Search Results (398)

Chronic kidney disease is defined as a progressive pathology that affects more than 10% of the world’s population, affecting waste filtration capacity. Sarcopenia, characterized by loss of muscle mass and strength, is a common complication in patients with chronic kidney disease undergoing hemodialysis. It is associated with inflammation, malnutrition and reduced quality of life. Hemodialysis is the fundamental treatment for people with chronic kidney disease, as it is key to the elimination of toxins from the body. Objective: The objective of this study was to determine the prevalence of probable sarcopenia in patients with chronic kidney disease in the Dialysis Unit of Extremadura (Spain). Material and Methods: This is a descriptive study in which 33 patients with chronic kidney disease receiving hemodialysis were selected as participants in the assessment of functional capacity and physical fitness. The procedure was performed prior to the dialysis session. Socio-demographic, clinical and physical variables were assessed. The assessment of probable sarcopenia was carried out using manual grip strength test (dynamometry), physical performance (4-meter walk test) and phase angle (PhA) (single frequency 50 Hz bioimpedance). The Charlson Comorbidity Index (CCI) was used to determine the severity of chronic disease and its impact, and analytical variables such as albumin, C-reactive protein (CRP), Neutrophil/Lymphocyte Index (NLI), Lymphocyte–Platelet Index (LPI) and total protein (TP), among others, were also included. Results: The prevalence of probable sarcopenia was 93.9% according to the criteria for muscle strength and physical performance (EWGSOP2). PhA showed statistically significant differences between the groups with and without sarcopenia (p = 0.039), suggesting its usefulness as a nutritional marker. No statistically significant differences were found between sarcopenia and age, albumin, Neutrophil/Lymphocyte Index or C-reactive protein (p > 0.05). Conclusions: There is a high prevalence of probable sarcopenia, associated with decreased handgrip strength and gait speed in patients with chronic kidney disease in hemodialysis. In addition, PhA stands out as an influential factor in the development of sarcopenia. Full article

Background and Objectives: Outcomes after trauma are traditionally attributed to injury severity and acute physiologic derangement. However, host vulnerability at presentation—reflecting underlying physiologic and nutritional status—may also be associated with bleeding severity and transfusion requirements following acute injury. Whether such vulnerability contributes additional risk information beyond established factors remains incompletely understood. Materials and Methods: We conducted a retrospective cohort study of adult trauma patients using a single-center trauma registry. Host vulnerability was assessed using a composite score (CE; range 0–3) based on admission hypoalbuminemia (<3.5 g/dL), anemia (hemoglobin < 11 g/dL), and reduced renal function (estimated glomerular filtration rate < 60 mL/min/1.73 m²). Primary outcomes were any blood transfusion and massive transfusion, defined as transfusion of ≥10 units of packed red blood cells within 24 h of admission. Associations between CE score and transfusion outcomes were evaluated using univariable and multivariable logistic regression models adjusted for age, Injury Severity Score (ISS), admission lactate level, and systolic blood pressure (SBP). Results: Among 4105 trauma patients, transfusion requirements increased progressively with higher CE scores. Rates of any transfusion rose from 21.7% in patients with CE 0 to 78.6% in those with CE 3, while massive transfusion increased from 1.9% to 23.1% across the same categories. In multivariable analyses, each 1-point increase in CE score was independently associated with higher odds of any transfusion (adjusted odds ratio [aOR] 3.21, 95% confidence interval [CI] 2.80–3.68) and massive transfusion (aOR 1.73, 95% CI 1.45–2.07). Conclusions: A composite score reflecting host vulnerability at presentation was associated with bleeding severity and transfusion requirements after trauma, beyond injury severity and acute physiologic factors. These findings suggest that simple laboratory-based markers may provide additional information for early risk stratification of hemorrhagic outcomes after trauma. Full article

