Search Results (6,343)

Atrial fibrillation (AF) is the most common supraventricular arrhythmia in adults, with a rising prevalence and a significant impact on quality of life and major cardiovascular outcomes. While atrial structural and electrical remodeling have long been central to AF pathophysiology, increasing evidence highlights the importance of psychological and mental health factors throughout the disease course. Depression, anxiety, and chronic stress are highly prevalent among individuals with AF and are associated with increased symptom burden, impaired quality of life (QoL), reduced treatment adherence, lower utilization of evidence-based therapies, and adverse clinical outcomes. Conversely, the diagnosis of AF itself may contribute to psychological distress, highlighting a complex bidirectional relationship between mental health and AF. This review summarizes current evidence on this interplay, with a focus on underlying mechanisms, including autonomic dysfunction and inflammation. Furthermore, the influence of mental health on outcomes and therapeutic strategies, and the clinical relevance of a multidisciplinary approach in contemporary AF management, are also examined. Full article

Background: Anterior ischemic optic neuropathy (AION) is a potentially vision threatening disorder that affects middle-aged and elderly individuals. The pathogenesis of the disease remains incompletely understood. However, the most universally accepted hypothesis suggests that a transient reduction in optic nerve head (ONH) perfusion, secondary to hypovolemia, nocturnal hypotension, or small-vessel disease, results in ischemic infarction of the anterior portion of the optic nerve. Case presentation: We present the case of a 61-year-old male patient with a history of arterial hypertension, type II diabetes mellitus, generalized atheromatosis, femoral bypass and stent implantation for chronic ischemia in his left leg, followed by brachial artery dissection that needed a prompt vascular intervention; he presented visual acuity loss in both eyes (BE), with the left eye (LE) being more affected than the right eye (RE). A complete ophthalmologic check-up was performed, and it revealed best-corrected visual acuity (BCVA) RE 0.5 Snellen, LE light perception, normal intraocular pressure (IOP), BE papillary edema and arteriovenous abnormalities. Visual field (VF) examination revealed RE inferior altitudinal defect and LE preabsolute scotoma. The diagnosis of BE anterior ischemic optic neuropathy and hypertensive retinopathy stage II was formulated. Following the aforementioned surgical procedures meant optimizing the patient’s critical vascular status, subsequent management of NA-AION systemic risk factors, along with implementing important lifestyle changes. No further cardiovascular events occurred, and visual field parameters remained stable at the three-year follow-up. Conclusions: Non-arteritic anterior ischemic optic neuropathy (NA-AION) remains a topic of interest for both ophthalmologists and neurologists worldwide. When confronted with a high-risk cardiovascular patient, a rapid and thorough systemic evaluation may prove beneficial. This management strategy could potentially contribute to maintaining a stable systemic outcome, despite major cardiovascular threats. Full article

Cardiac surgery-associated acute kidney injury (CS-AKI) increases short- and long-term mortality, progression to chronic kidney disease (CKD), and healthcare costs. Its pathogenesis is multifactorial—combining renal hypoperfusion, impaired oxygen delivery, hemodilution, inflammation, ischemia–reperfusion injury, and nephrotoxin exposure—so no single intervention confers universal protection. This narrative review appraises fourteen perioperative prevention strategies, grading each by study design, reproducibility, and concordance with contemporary guidelines. The strongest actionable evidence supports the preservation of renal oxygen delivery during cardiopulmonary bypass through goal-directed perfusion, perioperative amino acid infusion, and biomarker-guided Kidney Disease: Improving Global Outcomes (KDIGO) care bundles. Remote ischemic preconditioning, pulsatile flow, minimally invasive extracorporeal circulation, dexmedetomidine, N-acetylcysteine, levosimendan, hemoadsorption with the oXiris membrane, and natriuretic peptides show variable or subgroup-dependent signals limited by heterogeneous trial design and acute kidney injury (AKI) definitions. Prevention of CS-AKI is, therefore, best conceived as a multimodal, patient-centered process integrating preoperative risk stratification, intraoperative oxygen delivery optimization, patient blood management (PBM), and postoperative nephrotoxin avoidance and surveillance. Full article

