Special Issues

Special Issue Title: Cardiovascular disorders in chronic kidney disease

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· Deadline for manuscript submissions:  1 April 2020 

Special Issue Editor

Guest Editor

Prof. Dr. Janani Rangaswami

1. Sidney Kimmel College of Thomas Jefferson University, United States  

2. Department of Medicine/Nephrology, Einstein Medical Center, Philadelphia. 5401 Old York Road, Suite 363, Philadelphia 19141, United States

Website | E-Mail

Interests: Cardiorenal syndrome; Blood pressure variability; Pre-eclampsia; Cardiovascular outcomes in kidney disease; Cardio-nephrology

Special Issue Information

Dear Colleagues,

The increasing prevalence of vascular risk factors such as diabetes, obesity, and hypertension coupled with increased longevity has resulted in a worldwide epidemic of chronic kidney disease. The burden of cardiovascular disease in patients with chronic kidney disease is closely interwoven with the backdrop of common risk factors for disease in both organ systems, coupled with the strong influence of disease in one organ system on the development of disease in the other organ system. Cardiovascular disease represents a major cause of morbidity and mortality in patients with chronic kidney disease with all phenotypes of cardiovascular disease including heart failure, ischemic heart disease, valvopathies and arrhythmias being represented with high disease burden in patients with chronic kidney disease. Never has the implication of one organ system on the other been so profound, as in the current context of the cardio-nephrology symbiosis: complex interventional strategies for vascular disease, identification of novel biomarkers of renal and cardiac injury, the ever-increasing transplantation potential of patients with complex cardiac and renal disease, and the mutually significant prognostic implications between these organ systems. The therapeutic options in patients with cardiovascular and kidney disease are poised in exciting times with the advent of several novel anti-diabetic agents that have demonstrated significant benefits towards reduction of adverse cardiorenal events, and the push for cardioprotective strategies in patients with end stage kidney disease such as frequent dialysis and increased transplantation rates with the new health care initiative for kidney disease in the United States.

In this special issue of Reviews in Cardiovascular Medicine, we invite original articles and reviews on the topic of “Cardiovascular Disorders in Chronic Kidney Disease” for consideration for publication by cardiology and nephrology clinicians and researchers with an interest in cardiorenal medicine. This issue will address the pathophysiology, best practices with clinical management and knowledge gaps in the area of cardiovascular disease in patients with chronic kidney disease. This summary will be helpful to practicing clinicians and students caring for vulnerable patients with dual organ disease, and more importantly will hopefully catalyze further research towards delivering high quality care in a cost effective manner to these complex  patients.

Prof. Dr. Janani Rangaswami

Guest Editor


Manuscript Submission Information

Manuscripts should be submitted online at https://rcm.imrpress.org 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 papers will be 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 double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Reviews in Cardiovascular Medicine is an international peer-reviewed open access quarterly journal published by IMR Press.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is $1950. Submitted papers should be well formatted and use good English.


Coronary artery disease; Chronic kidney disease; Heart failure; arrythmias; Sudden cardiac death; Valvular heart disease; Pulmonary hypertensio; Cardiorenal outcomes; SGLT2 inhibitors; GLP-1 receptor agonists; Point of care ultrasound; Cardiac and kidney biomarkers