Background: Renal dysfunction is common in patients hospitalized with acute decompensated heart failure (ADHF) and represents a key component of cardiorenal syndrome. However, the relationships between renal impairment, cardiorenal biomarkers, and echocardiographic markers of myocardial function remain incompletely characterized in ADHF populations. Methods: We conducted a cross-sectional analysis of 144 consecutive patients hospitalized with ADHF. Renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Clinical, laboratory, and echocardiographic parameters were compared according to renal function. Correlation analyses, multivariable logistic regression, and receiver operating characteristic (ROC) curve analyses were performed to evaluate associations between renal dysfunction, cardiorenal biomarkers, and myocardial functional indices. Results: Patients with renal dysfunction were older (p = 0.002) and more frequently had diabetes mellitus (p = 0.006). Echocardiographic evaluation demonstrated significantly lower systolic mitral annular velocity (S′) (p < 0.001) and higher E/e′ ratios (p < 0.001) in patients with renal dysfunction, whereas left ventricular ejection fraction (p = 0.133) and global longitudinal strain (GLS) (p = 0.121) were similar between groups. Log-transformed NT-proBNP and albuminuria were significantly correlated with S′, GLS, and E/e′ (all p < 0.001). In multivariable analysis adjusted for clinically relevant confounders, chronic kidney disease (OR 8.16, 95% CI 2.13–31.34; p = 0.002) and the E/e′ ratio (OR 2.01, 95% CI 1.52–2.66; p < 0.001) remained independently associated with renal dysfunction. ROC analysis showed that E/e′ had the strongest ability to distinguish between patients with and without renal dysfunction (AUC 0.887, 95% CI 0.834–0.941; p < 0.001). Conclusions: Renal dysfunction in ADHF is associated with echocardiographic markers reflecting impaired longitudinal myocardial function and elevated filling pressure, with E/e′ emerging as the strongest echocardiographic correlate. The integration of echocardiographic parameters with cardiorenal biomarkers may improve the characterization of the cardiorenal profile in patients hospitalized with ADHF. Full article

Extracellular vesicles (EVs) mediate intercellular communication by delivering proteins and RNAs, with their molecular cargo often reflecting the biological context of their source. Perinatal tissues are promising sources of EV-related biomaterials with potential dermatologic applications. In this study, we compared EV-related molecular cargo from two umbilical cord-associated sources, umbilical cord mesenchymal stem cell (UCMSC)-derived EVs and cord blood plasma (CBP), to investigate whether these materials exhibit distinct functional effects on melanogenesis. UCMSC-derived EVs were isolated from conditioned culture medium and characterized using nanoparticle tracking analysis (NTA), cryo-electron microscopy (cryo-EM), and canonical EV marker detection, while cord blood samples were processed to obtain plasma following centrifugation and filtration, containing EVs together with soluble plasma components. Functional assays in the murine melanocyte cell line B16F10 demonstrated that UCMSC-derived EVs suppressed melanin production, whereas CBP treatment enhanced melanogenesis. Integrative omics analyses combining microRNAs (miRNAs) microarray profiling and proteomic characterization revealed distinct molecular signatures between UCMSC-derived EVs and CBP samples. Functional validation using miRNA mimic assays showed that selected miRNAs, including miR-6862-5p, miR-3622b-5p, miR-7847-3p, miR-6774-5p, and miR-4685-5p, reduced melanin production, whereas others, including miR-203a-3p, miR-126-3p, miR-139-5p, and miR-15b-5p, increased melanin levels. Pathway analysis using Ingenuity Pathway Analysis (IPA) (QIAGEN Inc.) associated these miRNA subsets with signaling pathways involved in melanogenesis. Together, these findings indicate that UCMSC-derived EVs and CBP exhibit opposite functional effects on melanogenesis and possess distinct miRNA and protein cargo profiles, providing potential molecular targets for modulating pigmentation and supporting the development of EV-related therapeutic strategies for pigmentation disorders. Full article