Background/Objectives: The objectives of this study were to compare emotional well-being, depressive symptoms, and psychiatric medication use between adults with and without diabetes in Spain and to identify sex-specific factors associated with these outcomes among individuals with diabetes. Methods: A population-based matched study was conducted using data from the 2023 Spanish National Health Survey (SNHS 2023). Adults aged ≥35 years with physician-diagnosed diabetes were individually matched (1:1) to controls without diabetes according to sex, exact age, and autonomous community of residence. Low emotional well-being (WHO-5 score < 50), clinically relevant depressive symptoms (PHQ-8 ≥ 10), and psychiatric medication use were assessed. Conditional logistic regression and sex-specific multivariable logistic regression models were fitted. Results: The study included 3710 participants (1855 with diabetes and 1855 matched controls without diabetes). The prevalence of low emotional well-being was significantly higher among participants with diabetes than among matched controls in both men (16.4% vs. 11.6%; p = 0.004) and women (28.8% vs. 21.6%; p < 0.001). Likewise, clinically relevant depressive symptoms were more frequent among individuals with diabetes (men: 32.7% vs. 24.9%, p < 0.001; women: 54.4% vs. 40.2%, p < 0.001), as was psychiatric medication use (men: 20.5% vs. 15.2%, p = 0.005; women: 39.5% vs. 30.2%, p < 0.001). After full adjustment, diabetes remained independently associated with low emotional well-being (men: aOR 1.48, 95% CI 1.03–2.13; women: aOR 1.43, 95% CI 1.14–1.78), depressive symptoms (men: aOR 1.31, 95% CI 1.02–1.69; women: aOR 1.38, 95% CI 1.08–1.77), and psychiatric medication use (men: aOR 1.34, 95% CI 1.02–1.75; women: aOR 1.35, 95% CI 1.06–1.73). Poor social support, physical inactivity, and several chronic comorbidities emerged as the factors most consistently associated with adverse mental health outcomes among individuals with diabetes. Conclusions: Adults with diabetes in Spain experience a substantially greater burden of adverse mental health than matched individuals without diabetes. Integrating routine mental health assessment and psychosocial support into diabetes care may help improve both psychological well-being and disease management. Full article

Background: Health assessment in custodial settings represents a core medico-legal function, particularly when clinical changes may influence detention compatibility and judicial decisions. Objective documentation of disease progression during incarceration is essential to ensure respect for the principle of healthcare equivalence and the protection of fundamental rights. Methods: A retrospective descriptive medico-legal analysis was conducted on 37 male inmates referred for forensic evaluation. Standardized assessments included anamnesis, physical and psychiatric examination, evaluation of medical records, and comparative evaluation of pre-detention and detention-period health status. Results: Pre-existing conditions accounted for 73% of pathologies, while 27% developed during imprisonment. Clinical deterioration occurred in 35.1% of inmates (13 cases). Psychiatric disorders were frequent (27%, 10 inmates), predominantly depressive. Conclusions: The findings indicate that imprisonment may constitute a setting that contributes to the progression of medical and psychiatric conditions, highlighting structural and organizational challenges within penitentiary healthcare. Strengthening standardized medico-legal assessment protocols, improving multidisciplinary collaboration, and ensuring continuity of care between prison and community health services are crucial steps toward protecting inmates’ health. This study provides an exploratory assessment of health conditions in a cohort of inmates within the Italian correctional system, emphasizing the central role of healthcare in custodial settings. Since many Italian correctional facilities are equipped with well-developed healthcare services and appropriate diagnostic and therapeutic resources, numerous acute and chronic medical conditions can be effectively managed within the prison setting, ensuring continuity of care while limiting the need for transfer to external healthcare facilities. Full article

