Renal function: the Cinderella of cardiovascular risk profile

The presence of an altered renal function in essential hypertension, advanced heart failure (HF) and after a myocardial infarction (MI) is associated with higher cardiovascular morbidity and mortality. Indices of altered renal function (e.g., microalbuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance or overt proteinuria) are independent predictors of cardiovascular morbidity and mortality in any of the three clinical situations. These parameters should then be routinely evaluated in clinical practice. These facts have several therapeutic implications. First, although there is no evidence-based information on the level of blood pressure that confers optimal renal protection, levels substantially lower than past recommendations are advisable. Second, hypertensive kidney damage should be prevented by early treatment of hypertensive patients, particularly those with microalbuminuria. Finally, to avoid further aggravation of high cardiovascular risk, antihypertensive agents devoid of unwanted metabolic side effects should be used for the treatment of hypertensive vascular damage. In HF, the combination of an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker seem to be the most renoprotective. Renal outcome is also improved by ACE inhibition after an MI. Finally, renal and cardiovascular outcome seem to run in parallel in all these situations.     

A voltage-based analysis of fluid delivery and outcomes in burn patients with electrical injuries over a 6-year period

IntroductionElectrical injuries are associated with significant morbidity for affected patients. While cardiac and surgical interventions have been extensively reported, no practice guidelines or studies have specifically addressed fluid delivery and associated outcomes of patients with electrical injuries. The study objective was to evaluate the differences in fluid delivery in patients with high (≥1000 V) and low (<1000 V) voltage electrical injuries.MethodsThis retrospective, observational study included adult electrical injury patients admitted for acute care. Patients with reported voltages were classified into high and low voltage subgroups. Primary outcomes of fluid administration and urine output over the first 24 h after injury were assessed between subgroups. Secondary outcomes included renal, cardiac, surgical, and additional complications such as mortality, cost, and length of stay.ResultsData were analyzed in 36 patients with reported voltages, including 26 patients in the high and 10 patients in the low voltage subgroups. Patients in the high voltage subgroup had a statistically significant higher median (IQR) total IV fluid given [46.6 (22.4–61.9) vs. 22.5 (8.3–31.4) mL/kg, p = 0.033] in the first 24 h to achieve a similar urine output to the low voltage subgroup. The high voltage patients had higher rates of myoglobinuria, rhabdomyolysis, and creatinine kinase elevation. Patients in the high voltage vs. low voltage group had significantly longer median (IQR) length of stay (days) [11 (2–19) vs. 1 (1–6); p = 0.015] and higher cost of hospital stay [$124,608 (19,486–296,991) vs. $16,165 (12,409–69,659); p = 0.033].ConclusionsThese results reinforce the importance of assessing electrical injuries and obtaining a voltage to provide patient-specific care, as high voltage electrical injuries receive more fluid than estimated maintenance rates. This study is the first of its kind to characterize fluid given for high and low voltage electrical injuries and effects on patient outcomes.     

Divergence between serum creatine and cystatin C in estimating glomerular filtration rate of critically ill COVID-19 patients

BackgroundThe clinical use of serum creatine (sCr) and cystatin C (CysC) in kidney function evaluation of critically ill patients has been in continuous discussion. The difference between estimated glomerular filtration rate calculated by sCr (eGFRcr) and CysC (eGFRcysc) of critically ill COVID-19 patients were investigated in this study.MethodsThis is a retrospective, single-center study of critically ill patients with COVID-19 admitted in intensive care unit (ICU) at Wuhan, China. Control cases were moderate COVID-19 patients matched in age and sex at a ratio of 1:1. The eGFRcr and eGFRcysc were compared. The association between eGFR and death were analyzed in critically ill cases. The potential factors influencing the divergence between eGFRcr and eGFRcysc were explored.ResultsA total of 76 critically ill COVID-19 patients were concluded. The mean age was 64.5 ± 9.3 years. The eGFRcr (85.45 (IQR 60.58–99.23) ml/min/1.73m²) were much higher than eGFRcysc (60.6 (IQR 34.75–79.06) ml/min/1.73m²) at ICU admission. About 50 % of them showed eGFRcysc < 60 ml/min/1.73 m² while 25% showed eGFRcr < 60 ml/min/1.73 m² (χ² = 10.133, p = 0.001). This divergence was not observed in moderate group. The potential factors influencing the divergence included serum interleukin-6 (IL-6), tumor necrosis factor (TNF-α) level as well as APACHEII, SOFA scores. Reduced eGFRcr (<60 mL/min/1.73 m²) was associated with death (HR = 1.939, 95%CI 1.078–3.489, p = 0.027).ConclusionsThe eGFRcr was generally higher than eGFRcysc in critically ill COVID-19 cases with severe inflammatory state. The divergence might be affected by inflammatory condition and illness severity. Reduced eGFRcr predicted in-hospital death. In these patients, we advocate for caution when using eGFRcysc.     