Background: Diabetic nephropathy (DN), also referred to as diabetic kidney disease, represents one of the most common microvascular complications of type 2 diabetes mellitus (T2DM) and remains a leading cause of end-stage renal disease worldwide. Conventional clinical markers, including albuminuria and estimated glomerular filtration rate (eGFR), are widely used for diagnosis and staging but may have limited sensitivity for detecting early renal injury and predicting disease progression. In recent years, circulating microRNAs (miRNAs) have emerged as promising non-invasive biomarkers that reflect underlying molecular mechanisms of diabetic nephropathy and may complement traditional clinical indicators. Objective: The present study aimed to evaluate serum and urinary levels of hsa-miRNA-770-5p across different stages of diabetic nephropathy and to assess its potential diagnostic value in relation to established indicators of renal function. Methods: A total of 257 participants were included and divided into four groups: healthy controls, patients with T2DM without nephropathy, patients with T2DM and DN in CKD stages I–II, and patients with DN undergoing maintenance hemodialysis (MHD). Serum and urinary levels of miRNA-770-5p were measured using quantitative real-time polymerase chain reaction (qPCR) and analyzed using the 2^−ΔΔCt method. Statistical analyses included comparisons between groups using ANOVA, correlation analyses with renal function parameters such as eGFR and proteinuria/albuminuria, and receiver operating characteristic (ROC) curve analysis to evaluate diagnostic performance. Results: Serum levels of miRNA-770-5p were significantly elevated in patients with DN and in patients undergoing maintenance hemodialysis compared with healthy controls and patients with T2DM without nephropathy. In contrast, urinary levels of miRNA-770-5p were markedly reduced in patients with DN. Serum levels in patients with T2DM without nephropathy were slightly lower than those observed in healthy controls. Significant correlations were identified between miRNA-770-5p levels and renal function parameters, including eGFR and proteinuria/albuminuria, supporting the biological relevance of this microRNA in renal injury. ROC curve analysis demonstrated good discriminatory ability for differentiating DN from T2DM without nephropathy (serum AUC = 0.82; urine AUC = 0.79). Conclusions: hsa-miRNA-770-5p demonstrates distinct and opposite patterns in serum and urine that correlate with the severity of diabetic nephropathy. The complementary changes observed in circulating and urinary levels support the potential of miRNA-770-5p as a non-invasive biomarker that may complement conventional clinical markers and provide additional insight into the molecular mechanisms involved in the development and progression of diabetic nephropathy. Full article

Background/Objectives: The renal resistive index (RRI) has emerged as an early marker of renal vascular resistance. The purpose of this study was to investigate the association between RRI on intensive care unit (ICU) admission and the development of acute kidney injury (AKI) in a general ICU population, and to assess its predictive accuracy. Methods: This prospective observational study was conducted in a multidisciplinary ICU. Consecutive mechanically ventilated adults were enrolled; RRI was measured within 24 h of admission after hemodynamic stabilization. AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria within seven days. Multivariable regression, receiver operating characteristic (ROC), reclassification, and mediation analyses were performed. Results: A total of 181 patients were included. AKI occurred in 36%. Median RRI was 0.73 (0.65–0.80). RRI correlated with age, acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores, lactate, and glomerular filtration rate (GFR) (all p < 0.001). In multivariable analysis, RRI was the only independent predictor of AKI (OR 2.86 per 0.05 increase, 95% CI 1.64–4.98, p = 0.001). It was also associated with an increased likelihood of presenting with a more severe AKI stage. RRI showed high discriminative ability (AUC = 0.89, 95% CI 0.84–0.94); the optimal cut-off was 0.77 (sensitivity 0.83, specificity 0.82). Adding RRI to a clinical model improved prediction (ΔAUC p = 0.049; net reclassification index (NRI) = 0.52, p < 0.001). Mediation analyses showed that RRI significantly mediated the effects of hypertension and low baseline GFR on AKI risk. Subgroup analyses confirmed consistent predictive performance across age, lactate, and sepsis categories. Conclusions: RRI is an independent early predictor of AKI and its severity, as well as a mediator of both hypertension and low GFR, regarding their effect on AKI development in ICU patients. RRI could serve as an early bedside marker of renal perfusion impairment in critically ill patients, guiding strategies aimed at reducing the risk of AKI. Full article