Patients with chronic liver disease are systematically excluded from acute myocardial infarction (AMI) trials, and prior real-world data rely on administrative coding alone. Whether ICD-coded liver disease and laboratory-defined liver fibrosis identify the same patients, and whether they predict the same outcomes, is unknown. We conducted a single-center retrospective cohort study of 1037 consecutive adults admitted with AMI (ICD-10 I21.x) to a tertiary New York center between November 2022 and December 2024. The primary exposure was ICD-defined advanced liver disease (cirrhosis, hepatic failure, or portal hypertension/decompensation; n = 102). The secondary, lab-based exposure was the Fibrosis-4 (FIB-4) index calculated from earliest admission AST, ALT, and platelet count (computable in 1031 patients, 99.4%), stratified as low (<1.45), indeterminate (1.45–3.25), or advanced (>3.25). Co-primary outcomes were invasive management (diagnostic angiography, percutaneous coronary intervention, or coronary artery bypass grafting) and in-hospital mortality. Multivariable logistic regression adjusted for age, sex, diabetes, chronic kidney disease, heart failure, and ST-elevation; the trend across FIB-4 tiers was assessed with the Cochran–Armitage test. Denominators throughout (including the 168/909 occult-fibrosis estimate) use the full exposure group as denominator under a missing-as-not-exposed convention; the four no-LD and two advanced-LD patients with missing FIB-4 are counted as non-advanced fibrosis for this calculation. Patients with ICD-defined advanced liver disease received invasive management less often (12.7% vs. 50.4%; adjusted odds ratio [aOR] 0.17, 95% CI 0.09–0.32) and died in hospital more often (43.1% vs. 7.9%; aOR 8.22, 95% CI 5.02–13.46) than patients without coded liver disease. Outcomes worsened monotonically across FIB-4 tiers (mortality 4.4% → 9.2% → 27.5%; invasive management 55.2% → 45.6% → 33.5%; both p < 0.001 by Cochran–Armitage trend test). Critically, 168 of 909 patients with no coded liver disease (18.5%) had FIB-4 > 3.25, representing a substantial population of unrecognized advanced fibrosis missed by clinical coding. Coded liver disease identifies a small, severely affected subgroup with markedly lower rates of invasive management and 6- to 8-fold higher mortality after AMI. Routine FIB-4 calculation, a free, three-variable lab score, identifies a much larger population with occult advanced fibrosis and graded excess risk that ICD codes miss entirely. Pending prospective validation, FIB-4 may serve as a low-cost adjunct to bedside risk stratification in AMI care. Full article

Liver fibrosis staging plays a key role in the prognosis and management of chronic liver disease. Liver biopsy remains the reference standard for fibrosis assessment but is limited by its invasiveness and risk of complications, while magnetic resonance elastography, though also considered a gold standard, is constrained by cost and limited availability. Ultrasound-based elastography techniques—vibration-controlled transient elastography (VCTE), point shear wave elastography (pSWE), and two-dimensional shear wave elastography (2D SWE)—have emerged as accessible non-invasive alternatives. This narrative review aimed to summarize the principles, diagnostic performance, advantages, and limitations of these three techniques across a range of etiologies. A comprehensive literature search was conducted across Scopus, PubMed, Embase, CINAHL, the Cochrane Library, Informit, and the JBI Database of Systematic Reviews and Implementation Reports, covering January 2015 to February 2026. Search terms included “vibration-controlled transient elastography”, “point shear wave elastography”, “two-dimensional shear wave elastography”, “liver stiffness measurement”, “non-invasive assessment” and “chronic liver disease”. International guidelines, systematic reviews and meta-analyses, large observational cohort studies, and narrative reviews were included in the synthesis. VCTE, pSWE, and 2D SWE all demonstrated good diagnostic performance for detecting advanced fibrosis and cirrhosis across multiple etiologies. VCTE was the most extensively validated technique, with standardized cut-offs endorsed by major international guidelines. pSWE and 2D SWE showed comparable diagnostic accuracy and can be integrated into conventional ultrasound systems, enabling simultaneous structural and stiffness assessment, although validated cut-off values for these two techniques are not yet established in current guidelines, and absolute stiffness values are not directly interchangeable across techniques, manufacturers, or software versions. Obesity, inflammation, steatosis and recent food intake were identified as factors affecting measurement accuracy across all three techniques. Ultrasound-based elastography techniques offer effective, non-invasive alternatives to liver biopsy for fibrosis assessment. VCTE remains the most validated option despite cost and availability constraints, while pSWE and 2D SWE offer comparable accuracy with practical integration advantages. Future research should focus on standardizing cut-off values, addressing confounding factors, and combining elastography with biomarkers and AI-driven models. Full article

