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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Definition Diabetic nephropathy is a chronic kidney complication that results from prolonged hyperglycemia.Prevalence It is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, affecting up to half of individuals with diabetes.Pathophysiology • Sustained hyperglycemia triggers multiple hemodynamic and metabolic changes in the kidney. • Early in the disease, increased renal blood flow and glomerular hyperfiltration...
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The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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PathophysiologyType 2 diabetes mellitus (T2DM ) is a chronic metabolic disorder characterized by insulin resistance and progressive pancreatic β-cell dysfunction, leading to impaired glucose homeostasis. It results from interactions among genetic predisposition, environmental factors, and metabolic stressors, such as overnutrition and a sedentary lifestyle.Insulin Resistance and Glucose DysregulationEarly T2DM involves insulin resistance in skeletal muscle, adipose tissue, and the liver.
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Beyond Traditional Silos: An Integrated Framework Leveraging Novel Pathways for Reducing Cardio-renal Risk in Type 2

Hani M Sabbour1, Mohamad Hassanein2,3, Mohamed Farghaly4

  • 1Department of Cardiology, Mediclinic Hospital, Abu Dhabi, UAE.

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Summary

Diabetes and chronic kidney disease (CKD) significantly increase cardiovascular disease risk. Experts identified treatment gaps for managing these interconnected conditions in the Middle East.

Keywords:
Chronic kidney diseasecardiovascular diseasediabetes mellitusfinerenonemineralocorticoid receptor antagonistrenin-angiotensin systemsodium-glucose co-transporter-2 inhibitors

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Area of Science:

  • Cardiology
  • Nephrology
  • Diabetology

Background:

  • Diabetes mellitus is a primary driver of chronic kidney disease (CKD) progression, increasing end-stage renal disease risk.
  • CKD patients face heightened cardiovascular disease (CVD) risks, including coronary artery disease, heart failure, and arrhythmias, due to the cardiorenal connection.

Purpose of the Study:

  • To review the epidemiology, pathophysiology, diagnosis, and treatment of CKD in diabetic patients.
  • To identify treatment gaps and unmet needs for managing the cardiorenal connection in the Middle East.
  • To discuss the roles of clinical specialties in simplifying patient journeys.

Main Methods:

  • An online expert panel of cardiologists, nephrologists, and diabetologists convened in November 2021.
  • A comprehensive review of current literature on diabetes, CKD, and CVD was conducted.
  • Discussion focused on treatment options to reduce morbidity and mortality in high-risk populations.

Main Results:

  • Diabetes significantly accelerates kidney function decline and is linked to increased CVD risk.
  • The cardiorenal connection exacerbates complications in patients with diabetes and CKD.
  • Identified treatment gaps require multidisciplinary approaches for optimal patient care.

Conclusions:

  • Integrated management strategies are crucial for patients with diabetes, CKD, and CVD.
  • Simplifying the patient journey through coordinated care can improve outcomes.
  • Addressing unmet needs in the Middle East requires a focus on the cardiorenal nexus.