• Left ventricular ejection fraction
• left ventricular end-diastolic diameter
• mortality
• peritoneal dialysis

• Humans
• Female
• Male
• Retrospective Studies
• Peritoneal Dialysis
• Middle Aged
• Stroke Volume
• Kidney Failure, Chronic/therapy
• Kidney Failure, Chronic/mortality
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/physiopathology
• Ventricular Dysfunction, Left/physiopathology
• Ventricular Dysfunction, Left/etiology
• Ventricular Dysfunction, Left/mortality
• Aged
• Prognosis
• China/epidemiology
• Heart Ventricles/diagnostic imaging
• Heart Ventricles/physiopathology
• Adult
• Ventricular Function, Left
• Risk Factors

• cardiac magnetic resonance imaging
• end‐stage renal disease
• left ventricular phenotype
• native T1/T2 mapping

• Humans
• Male
• Female
• Peritoneal Dialysis
• Middle Aged
• Prospective Studies
• Kidney Failure, Chronic/diagnostic imaging
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/therapy
• Hypertrophy, Left Ventricular/diagnostic imaging
• Hypertrophy, Left Ventricular/physiopathology
• Adult
• Heart Ventricles/diagnostic imaging
• Ventricular Remodeling/physiology
• Multiparametric Magnetic Resonance Imaging
• Phenotype
• Myocardium/pathology
• Magnetic Resonance Imaging, Cine/methods
• Aged

• 82171918 National Natural Science Foundation of China

Acute kidney injury (AKI) is a common disorder in critically ill hospitalized patients. Its main pathological feature is the activation of the sympathetic nervous system and the renin-angiotensin system (RAS). This disease shows a high fatality rate. The reason is that only renal replacement therapy and supportive care can reduce the impact of the disease, but those measures cannot significantly improve the mortality. This review focused on a generalization of the interaction between acute kidney injury and the central nervous system (CNS). It was found that the CNS further contributes to kidney injury by regulating sympathetic outflow and oxidative stress in response to activation of the RAS and increased pro-inflammatory factors. Experimental studies suggested that inhibiting sympathetic activity and RAS activation in the CNS and blocking oxidative stress could effectively reduce the damage caused by AKI. Therefore, it is of significant interest to specify the mechanism on how the CNS affects AKI, as we could use such mechanism as a target for clinical interventions to further reduce the mortality and improve the complications of AKI.

Systematic Review Registration: [www.ClinicalTrials.gov], identifier [registration number].

• Acute Kidney Injury/epidemiology
• Aged
• Aged, 80 and over
• Case-Control Studies
• Cohort Studies
• Female
• Heart Failure/epidemiology
• Hospitalization/statistics & numerical data
• Humans
• Male
• Middle Aged
• Mortality
• Myocardial Infarction/epidemiology
• Non-ST Elevated Myocardial Infarction/epidemiology
• Renal Insufficiency, Chronic/epidemiology
• Retrospective Studies
• Risk Factors
• ST Elevation Myocardial Infarction/epidemiology

• Angiographic scoring
• Clinical variables
• Coronary artery disease
• Prognosis

• Cardiovascular magnetic resonance
• End stage renal disease
• Native T1 mapping
• Secondary hyperparathyroidism

• Adult
• Aged
• Biomarkers/blood
• Case-Control Studies
• Female
• Heart Diseases/diagnostic imaging
• Heart Diseases/etiology
• Heart Diseases/pathology
• Heart Diseases/physiopathology
• Humans
• Hyperparathyroidism, Secondary/blood
• Hyperparathyroidism, Secondary/diagnosis
• Hyperparathyroidism, Secondary/etiology
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/diagnosis
• Kidney Failure, Chronic/therapy
• Magnetic Resonance Imaging, Cine
• Male
• Middle Aged
• Myocardium/pathology
• Parathyroid Hormone/blood
• Predictive Value of Tests
• Prospective Studies
• Renal Dialysis/adverse effects
• Risk Assessment
• Risk Factors
• Stroke Volume
• Time Factors
• Treatment Outcome
• Up-Regulation
• Ventricular Function, Left

• The National Natural Science Foundation of China
• Universal Application Project of Health Commission of Sichuan Province

Cardiovascular diseases (CVDs) are the main cause of death in patients with chronic kidney disease (CKD). Interleukin-4 (IL-4) is considered an inflammatory cytokine. However, few studies have investigated the association between serum IL-4 and cardiovascular events in CKD. This study investigated whether serum IL-4 levels were associated with an increased risk of cardiovascular (CV) events in patients with CKD.

A total of 302 patients with stage 1–5 CKD were followed up for a mean of 32 (range=4–36) months for end points (CV events). Serum IL-4 levels were measured at baseline. The independent relationship between serum IL-4 and the risk of CV events was assessed with multivariate Cox regression analysis.

The average age of this cohort (N=302) was 65.4 years. A total of 69.9% of them were male. CV events numbered 41 (13.6%) during the follow-up period. The Kaplan–Meier analysis showed that the rate of CV events was higher in patients with CKD with IL-4 levels above the mean (126.2 pg/mL) than in those with IL-4 levels below the mean. The multivariate Cox proportional hazard analysis revealed that serum IL-4 (HR=1.650, 95% CI 1.266–2.210, P<0.001) was associated with CV events in these patients with CKD. Sensitivity analysis showed that the association between serum IL-4 and CV events was not affected by the use of anti-inflammatory medication. The significant association between higher IL-4 levels and increased risk of CV events existed in patients with CKD3-5 but not in patients with CKD1-2 by using the stratified analysis.