Oroantral communication (OAC) is a known complication of maxillary tooth extraction that may lead to issues such as oroantral fistula formation and chronic maxillary sinus disease if left untreated. Although several surgical techniques for OAC closure have been described in the existing research, autotransplantation of a third molar represents a rarely reported alternative. This method not only allows for the closure of OAC but also restores masticatory function and may be an alternative to implantation. This review evaluates the available literature on third molar autotransplantation for OAC management, with particular attention to donor tooth selection, recipient-site preparation, surgical techniques, postoperative management, and clinical outcomes. The currently available literature on the mentioned topic is limited and consists predominantly of case reports and small clinical series. Nevertheless, published cases indicate that third molar autotransplantation may provide successful OAC closure and functional tooth replacement in appropriately selected cases. Significant heterogeneity and incomplete reporting of surgical and postoperative procedures, however, limit the strength of the available evidence. In this article, we propose a clinically oriented algorithm to facilitate decision-making in selected cases. This algorithm should be regarded as an expert-based framework requiring prospective clinical validation rather than an established standard of care. Full article

Endothelial dysfunction is a key mechanism linking obesity, metabolic disturbances, and cardiovascular disease, contributing to the development and progression of atherosclerosis and other vascular complications. This review provides a comprehensive overview of the molecular mechanisms underlying endothelial dysfunction in obesity and discusses current diagnostic approaches and therapeutic strategies aimed at restoring vascular homeostasis. The available evidence indicates that chronic inflammation, oxidative stress, insulin resistance, reduced nitric oxide bioavailability, increased reactive oxygen species production, and dysregulated adipokine signaling play central roles in endothelial impairment. Recent advances in functional vascular assessment, circulating biomarkers, and imaging techniques have improved the early identification of endothelial dysfunction and cardiovascular risk. Current therapeutic strategies include pharmacological agents, such as glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter 2 inhibitors, metformin, and dipeptidyl peptidase-4 inhibitors, together with lifestyle interventions based on healthy dietary patterns and regular aerobic and resistance exercise. These approaches improve glycemic control, reduce inflammation and oxidative stress, enhance endothelial function, and contribute to cardiovascular protection. Overall, the evidence supports an integrated and personalized management strategy targeting both metabolic and vascular abnormalities to reduce cardiovascular risk and improve long-term clinical outcomes in individuals with obesity. Full article

Glucagon-like peptide-1 (GLP-1) receptor agonists and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists have transformed obesity management by producing substantial, sustained weight loss and improving metabolic health. Alongside these benefits, their effects on appetite, food intake, and gastrointestinal function have raised increasing interest in the nutritional consequences of pharmacologically induced weight loss. Although reductions in energy intake contribute to therapeutic efficacy, they may also influence protein intake, dietary quality, micronutrient adequacy, and skeletal muscle health, particularly in individuals with pre-existing nutritional vulnerability. This narrative review summarizes current evidence regarding nutritional considerations during GLP-1-based therapy, including changes in dietary intake, protein and micronutrient adequacy, body composition, muscle health, and nutritional assessment. Particular attention is given to populations at increased nutritional risk, practical approaches to nutritional monitoring, and strategies to support adequate nutrition during treatment. Current evidence suggests that nutritional responses to GLP-1-based therapy are heterogeneous and cannot be adequately evaluated using body weight alone. Assessment of dietary intake, body composition, muscle function, physical performance, and individual clinical characteristics provides a more comprehensive understanding of nutritional status than anthropometric measures alone. While routine supplementation or intensive monitoring is not supported for all patients, a risk-based and individualized approach appears appropriate, particularly for older adults and individuals with sarcopenic obesity, previous bariatric surgery, chronic gastrointestinal disease, or persistent treatment-related gastrointestinal symptoms. Future research should establish clinically meaningful nutritional outcomes and determine which nutritional interventions improve patient-centered outcomes during long-term obesity management. Full article