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Closing gaps in the care of patients with heart-kidney disease: the time is now
Janani Rangaswami
Reviews in Cardiovascular Medicine    2021, 22 (2): 257-258.   DOI: 10.31083/j.rcm2202029
Abstract319)   HTML59)    PDF(pc) (74KB)(353)       Save
No abstract present.
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Angiotensin converting enzyme inhibitors and angiotensin receptor blockers in acute heart failure: invasive hemodynamic parameters and clinical outcomes
Kevin Bryan Lo, Hesam Mostafavi Toroghi, Grace Salacup, Jiahui Jiang, Ruchika Bhargav, Eduardo Quintero, Kira Balestrini, Anum Shahzad, Roy O. Mathew, Peter A McCullough, Janani Rangaswami
Reviews in Cardiovascular Medicine    2021, 22 (1): 199-206.   DOI: 10.31083/j.rcm.2021.01.216
Abstract355)   HTML49)    PDF(pc) (222KB)(547)       Save
There are limited data regarding the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) in acute heart failure (AHF). The purpose is to determine the patterns of ACEi/ARB use at the time of admission and discharge in relation to invasive hemodynamic data, mortality, and heart failure (HF) readmissions. This is a retrospective single-center study in patients with AHF who underwent right heart catheterization between January 2010 and December 2016. Patients on dialysis, evidence of shock, or incomplete follow up were excluded. Multivariate logistic regression analysis was used to analyze the factors associated with continuation of ACEi/ARB use on discharge and its relation to mortality and HF readmissions. The final sample was 626 patients. Patients on ACEi/ARB on admission were most likely continued on discharge. The most common reasons for stopping ACEi/ARB were worsening renal function (WRF), hypotension, and hyperkalemia. Patients with ACEi/ARB use on admission had a significantly higher systemic vascular resistance (SVR) and mean arterial pressure (MAP), but lower cardiac index (CI). Patients with RA pressures above the median received less ACEi/ARB (P = 0.025) and had significantly higher inpatient mortality (P = 0.048). After multivariate logistic regression, ACEi/ARB use at admission was associated with less inpatient mortality; OR 0.32 95% CI (0.11 to 0.93), and this effect extended to the subgroup of patients with HFpEF. Patients discharged on ACEi/ARB had significantly less 6-month HF readmissions OR 0.69 95% CI (0.48 to 0.98). ACEi/ARB use on admission for AHF was associated with less inpatient mortality including in those with HFpEF.
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Continuation of Chronic Heart Failure Therapies During Heart Failure Hospitalization - a Review
Girish Singhania, Abutaleb A. Ejaz, Peter A. McCullough, Aaron Y. Kluger, Saravanan Balamuthusamy, Bhagwan Dass, Namrata Singhania, Adhish Agarwal
Reviews in Cardiovascular Medicine    2019, 20 (3): 111-120.   DOI: 10.31083/j.rcm.2019.03.562
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Randomized controlled trials have demonstrated the benefits of guideline-directed medical therapy in the outpatient setting for treatment of chronic heart failure. However, the benefits of continuation (or discontinuation) of major chronic heart failure therapies when treating acute heart failure during hospitalization are less clear. Real and anticipated worsening renal function, hyperkalemia and hypotension are the three major reasons for discontinuation of renin-angiotensin-aldosterone system inhibitors during hospitalization, and a failure to resume renin-angiotensin-aldosterone system inhibitors before discharge could worsen cardiovascular outcomes. Available data, mostly observational, shows that continuation or initiation of renin-angiotensin-aldosterone system inhibitors appears efficacious, safe, and well tolerated in majority of acute heart failure patients during hospitalization. Worsening renal function portends poor prognosis only if associated with congestion in acute heart failure, and clinicians should not de-escalate diuretic therapy routinely for worsening renal function.

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Renal implications of pulmonary arterial capacitance in acute heart failure with preserved ejection fraction
Hesam Mostafavi Toroghi, Kevin Bryan Lo, Mary Rodriguez Ziccardi, Benjamin Horn, Napatt Kanjanahattakij, Erum Malik, Jorge Penalver, Janani Rangaswami, Shuchita Gupta, Aman Amanullah
Reviews in Cardiovascular Medicine    2019, 20 (4): 267-272.   DOI: 10.31083/j.rcm.2019.04.576
Abstract499)   HTML34)    PDF(pc) (348KB)(972)       Save

Worsening renal function in patients with heart failure with preserved ejection fraction is associated with poor outcomes. Pulmonary arterial capacitance is a novel right heart catheterization derived hemodynamic metric representing pulmonary arterial tree distensibility and right ventricle afterload. Given the strong association between heart failure, pulmonary hypertension, and kidney function, the goal of this study is to investigate the correlation between Pulmonary arterial capacitance and long-term renal function in patients with heart failure with preserved ejection fraction. In this retrospective single center study, data from 951 patients with the diagnosis of heart failure, who underwent right heart catheterization were analyzed. Eight hundred and one patients with reduced ejection fraction, end-stage kidney disease on hemodialysis, acute myocardial infarction, and severe structural valvular disorders, were excluded. Pulmonary arterial capacitance was calculated as the stroke volume divided by pulmonary artery pulse pressure (mL/mmHg). Hemodynamic and clinical variables including baseline renal function were obtained at the time of the right heart catheterization, and renal function was also obtained at 3-5 years after right heart catheterization. The final cohort consisted of 150 subjects with a mean age 68 ( ± 14.2) years, 93 (62%) were female. The mean value for Pulmonary arterial capacitance was 2.82 ( ± 2.22) mL/mm Hg and the mean Glomerular Filtration Rate was 60.32 mL/min/l.73 m2 ( ± 28.36). After multivariate linear regression analysis (including baseline Estimated Glomerular Filtration Rate as one of the variates), only age and Pulmonary arterial capacitance greater than 2.22 mL/mm Hg were predictors of long term Glomerular Filtration Rate. Pulmonary arterial capacitance as a novel right heart catheterization index could be a predictor of long-term renal function in patients with heart failure with preserved ejection fraction.