十味诃子丸联合阿魏酸哌嗪治疗慢性肾小球肾炎的临床研究

目的 探讨十味诃子丸联合阿魏酸哌嗪治疗慢性肾小球肾炎的临床疗效。方法 选取2021年1月—2023年3月南京医科大学附属江苏盛泽医院收治的136例慢性肾小球肾炎患者，按数字随机法将患者分对照组（68例）和治疗组（68例）。对照组患者口服阿魏酸哌嗪片，200 mg/次，3次/d。在对照组基础上，治疗组口服十味诃子丸，4丸/次，3次/d。两组患者治疗28 d。观察两组患者临床疗效，比较治疗前后两组患者症状缓解时间，肾功能指标尿素氮（BUN）、血清肌酐（SCr）、24 h尿蛋白量（24 h Upro），血清炎性因子白细胞介素-6（IL-6）、血管内皮生长因子（VEGF）、肿瘤坏死因子-α（TNF-α）、基质金属蛋白酶-9（MMP-9）水平及不良反应。结果 治疗后，治疗组总有效率为98.53%，明显高于对照组总有效率（85.29%，P＜0.05）。治疗后，治疗组症状缓解时间均明显早于对照组（P＜0.05）。治疗后，两组患者BUN、SCr、24 h Upro、IL-6、TNF-α和VEGF均明显降低，而MMP-9水平明显升高（P＜0.05），且治疗组这些指标均明显好于对照组（P＜0.05）。治疗后，治疗组不良反应总发生率（4.41%）明显低于对照组发生率（10.29%，P＜0.05）。结论 十味诃子丸联合阿魏酸哌嗪治疗慢性肾小球肾炎效果确切，临床症状明显改善，调节肾功能状态，可使炎性反应减弱，且安全有效。     

Association between serum uric acid levels and cardiovascular risk factors among adults in India

Background and aimThe objective of this study was to explore the association between serum uric acid (SUA) levels and cardiovascular risk factors in the Indian population.Methods and resultsThis was a cross-sectional, population-based study. The study enrolled adults aged 20 years and above residing in rural, sub-urban, and urban. All participants completed a detailed questionnaire, underwent anthropometric measurements, and had blood samples collected. Participants were divided into three tertiles based on their SUA concentrations. A total of 2976 participants were included in this study, with 865 from rural, 1030 from sub-urban, and 1081 from urban populations. The mean values of cardiovascular risk factors were significantly higher in tertile 3 (p < 0.001) as compared to the other tertiles. However, we observed a negative trend between the increase of SUA and SUA/Scr ratio and HbA1c levels (Pearson correlation r = −0.068; p < 0.001 and r = −0.140; p < 0.001, respectively). The healthy and prediabetic groups did not show any significant change in HbA1c with increasing SUA levels, while an inverse trend was observed in diabetics. In the diabetic population, both men and women showed an inverse trend between increasing SUA levels and HbA1c in both known and newly diagnosed diabetes (p < 0.001).ConclusionsThe study found a positive association between SUA levels and cardiovascular risk factors. However, HbA1c was inversely correlated with increasing SUA tertiles in both known and newly diagnosed diabetes, as compared to the general population. Additionally, both men and women with diabetes consistently showed an inverse relationship between increasing SUA/SCr ratio and HbA1c levels.