Background/Objectives: Anticoagulation in advanced chronic kidney disease (CKD) remains challenging due to limited representation in clinical trials, resulting in uncertainty regarding optimal drug selection, dosing, and monitoring strategies. Methods: We conducted a cross-sectional, web-based survey of clinicians involved in CKD care and anticoagulation prescribing. The questionnaire explored respondent characteristics, methods of renal function estimation, anticoagulant selection across common CKD scenarios, anticoagulants’ dosing and monitoring practices, and approaches to anticoagulation in nephrotic syndrome. Results: Fifty-seven clinicians participated in the survey. Unfractionated heparin was the preferred agent for venous thromboembolism (VTE) prophylaxis in patients with stage 4 and 5 CKD, or on dialysis. For acute VTE treatment, anticoagulant choice varied by CKD severity, with unfractionated heparin, direct oral anticoagulants (DOACs), and low-molecular-weight heparin (LMWH) all reported to be used depending on stages of CKD. Warfarin and DOACs were commonly used for treatment of chronic VTE and atrial fibrillation (AF), with warfarin more frequently selected in patients receiving dialysis. Apixaban was the most frequently reported DOAC, typically at a dose of 2.5 mg twice daily in advanced CKD and dialysis. Renal function estimation methods varied, with Cockcroft–Gault most used overall, while nephrologists more frequently reported MDRD or CKD-EPI equations. Most respondents reported not routinely monitoring DOAC levels, and the majority indicated the absence of a structured multidisciplinary team (MDT) for managing anticoagulated CKD patients. Clinical practice varied according to specialty, experience, and healthcare setting, particularly in anticoagulant selection, dosing strategies, and use of risk stratification tools. Conclusions: Anticoagulation practices in advanced CKD are highly heterogeneous, reflecting persistent evidence gaps. While unfractionated heparin and warfarin remain central in patients with stage 5 CKD or on dialysis, DOAC use—particularly apixaban—has expanded, often with empiric dose reduction. These findings underscore the need for clearer guidance, standardized approaches to renal function assessment, multidisciplinary care pathways, and prospective studies focusing on anticoagulation use in CKD populations. Full article

Direct-acting antiviral (DAA) therapy has dramatically transformed the management of hepatitis C virus (HCV) infection in chronic kidney disease (CKD). Severe renal impairment and dialysis dependence are no longer considered major barriers to virologic cure. The main difficulties have shifted toward efficient diagnosis, choosing the regimen in the presence of cirrhosis and drug interactions, coordinating treatment with kidney transplantation, managing HCV-associated immune-complex kidney disease, and providing treatment in dialysis and resource-limited settings. This narrative review aims to discuss these issues in a decision-oriented manner, using verified guidelines, systematic reviews, important clinical trials, transplant cohorts, and studies of cryoglobulinemic disease, while explicitly comparing the strength and consistency of the underlying evidence and highlighting areas of genuine clinical uncertainty. Present evidence supports using the recommended DAA regimens without renal dose adjustment, while ribavirin needs dose modification when kidney function is reduced and can result in hemolytic anemia. Kidneys from HCV-viremic donors can be transplanted to recipients without HCV infection when proper informed consent, rapid access to DAA treatment, and organized post-transplant monitoring are available, although the minimum effective duration of peri-transplant antiviral prophylaxis remains unresolved. Antiviral therapy is the first-line treatment for HCV-associated glomerular disease, while rituximab-based immunosuppression is largely reserved for severe, rapidly progressive, or persistent cryoglobulinemic vasculitis. Future progress will depend less on proving antiviral efficacy and more on closing the gaps between screening, confirmatory testing, starting treatment, transplantation pathways, and long-term follow-up, gaps that stem from inequities in diagnostic infrastructure, drug reimbursement, and healthcare-system organization as much as from any remaining biomedical uncertainty. Full article

Background/Objectives: Obesity is a chronic, progressive, and relapsing disease that requires long-term, multidisciplinary management rather than episodic weight-loss treatment. Although novel incretin-based anti-obesity pharmacotherapies, including GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, have markedly improved the clinical management of obesity, weight reduction alone does not fully capture treatment success. Body composition, lean mass preservation, physical function, nutritional adequacy, psychological well-being, adherence, and long-term weight-loss maintenance are increasingly recognized as essential therapeutic outcomes. This narrative review critically examines the role of lifestyle medicine as a co-therapeutic strategy during modern anti-obesity pharmacotherapy, with particular attention to physical activity, nutrition, behavioral support, and individualized monitoring. Methods: A narrative literature search was conducted in PubMed up to June 2026. The review included studies addressing adults with overweight or obesity and evidence related to anti-obesity pharmacotherapy, physical activity, nutrition, body composition, functional outcomes, eating behavior, quality of life, treatment tolerability, adherence, weight regain, and long-term maintenance. Results: Current evidence indicates that incretin-based therapies produce substantial and clinically meaningful weight loss, but pharmacological efficacy may be limited by reductions in lean mass, gastrointestinal adverse events, inadequate nutritional intake, treatment discontinuation, and weight regain after drug withdrawal. Physical activity should be considered a therapeutic component rather than only a tool for increasing energy expenditure, as aerobic exercise supports cardiometabolic health and cardiorespiratory fitness, while resistance training helps preserve muscle strength, bone health, and functional capacity. Nutritional strategies are equally important, particularly during appetite suppression, to maintain adequate protein, fiber, fluids, micronutrients, and diet quality. Behavioral factors, including sleep, stress, mood, stigma, self-regulation, and the food environment, may influence adherence and long-term outcomes. Conclusions: Novel anti-obesity drugs should not be viewed as replacements for lifestyle medicine but as powerful tools within an integrated chronic-care model. The goal of treatment should move beyond maximal body-weight reduction to durable improvements in body composition, metabolic health, physical function, nutritional status, quality of life, and weight-loss maintenance. Full article