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The dynamic relationship between serum chloride and cardiorenal syndrome
Amir Kazory, Maria Rosa Costanzo
Reviews in Cardiovascular Medicine    2020, 21 (1): 25-29.   DOI: 10.31083/j.rcm.2020.01.6
Abstract783)   HTML65)    PDF(pc) (191KB)(1156)       Save

Low serum sodium concentration has long been recognized as an established marker of short- and long-term morbidity and mortality in patients with heart failure (HF), and is commonly included in various risk prediction models. Mechanisms leading to hyponatremia (e.g. maladaptive neurohormonal activation) could also lead to concurrent decline in serum chloride levels. Besides, chloride has distinct biological roles (e.g. modulation of renal tubular sodium transporters) that are relevant to the pathophysiology and therapy of HF, making it a potent cardiorenal connector. Several clinical studies have recently reported on a potentially overlooked link between low serum chloride levels and adverse outcomes in patients with a wide variety of HF syndromes, which could indeed be stronger than that of sodium. While evidence on predictive value of chloride is accumulating in various patient populations and settings, the limited available interventional studies have so far yielded conflicting results. It remains to be elucidated whether hypochloremia represents a marker of disease severity and prognosis, or it is an actual pathogenetic mechanism, hence being a potential novel target of therapy. Current ongoing studies are designed to better understand the mechanistic aspects of the role of hypochloremia in HF and shed light on its clinical applicability.

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Management of heart failure in patients with end-stage kidney disease on maintenance dialysis: a practical guide
Megan S. Joseph, Maryse Palardy, Nicole M. Bhave
Reviews in Cardiovascular Medicine    2020, 21 (1): 31-39.   DOI: 10.31083/j.rcm.2020.01.24
Abstract1359)   HTML217)    PDF(pc) (2538KB)(2116)       Save

End-stage kidney disease (ESKD) and heart failure (HF) often coexist and must be managed simultaneously. Multidisciplinary collaboration between nephrology and cardiology is critical when treating patients with such complicated physiology. There is no "one-size-fits-all" approach to the evaluation of patients with new left ventricular systolic dysfunction, and diagnostic testing should be adapted to an individual's risk factors. Guideline-directed medical therapy (GDMT) for systolic heart failure should be employed in these patients. While limited randomized data exist, observational data and post hoc analyses suggest that GDMT, including renin angiotensin aldosterone system inhibitors, is associated with improved cardiovascular outcomes and can be safely initiated at low doses with close monitoring of kidney function in this population. Volume status is typically managed through ultrafiltration, so close communication between cardiology and nephrology is necessary to achieve a patient's optimal dry weight and mitigate intradialytic hypotension. Patient education and engagement regarding sodium and fluid restriction is crucial, and symptom burden should be reassessed following changes to the dialysis regimen.

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Insulin resistance underlies the elevated cardiovascular risk associated with kidney disease and glomerular hyperfiltration
María M. Adeva-Andany, Carlos Fernández-Fernández, Natalia Carneiro-Freire, Elvira Castro-Quintela, Ana Pedre-Piñeiro, Mónica Seco-Filgueira
Reviews in Cardiovascular Medicine    2020, 21 (1): 41-56.   DOI: 10.31083/j.rcm.2020.01.5102
Abstract508)   HTML42)    PDF(pc) (320KB)(908)       Save