A simple, fast, and cost-effective organic solvent-based protocol was developed for DNA extraction from deer antlers and prepared trophy skulls, eliminating the need for commercial kits or cryogenic grinding. The method combines bead-based mechanical homogenization with a 4 h enzymatic digestion in EDTA buffer containing N-lauryl sarcosine and Proteinase K, followed by phenol–chloroform–isoamyl alcohol purification and centrifugal filtration. DNA quality and quantity were evaluated using agarose gel electrophoresis, Qubit fluorometry, and Nanodrop spectrophotometry. The protocol was tested on 60 samples, comprising 30 antlers and 30 pedicle parts from prepared trophy skulls of roe deer (Capreolus capreolus), fallow deer (Dama dama), and red deer (Cervus elaphus). To assess suitability for downstream applications, species-specific microsatellite markers were amplified using multiplex PCR, successfully generating complete genotypes from all 60 samples. These results, along with a demonstrated case study, confirm that the developed protocol provides high-quality DNA suitable for molecular genetic investigations, enabling reliable genotyping from small amounts of both antler and processed trophy materials in forensic and conservation contexts. Full article

Background/Objectives: Peak cough flow (PCF) is an objective measure of cough effectiveness after stroke, but biomarkers reflecting physiological vulnerability related to reduced PCF are not well established. We investigated whether bone turnover markers (BTMs)—C-terminal telopeptide of type I collagen (CTX) and procollagen type 1 N-terminal propeptide (P1NP)—were associated with PCF in subacute ischemic stroke. Methods: In this retrospective study, 112 patients admitted within 21 days of stroke onset had fasting morning CTX and P1NP measured by electrochemiluminescence immunoassay, and PCF measured within 72 h of admission. Associations were assessed using Spearman correlation and multivariable linear regression with BTMs standardized (per 1 standard deviation increase), adjusting for age, sex, body mass index, onset-to-admission days, National Institutes of Health Stroke Scale score, Korean version of the Modified Barthel Index, estimated glomerular filtration rate, smoking status, and brainstem lesion. Results: CTX showed an inverse correlation with PCF (rho = −0.469; p < 0.001) and remained independently associated with lower PCF after multivariable adjustment (β = −42.32 L/min; 95% confidence interval, −56.12 to −28.52; p < 0.001), whereas P1NP showed weaker associations. In secondary outcome analyses, higher CTX was associated with low PCF (PCF < 160 L/min), aspiration pneumonia, and longer length of stay. Conclusions: Higher CTX levels were independently associated with lower peak cough flow and selected respiratory-related outcomes in this retrospective cohort. These findings are hypothesis-generating, do not imply prognostic validation, and warrant confirmation in prospective multicenter studies assessing incremental predictive value. Full article