Background: Self-care and healthy dietary habits are fundamental components of heart failure (HF) management, yet the relationship between dietary quality and self-care remains insufficiently explored. This study investigated the association between dietary habits and self-care behaviors among patients with HF. Methods: A cross-sectional study was conducted among 137 adults with HF attending outpatient clinics in Greece. Self-care behaviors were assessed using the Hippocratic Heart Failure Self-Care Scale (HHFSCS), and dietary quality was evaluated using the validated Greek version of the Cardiovascular Diet Questionnaire-2 (CDQ-2). Associations between demographic characteristics, dietary measures, and self-care were examined using non-parametric tests and multivariable general linear models adjusted for demographic characteristics. Results: The mean HHFSCS score was 41.0 ± 11.3, indicating a moderate level of self-care. Higher scores were observed for medication adherence and appointment keeping, whereas lower scores were observed for exercise, smoking-related behaviors, alcohol-related behaviors, and symptom monitoring. The mean total CDQ-2 score was 8.57 ± 7.17. Overall dietary quality was not significantly associated with total self-care after adjustment for age, sex, marital status, educational level, and employment status (B = −0.102, 95% CI: −0.338 to 0.134, p = 0.394). Among the dietary components, only the saturated fatty acid (SFA) score remained significantly associated with total self-care after adjustment (p = 0.015), whereas fruit and vegetable and monounsaturated fatty acid scores were not significant. Employment status was also significantly associated with self-care (p < 0.001). Conclusions: Overall dietary quality was not significantly associated with total self-care in this sample of patients with HF. However, the observed association between the SFA component and self-care suggests that specific aspects of dietary behavior may warrant further investigation. Given the cross-sectional design and reliance on self-reported measures, these findings should be interpreted cautiously and do not establish directionality or causality. Prospective studies incorporating objective dietary and behavioral measures are needed to further clarify the relationship between dietary habits and self-care in HF. Full article

Background/Objectives: Type 2 diabetes (T2D) is a major risk factor for cardiovascular disease and chronic kidney disease (CKD), yet the extent of longitudinal CKD screening in routine clinical practice remains unclear. This study aimed to assess long-term cardiorenal outcomes and CKD screening practices in patients with T2D managed across primary care and endocrinology settings, evaluating the feasibility of risk stratification in real-world practice. Methods: We conducted a retrospective cohort study using anonymized data from the Telotrón database (2.2 million patients). Adults with T2D attended across primary and endocrinology care were followed from 1 January 2018 to 31 December 2022. Frequency of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) measurements, and cumulative proportion of kidney and cardiovascular events, hospitalizations, and mortality were assessed. Results: Among 13,600 individuals, 31.1% experienced a kidney event and 18.6% a cardiovascular event over 5 years. All-cause hospitalization occurred in 24.9% and 16.1% died. First occurrence of an abnormal eGFR or UACR measurement occurred in 37.0% of participants without baseline CKD, and 45.4% with baseline CKD showed progression. Annual monitoring was limited, with 39.1% and 16.6% undergoing at least one yearly assessment, and 2.9 and 1.5 mean number of measurements per patient for eGFR and UACR, respectively. Conclusions: Despite receiving endocrinology care, kidney disease progression and cardiovascular events remain a major concern in T2D, and yet suboptimal albuminuria and eGFR assessment limit early detection and risk stratification, thereby hindering risk-directed management. Full article