The curve that describes the relationship between glomerular filtration rate (GFR) and cardiovascular risk is U-shaped, indicating that both reduced GFR (kidney failure) and elevated GFR (glomerular hyperfiltration) are equivalent cardiovascular risk factors. The elevated cardiovascular risk associated with abnormal GFR is not explained by standard cardiovascular risk factors. The relationship between GFR and all-cause mortality follows a similar pattern, so that altered GFR (either low or high) increases the risk for overall mortality. Glomerular hyperfiltration is an adaptive process that arises under conditions that demand improved kidney excretory capacity, such as animal protein ingestion and kidney failure. Unlike vegetable protein, animal protein consumption increases dietary acid load and requires an elevation of the GFR to restore acid-base balance. The loss of functioning nephrons in diseased kidneys requires a compensatory increase of the GFR in the nephrons that remain working to enhance whole-kidney GFR. A major factor that raises GFR is the pancreatic hormone glucagon. Glucagon infusion and endogenous glucagon release increase GFR in healthy subjects and patients with kidney failure. In addition to its kidney hemodynamic effect, glucagon causes insulin resistance. Like hyperglucagonemia, insulin resistance develops across the entire spectrum of abnormal GFR, from glomerular hyperfiltration to advanced kidney disease. Insulin resistance is associated with subclinical vascular injury in the general population and patients with diabetes and kidney failure, being a strong cardiovascular risk factor in these population groups. Animal protein consumption activates glucagon secretion and promotes insulin resistance, having a detrimental effect on cardiovascular disease and renal outcomes.

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High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond
Anthony (Ming-yu) Chuang, Mau T Nguyen, Woon-Man Kung, Sam Lehman, Derek P Chew
Reviews in Cardiovascular Medicine    2020, 21 (2): 191-203.   DOI: 10.31083/j.rcm.2020.02.17
Abstract903)   HTML125)    PDF(pc) (1018KB)(1863)       Save
Acute myocardial infarction (MI) represents one of the most common hospital encounters, with significant short-term and long-term morbidity and mortality, and frequently occurs in patients with chronic kidney disease (CKD). Cardiac troponin is an exquisitely sensitive biomarker for myocardial injury and plays an essential role in the diagnosis, risk-stratification, and management of MI. In 2017, the United States Food and Drug Administration approved Roche Diagnostics' 5th generation high-sensitivity cardiac troponin (hs-cTn) for clinical use. Whilst the improved analytical sensitivity of these new high-sensitivity troponin assays facilitate early diagnosis of MI, it also frequently identifies troponin elevations above the conventional reference threshold in the context of non-coronary conditions such as renal dysfunction, and can represent a major diagnostic challenge to clinicians. Furthermore, the optimal management strategy of patients with troponin elevation and high comorbidity burden, a common issue in patients with CKD, remains undefined. In recent years, there has been substantial research and progress undertaken in this rapidly evolving area. In this review, we aim to provide clinicians with an overview of hs-cTn in the setting of CKD as well as an update on its application and the particular considerations involved in the management of myocardial infarction, stable coronary artery disease and myocardial injury in this high risk population.
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Accelerated and intensified calcific atherosclerosis and microvascular dysfunction in patients with chronic kidney disease
Meer Fakhry, Mandeep S. Sidhu, Sripal Bangalore, Roy O. Mathew
Reviews in Cardiovascular Medicine    2020, 21 (2): 157-162.   DOI: 10.31083/j.rcm.2020.02.99
Abstract630)   HTML47)    PDF(pc) (629KB)(1432)       Save
Cardiovascular disease, and in particular coronary artery disease (CAD), remains an important contributor of morbidity and mortality among patients with chronic kidney disease (CKD). Classic symptomatology of CAD and effectiveness of established therapeutic measures is less frequent in patients with CKD. This suggests unique characteristics of CAD among patients with CKD. Two important features of CAD in CKD include increased calcific density of atherosclerotic plaques and of the vessels themselves (coronary artery calcification –– CAC), as well as a decrease in microcirculatory function –– or coronary microcirculatory dysfunction. A multitude of pathophysiologic pathways have been identified that contribute to CAC in CKD; less is known about the pathophysiology of microcirculatory dysfunction. It is not well established if these two processes are directly related to each other, but the combination results in a greater severity of effect on overall myocardial function and may in part explain the greater preponderance of silent myocardial infarction. Further investigation is needed to better understand these unique aspects of CAD in CKD as well as the role they play in overall CVD in this group, and ultimately therapeutics that may lessen the burden of disease.
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