Background/Objectives: Cardiorenal syndrome type 2 (CRS-2) is characterized by progressive renal dysfunction caused by chronic heart failure (HF) and is associated with increased morbidity and mortality. However, the prognostic value of renal biomarkers in patients with CRS-2 hospitalized for decompensated HF remains unclear. Methods: This prospective observational cohort study included 200 consecutive patients hospitalized for decompensated HF in the Intensive Care Unit of the Clinic for Internal Medicine at the University Clinical Centre Tuzla between April and October 2025. CRS-2 was defined as chronic HF with chronic kidney disease persisting for ≥3 months before admission according to KDIGO criteria. Patients were followed for three months. The primary composite outcome was all-cause mortality or initiation of renal replacement therapy. Results: CRS-2 was identified in 130 patients (65.0%) and was associated with higher in-hospital mortality (32.3% vs. 11.4%, p = 0.002) and three-month mortality (44.6% vs. 21.4%, p = 0.002). Within the CRS-2 subgroup, patients who experienced the primary composite outcome had higher admission levels of cystatin C and urinary albumin-to-creatinine ratio (UACR) and lower estimated glomerular filtration rate (eGFR). ROC analysis demonstrated moderate discriminative ability of cystatin C (AUC 0.739) and UACR (AUC 0.733). In Cox regression analysis, cystatin C (HR 1.534, 95% CI 1.263–1.863, p < 0.001) and UACR (HR 1.003, 95% CI 1.001–1.006, p = 0.001) were significantly associated with the primary composite outcome. Conclusions: Renal dysfunction markers, particularly cystatin C and albuminuria, are associated with early adverse outcomes in CRS-2 patients hospitalized for decompensated HF. Routine assessment of these biomarkers may provide additional prognostic information and support risk assessment in this high-risk population. Full article

Background and Objectives: Diabetes mellitus (DM) is a highly prevalent comorbidity among critically ill patients and may significantly influence intensive care unit (ICU) outcomes through metabolic, immune, and cardiovascular mechanisms. This study aimed to evaluate the impact of DM on clinical profile, comorbidities, complications, need for intensive support, and mortality in adult ICU patients. Materials and Methods: A retrospective observational study was conducted between January and December 2024 in a tertiary ICU, including 1344 adult patients. Among them, 435 (32.37%) had DM. Demographic data, admission diagnoses, laboratory parameters, comorbidities, complications, therapeutic interventions, and outcomes were analyzed. Comparative statistical analysis and multivariate logistic regression were performed to identify independent predictors of ICU mortality. Results: Patients with DM were significantly older than patients without diabetes mellitus (non-DM group) (69.62 ± 10.26 vs. 67.16 ± 14.26 years, p < 0.001) and more frequently female (57%, p = 0.0002). At admission, they presented higher glycemia (204.7 vs. 134.0 mg/dL, p < 0.00001), reduced glomerular filtration rate (47.2 vs. 59.5 mL/min/1.73 m², p < 0.00001), and more pronounced lymphocytopenia (p = 0.025). Cardiovascular and renal comorbidities were significantly more prevalent in DM, including hypertension (76.3%), heart failure (32.4%), and chronic kidney disease (33.1%) (all p < 0.01). DM was associated with increased odds of sepsis (OR 1.56), acute kidney injury (OR 1.51), and obesity (OR 2.57). ICU mortality was significantly higher in patients with DM (54.9% vs. 46.3%, p = 0.004; RR 1.19). Independent predictors of death included mechanical ventilation (OR 36.48), inotropic therapy (OR 4.74), hemodialysis (OR 2.57), elevated lactate, neutrophilia, and reduced glomerular filtration rate (GFR). Conclusions: DM was associated with increased ICU mortality and a higher burden of cardio-renal comorbidities and complications; however, mortality in the multivariate model was primarily driven by markers of organ dysfunction and the need for advanced supportive therapies. Early risk stratification and individualized management strategies are essential to improve outcomes in critically ill patients with diabetes. Full article

