therapeutic implications of targeting gut microbiota’s ODA in this vulnerable population. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Cardiovascular Disease)
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9 pages, 313 KiB  
Article
Resistin: A Potential Indicator of Aortic Stiffness in Non-Dialysis Chronic Kidney Disease Patients
by Chiu-Huang Kuo, Min-Shuo Chen, Chih-Hsien Wang, Yu-Hsien Lai, Yu-Li Lin and Bang-Gee Hsu
Medicina 2023, 59(9), 1652; https://doi.org/10.3390/medicina59091652 - 13 Sep 2023
Viewed by 1269
Abstract
Background and Objectives: In the progression and development of atherosclerosis, resistin plays a significant role. Chronic kidney disease (CKD), frequently associated with atherosclerosis, exhibits a marked increase in morbidity and mortality rates. This study set out to explore the association between aortic [...] Read more.
Background and Objectives: In the progression and development of atherosclerosis, resistin plays a significant role. Chronic kidney disease (CKD), frequently associated with atherosclerosis, exhibits a marked increase in morbidity and mortality rates. This study set out to explore the association between aortic stiffness and serum levels of resistin in non-dialysis-dependent CKD patients ranging from stages 3 to 5. Materials and Methods: We collected fasting blood samples from 240 CKD patients across stages 3 to 5. The concentration of resistin in serum was determined using a commercially available enzyme immunoassay kit. Those patients who exhibited a carotid–femoral pulse wave velocity (cfPWV) greater than 10 m/s were identified as the aortic stiffness group. Results: Out of the 240 CKD patients, 88 (36.7%) were classified within the aortic stiffness group. This group demonstrated higher incidences of diabetes, advanced age, increased body weight, body mass index, body fat mass, systolic and diastolic blood pressure, fasting glucose, and serum resistin levels. Multivariate logistic regression analysis highlighted resistin, diabetes, and body weight as independent predictors of aortic stiffness. Additionally, body fat mass, logarithmically transformed cfPWV (log-cfPWV) values and log-triglyceride levels were independent predictors of log-resistin levels by multivariate stepwise linear regression analysis. Conclusions: In CKD patients from stages 3 to 5, a positive correlation exists between elevated serum resistin levels and cfPWV values, identifying resistin as a potential predictor of aortic stiffness. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Cardiovascular Disease)
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10 pages, 842 KiB  
Article
Urinary Marinobufagenin in Patients with Non-Advanced Chronic Kidney Disease: A Cross-Sectional Study
by Davide Bolignano, Marta Greco, Mario D’Agostino, Paola Cianfrone, Loredana Tripodi, Roberta Misiti, Mariateresa Zicarelli, Ludovica Ganino, Daniela Patrizia Foti, Michele Andreucci and Giuseppe Coppolino
Medicina 2023, 59(8), 1392; https://doi.org/10.3390/medicina59081392 - 29 Jul 2023
Cited by 2 | Viewed by 1227
Abstract
Background and Objectives: The global prevalence of chronic kidney disease (CKD) is on the rise, posing important challenges for healthcare systems. Thus, the search for new factors potentially involved in the pathogenesis, progression and complications of early CKD remains urgent. Marinobufagenin (MBG) [...] Read more.
Background and Objectives: The global prevalence of chronic kidney disease (CKD) is on the rise, posing important challenges for healthcare systems. Thus, the search for new factors potentially involved in the pathogenesis, progression and complications of early CKD remains urgent. Marinobufagenin (MBG) is a natriuretic endogenous cardiotonic steroid, and increased circulating levels of it may accelerate kidney damage. In this study, we explored the possible clinical significance of measuring urinary marinobufagenin (uMBG) in patients with non-advanced CKD. Materials and Methods: One hundred and eight adult CKD patients (mean age 71.6 ± 10 years, 70.4% male; mean eGFR 40.54 ± 17 mL/min/1.73 m2) were enrolled in this cross-sectional study. uMBG was measured together with a series of clinical, anthropometric, laboratory and instrumental analyses. Twenty-five healthy matched subjects served as controls for the uMBG measurement. Results: The uMBG values were lower in the patients with CKD as compared to those of the controls (0.37 [IQR: 0.25–0.45] vs. 0.64 [0.46–0.78] nmol/L. p = 0.004), and a significant trend in eGFR levels was noticed across the decreasing uMBG tertiles (p = 0.03). Regarding the correlation analyses, the uMBG values remained robustly associated with the eGFR in multivariate models employing either uMBG or eGFR as the dependent variable (β = 0.248; p = 0.01 and β = 0.139; p = 0.04, respectively). Besides the eGFR, the independent predictors of uMBG values in this population were the use of statins (β = −0.326; p = 0.001), the presence of diabetes (β = 0.243; p = 0.009) and urine sodium (β = 0.204; p = 0.01). Conclusions: Reduced uMBG excretion may reflect impaired renal clearance, which may contribute to the detrimental effects attributed to this hormone due to systemic accumulation. Future studies are needed to clarify the biological mechanisms placing uMBG at the crossroad of sodium intake and the presence of diabetes in CKD-suffering individuals and to verify whether a statin treatment may somewhat limit the detrimental effects of MBG in the presence of impaired renal function. Full article
(This article belongs to the Special Issue Chronic Kidney Disease and Cardiovascular Disease)
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