Diabetic nephropathy patients traditionally show significant macroalbuminuria prior to the development of renal impairment. However, this clinical paradigm has recently been questioned. Epidemiological surveys confirm that chronic kidney disease (CKD) diagnosed by a low glomerular filtration rate (GFR) is more common in diabetic patients than in the non-diabetic population but a low number of patients had levels of proteinuria above that which traditionally defines overt diabetic nephropathy (>500 mg/g). The large number of patients with low levels of proteinuria suggests that the traditional clinical paradigm of overt diabetic nephropathy is changing since it does not seem to be the underlying renal lesion in most of diabetic subjects with CKD.

No abstract

No abstract

No abstract

Background and Aims: Anemia is a common complication of heart failure and chronic kidney disease (CKD). Sacubitril-valsartan is a novel therapy for the treatment of chronic heart failure with a reduced ejection fraction (HFrEF). We have evaluated the short-term effects of sacubitril-valsartan on the anemia of CRS. Methods: The study group comprised 39 patients with HFrEF, who were followed-up for three months. The study is a retrospective analysis of clinical data. Data of 3 months’ visit and baseline visit were recorded including: plasmatic creatinine, glomerular filtration rate, cystatin C, kaliemia, haemoglobin, pro-BNP and albuminuria. Results: In all, 34 patients ended the follow-up. Mean sacubitril-valsartan dosage at baseline was 101±62 mg/day and 126±59 mg/day at end. Mean hemoglobin increased from 12.2±1.1 g/dl at baseline to 12.9±1.0 g/dl (p = 0.001,). Prevalence of anemia was 64.7% (95%CI,47.9-78.5%) at baseline and 38.4 (95%CI,23.9-55.0%) after the follow-up (p = 0.016). Serum cystatin C levels decreased from 2.71±1.0 to 2.48±1.0 mg/l (p = 0.028). Serum K levels remained unchanged (baseline 4.94±0.60, three months visit 4.94±0.61 mmol/l, p = 0.998). Conclusions: Sacubitril-valsartan improves anemia in CRS patients. An improvement of serum cystatin levels was observed. Few untoward effects were detected. These findings should be confirmed in wider clinical trials.