Introduction/Objectives: Body composition changes and diet quality may contribute to metabolic complications and graft outcomes after kidney transplantation. We evaluated the relationships between diet quality and CT-derived body composition components (skeletal muscle mass, muscle quality/myosteatosis, and visceral adiposity) and explored their associations with metabolic markers and graft function. Materials and Methods: In this single-center retrospective cross-sectional study, we included 161 adult first kidney transplant recipients (KTRs) with a functioning graft and ≥12 months of follow-up. Body composition was quantified on routine abdominal CT at the L3 level using skeletal muscle index (SMI), mean muscle attenuation (Hounsfield units) for myosteatosis, and visceral adipose tissue area (VAT). Diet quality was scored using the Revised Diet Quality Index (DQI-R). Graft function was followed with creatinine-based estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI equation. Results: Mean age was 45.7 ± 13.2 years and 58% were men. The prevalence of low muscle mass was 26.0%, myosteatosis 73.5%, and visceral obesity (VAT ≥ 100 cm²) 45.6%. No participant had “good” diet quality; 48.4% had poor diet quality. DQI-R showed a weak positive correlation with SMI (r = 0.157; p = 0.047) but was not significantly related to VAT, subcutaneous adipose tissue (SAT), Kidney transplant recipient (VSR) or myosteatosis. In multivariable models, age and VAT were associated with HbA1c, whereas body composition and diet quality variables were not independent predictors of eGFR. Myosteatosis was independently associated with older age. Conclusions: Visceral adiposity and impaired muscle quality frequently clustered and were linked to metabolic status. These findings support post-transplant follow-up strategies that go beyond BMI and integrate body composition and nutritional assessment within a multidisciplinary care model. Full article

Background: Diabetic kidney disease is a major complication of type 2 diabetes mellitus (T2DM) and a leading cause of chronic kidney disease (CKD) worldwide. While diabetes duration is often considered a marker of cumulative metabolic exposure, its independent contribution to renal decline beyond aging and hypertension remains incompletely defined. Methods: We conducted a cross-sectional study including 250 adults with T2DM. Diabetes duration was analyzed both as a continuous variable and across four predefined strata (0–4, 5–9, 10–14, and ≥15 years). The primary endpoint was estimated glomerular filtration rate (eGFR), analyzed as a continuous outcome. Functional CKD was defined as eGFR < 60 mL/min/1.73 m². Linear and logistic regression models were constructed in unadjusted and adjusted forms (age, sex, BMI, hypertension, HbA1c). A sensitivity analysis modeling duration per 5-year increase was performed. Results: Mean eGFR declined significantly across duration strata (82.45, 84.27, 78.72, and 61.57 mL/min/1.73 m², respectively; p < 0.001). The prevalence of functional CKD increased markedly in patients with ≥15 years of diabetes (54.2%) compared with shorter-duration groups (~15–18%; p < 0.001). In linear regression, each additional year of diabetes was associated with a 1.32 mL/min/1.73 m² decline in eGFR (p < 0.001), remaining significant after adjustment (β = −0.85; p < 0.001). In logistic regression, each additional year was associated with a 10.7% increase in adjusted odds of CKD (OR = 1.11; 95% CI 1.04–1.17; p < 0.001). Each 5-year increment conferred a 66% increase in adjusted CKD risk (OR = 1.66; 95% CI 1.25–2.21; p < 0.001). Patients with ≥15 years of diabetes had nearly fourfold higher adjusted odds of CKD compared with those with 0–4 years (OR = 3.90; 95% CI 1.42–10.75; p = 0.008). Conclusions: Diabetes duration is strongly and independently associated with declining kidney function. Prolonged disease exposure confers a substantial increase in CKD risk, even after adjustment for age, hypertension, and metabolic factors. These findings highlight the progressive nephrotoxic impact of cumulative hyperglycemic exposure and underscore the need for early and sustained nephroprotective strategies in T2DM. Full article