Higher serum IL-4 levels were associated with an increased risk of CV events during follow-up. Elevated serum IL-4 levels may help clinicians predict early CV events in patients with CKD.

• Cox regression
• cardiovascular event
• chronic kidney disease
• interleukin-4
• prognosis

• NT-proBNP
• acute coronary syndromes
• biomarkers
• chronic kidney disease
• echocardiography

• Cardiomyopathy
• Inflammation
• Myocardial infarction
• Remodeling
• Valvular diseases

• Left ventricular end-diastolic volume
• Peritoneal dialysis
• Serum apolipoprotein B

The impact of Cockroft-Gault (C-G) derived estimated glomerular filtration rate (eGFR) on mortality and major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) was assessed.

A total of 884 patients were classified into four categories according to admission creatine derived eGFR: < 60, 60 - < 90, 90 - < 120, and ≥ 120 mL/min/1.73 m².

In-hospital and long-term MACEs were significantly higher in eGFR < 60 mL/min/1.73 m² subgroup (P < 0.001 and P = 0.028). Multivariate analysis demonstrated 7.78-fold (95% CI: 0.91 - 66.8) higher mortality risk in eGFR < 60 mL/min/1.73 m² subgroup.

As an easily applicable bedside method, C-G derived eGFR could be important for prediction of in-hospital and long-term mortality and MACE in STEMI patients undergoing primary PCI.

• Cockcroft-Gault
• Estimated glomerular filtration rate
• Major adverse cardiac events
• Mortality
• ST-segment elevation myocardial infarction

Numerous previous studies have shown that renal insufficiency (RI) in patients with acute coronary syndrome is associated with poor cardiovascular outcomes. These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction (STEMI) in China. The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.

This was a multicenter, observational, prospective-cohort study. 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI, between January 1,2006 and December 31,2006. Estimation of glomerular filtration rate (eGFR) was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients. The patients were categorized according to eGFR, as normal renal dysfunction (eGFR ≥ 90 ml∙min^-1∙1.73 m^-2), mild RI (60 ml∙min^-1∙1.73 m^-2 ≤ eGFR < 90 ml∙min^-1∙1.73 m^-2) and moderate or severe RI (eGFR < 60 ml∙min^-1∙1.73 m^-2). The association between RI and inhospital and 6-year mortality of was evaluated.

Seven hundred and eighteen patients with STEMI were evaluated. There were 551 men and 167 women with a mean age of 61.0 ± 13.0 years. Two hundred and eighty patients (39.0%) had RI, in which 61 patients (8.5%) reached the level of moderate or severe RI. Patients with RI were more often female, elderly, hypertensive, and more patients had heart failure and stroke with higher killip class. Patients with RI were less likely to present with chest pain. The inhospital mortality (1.4% vs. 5.9% vs. 22.9%, P < 0.001), 6-year all-cause mortality (9.5% vs. 19.8 vs. 45.2%, P < 0.001) and 6-year cardiac mortality (2.9% vs. 12.2% vs. 23.8%, P < 0.001) were markedly increased in patients with RI. After adjusting for other confounding factors, classification of admission renal function was an independent predictor of inhospital mortality (Odd ratio, 1.966; 95% confidence interval [CI], 1.002-3.070, P = 0.019), 6-year all-cause mortality (relative risk [RR] = 1.501, 95% CI: 1.018-4.373, P = 0.039) and 6-year cardiac mortality (RR = 1.663, 95% CI: 1.122-4.617, P = 0.042).

RI is very common in STEMI patients. RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.

• Acute coronary syndrome
• Bleeding
• Chronic kidney disease
• Mortality

to explore the impact of admission serum creatinine concentration on the in-hospital mortality and its interaction with age and gender in patients with acute ST-segment elevation myocardial infarction (STEMI) in China.

1424 acute STEMI patients were enrolled in the study. Anthropometric and laboratory measurements were collected from every patient. A Cox proportional hazards regression model was used to determine the relationships between the admission serum creatinine level (Cr level), age, sex and the in-hospital mortality. A crossover analysis and a stratified analysis were used to determine the combined impact of Cr levels with age and gender.

Female (HR 1.687, 95%CI 1.051∼2.708), elevated Cr level (HR 5.922, 95%CI 3.780∼9,279) and old age (1.692, 95%CI 1.402∼2.403) were associated with a high risk of death respectively. After adjusting for other confounders, the renal dysfunction was still independently associated with a higher risk of death (HR 2.48, 95% CI 1.32∼4.63), while female gender (HR 1.19, 95%CI 0.62∼2.29) and old age (HR 1.77, 95%CI 0.92∼3.37) was not. In addition, crossover analysis revealed synergistic effects between elevated Cr level and female gender (SI = 3.01, SIM = 2.10, AP = 0.55). Stratified analysis showed that the impact of renal dysfunction on in-hospital mortality was more pronounced in patients <60 years old (odds ratios 11.10, 95% CI 3.72 to 33.14) compared with patients 60 to 74 years old (odds ratios 5.18, 95% CI 2.48∼10.83) and patients ≥75years old (odds ratios 3.99, 95% CI 1.89 to 8.42).

Serum Cr concentration on admission was a strong predictor for in-hospital mortality among Chinese acute STEMI patients especially in the young and the female.

• and oxidative stress
• cardiac function
• exercise
• kidney disease
• nitric oxide

• acute myocardial infarction
• glomerular filtration rate
• left ventricle remodeling
• renal insufficiency
• tissue Doppler

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes (ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.

• Chronic kidney disease
• Acute coronary syndromes
• Non-ST-elevation myocardial infarction
• ST-elevation myocardial infarction
• Percutaneous coronary intervention
• Renal insufficiency