Introduction: Metabolic acidosis is common after kidney transplantation and is associated with adverse outcomes. However, its vascular and functional correlates in kidney transplant recipients remain insufficiently characterized. Methods: We conducted a cross-sectional study of adult kidney transplant recipients attending routine outpatient visits at a tertiary transplant center. Metabolic acidosis was defined as serum bicarbonate < 22 mmol/L. Arterial stiffness was assessed by carotid–femoral pulse wave velocity (PWV), and physical frailty was evaluated using the Fried frailty phenotype. Multivariable regression models were used to identify determinants of metabolic acidosis and to examine its association with arterial stiffness and frailty severity. Results: Among 239 patients (median age 46 years), 154 (64%) had metabolic acidosis. Lower estimated glomerular filtration rate and higher systemic inflammation were independently associated with metabolic acidosis. Metabolic acidosis was independently associated with higher arterial stiffness, with a 1.41 m/s higher PWV after adjustment for age, sex, blood pressure, kidney function, and diabetes mellitus (p < 0.001). Although metabolic acidosis was associated with greater frailty severity in minimally adjusted models, this association was attenuated and no longer statistically significant after further adjustment for kidney function, diabetes, and inflammation. In stable kidney transplant recipients, metabolic acidosis is independently associated with increased arterial stiffness but not with frailty after accounting for key clinical confounders. Conclusions: These findings highlight metabolic acidosis as a marker of vascular vulnerability and a potential therapeutic target after kidney transplantation. Full article

Background: Sarcopenia is highly prevalent in older adults and in individuals with impaired kidney function, where it is associated with adverse clinical outcomes. A creatinine–cystatin C–based sarcopenic index has been proposed as a surrogate marker of muscle status; however, its association with sarcopenia as defined by the EWGSOP2 framework, particularly in the context of renal dysfunction, remains uncertain. Methods: Older adults were classified according to EWGSOP2 criteria into probable, confirmed, and severe sarcopenia. Associations between the sarcopenic index and sarcopenia phenotypes were examined using group comparisons and multivariable logistic regression analyses in the overall cohort and in a subgroup of participants with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Results: The sarcopenic index was not independently associated with probable, confirmed, or severe sarcopenia. In contrast, age emerged as the strongest independent correlate of probable sarcopenia (OR 1.12; 95% CI 1.05–1.19, p = 0.001), while body mass index was independently associated with confirmed sarcopenia (OR 0.91; 95% CI 0.86–0.96, p < 0.001). Similar patterns were observed in participants with reduced kidney function. Conclusions: Within the present analytical framework, the sarcopenic index did not show a meaningful association with EWGSOP2-defined probable sarcopenia, the most uniformly assessable EWGSOP2 stage, in older adults, including those with reduced kidney function. Exploratory analyses of more advanced sarcopenia stages did not reveal additional associative information. These findings should be interpreted within a descriptive and associative framework rather than a formal assessment of diagnostic or clinical decision-making performance. Full article

Background: Cardiorenometabolic syndrome (CRMS) reflects the interaction between heart failure (HF), chronic kidney disease, and metabolic disorders. Its prognostic impact during the acute phase of HF remains poorly defined. The primary objective of this study was to assess whether severe CRMS (sCRMS: estimated glomerular filtration rate <45 mL/min/1.73 m² associated with type 2 diabetes mellitus and/or obesity) predicts worse clinical outcomes. Methods: This was a retrospective observational study of a prospective cohort including 2228 patients admitted for acute HF between 2015 and 2025. Clinical characteristics and outcomes (mortality, HF readmission, and the composite endpoint) were compared between patients with and without sCRMS. Results: sCRMS was present in 486 patients (21.8%) who were older, had worse functional class, and a higher burden of cardiovascular comorbidities. They presented more frequently with systemic congestion and less often with de novo HF. During follow-up, sCRMS was associated with higher mortality (29.4% vs. 18.4%), HF readmissions (56.2% vs. 33.5%), and the composite endpoint (85.6% vs. 51.9%) (all p < 0.001). In multivariable analysis, sCRMS remained an independent predictor of mortality (HR 1.25), readmissions (HR 1.24), and overall morbidity and mortality (HR 1.20). Conclusions: In patients hospitalized for acute HF, sCRMS consistently identified a clinically vulnerable phenotype with an unfavorable prognosis. These findings support the value of sCRMS as a simple and reproducible prognostic marker and highlight the need for integrated cardiorenometabolic strategies during post-discharge follow-up. Full article