Introduction: Pathophysiological interaction between the heart and kidneys represents the basis for clinical entities called cardiorenal syndromes. The purpose of the study was to assess the relations between acute and chronic cardiorenal syndromes and biomarkers [advanced oxidation protein products, brain natriuretic peptide, malondialdehyde, xanthine oxidoreductase (XOD), xanthine oxidase, xanthine dehydrogenase, interleukin 8, cystatin C, plasminogen activator inhibitor-1, high-sensitive troponin T, C-reactive protein and glomerular filtration rate, measured by the Modification of Diet in Renal Disease (MDRD) formula], to hypothesize biomarkers that might provide a prompt identification of acute or chronic cardiorenal syndromes, and to distinguish acute versus chronic types of these syndromes. Methods: A total of 114 participants were enrolled in this study, i.e. 79 patients divided into subgroups of acute and chronic cardiorenal syndromes and 35 volunteers. Results: Nonadjusted odds ratio (OR) showed that there was a significant risk for acute cardiorenal syndrome with increased XOD activity (p = 0.037), elevated cystatin C concentration (p = 0.038) and MDRD (p = 0.028). Multivariable adjusted OR, on the other hand, revealed that only glomerular filtration rate measured by the MDRD formula had a significance for acute cardiorenal syndrome (p = 0.046). Nonadjusted OR showed a significant risk for chronic cardiorenal syndrome only in elderly (p = 0.002). Multivariable adjusted OR exhibited that age was the only risk factor for chronic cardiorenal syndrome (p = 0.012). Conclusion: Cystatin C, glomerular filtration rate measured by the MDRD equation and XOD were independent risk factors for acute cardiorenal syndrome, while age remained an independent risk factor for chronic cardiorenal syndrome. When comparing ORs of evaluated parameters, the highest significance for acute cardiorenal syndrome was plasma concentration of cystatin C.

Chronic renal failure (CRF) is a condition associated with the risk of cardiovascular complications. Systemic inflammatory response, initiated by the pathogen-associated molecular-pattern (PAMP) molecules, exerts many similarities with the damage-associated molecular-pattern (DAMP) molecule-induced systemic response. Up to now, a number of DAMP molecules were identified. We hypothesized that the available circulating nucleic acids, acting as DAMPs, may modulate immunoinflammatory reaction in CRF. Patients with the different stages of chronic kidney disease, kidney transplantation, and patients on dialysis were included in the study. Obtained results about higher concentration of circulating ribonucleic acid (RNA), according to the stages of kidney diseases, may contribute to the hypothesis that damaged kidney tissue releases nucleic acids. Circulating RNAs expressed maximal absorbance peak at 270 nm in spectrophotometric scan analysis, which corresponded to polyC, compared to different standard samples. During in vitro conditions, by using the culture of human residential macrophages, circulating RNA isolated from patients with IV-V-stage renal diseases, patients on hemodialysis, and patients who underwent renal transplantation were able to significantly change signal transduction proteins related to inflammation and antiviral response. They significantly increased the intracellular concentration of active nuclear transcription factor nuclear factor kappa B (NF-kB), interferon regulatory factors (IRF)-3, and IRF-7 and significantly decreased melanoma differentiation-associated protein-5 (MDA-5) and p38. In this way, it seems that circulating RNA, acting as DAMP, may contribute to the mechanisms of additional inflammatory reaction, possible immune destruction, and decreased antiviral response, related to complications in kidney diseases.

Aim. To determine levels of interleukin-8 (IL-8) and plasminogen activator inhibitor-1 (PAI-1) in different cardiorenal syndrome (CRS) modalities and to compare findings to some already investigated direct and indirect parameters of inflammation and atherosclerosis. Materials and Methods. Testing involved 114 examinees, divided into control and clinical groups suffering from different modalities and were formed according to the basis of a valid classification for CRS. Results. C-reactive protein (CRP) was significantly higher in all CRSs in comparison to the control group (P < 0.05). PAI-1 in CRSs was statistically higher than in the control group. IL-8 was increased in all CRSs, and especially in CRS-5, where no significance was found. PAI-1 correlated with IL-8 in all CRSs, with significant value in CRS-2 and CRS-5. Correlation for PAI-1 and high-density lipoproteins (HDL) was found in CRS-4, while IL-8 was found to be related to CRP level in all CRSs, with significance only in CRS-1 (P < 0.001). Conclusions. C-reactive protein, IL-8, and PAI-1 could be useful for clinical differentiation of chronic modalities of CRSs. Inflammation was the most pronounced in CRS-4. Lipid status parameters could be useful for differentiation of CRSs. Furthermore, HDL in chronic primary kidney diseases and triglycerides and total cholesterol in CRS-5 could be valuable.

Background and Aims Potassium excretion is a secretory phenomenon and levels are often abnormal in patients with heart failure. An abnormal sodium serum level is the most common electrolyte disorder and independent predictor of readmission for heart failure and post discharge death. Since different factors could affect balance of Potassium in Cardiorenal syndrome, in this study soft computing was used to predict most important factors for the detection of the severity of systolic heart failure by ejection fraction (EF), and a subclinical phase of the cardiorenal disease by EPI creatinine-cystatin C formula (Chronic Kidney Disease Epidemiology Collaboration). Method The balance of potassium in Cardiorenal syndrome is analyzed by soft computing approach namely adaptive neuro fuzzy inference system or ANFIS. Results The clinical group consisted of 79 patients, 40 of whom were men (50.63%) and 39 of whom were women (49.37%), in the average age of 70.72 ± 9.26 years. After comparing serum electrolytes (Na+, K+) did not differ significantly in the clinical group from those of the control group. The tested biomarkers showed significantly higher values in the clinical group than in the control group: BNP (p&lt;0.001), cystatin C (p&lt;0.001). Figures 1 and 2 shows flowcharts of the used inputs and outputs and how they are implemented in the ANFIS networks. There are two ANFIS networks since there are two outputs. ANFIS networks shold determine which input has the strongest influence on the given outputs nased on root mean squre errors or prediciton accuracy.Based on the training error (trn) one can determine the inputs influence on the given output. Checking error (chk) is used to track the results validity. In other words the checking errors could track training error. It was found that BNP (pg/mL) has the most influence on the - EPI creatinine-cystatin C formula. Serum sodium (Na) has the most influence on the ejection fraction (EF). Conclusion Serum sodium-potassium disturbances are associated with advanced heart failure and reduced prognosis. ANFIS is suitable for nonlinear systems with highly redundant data. Although there are encouraging advances around this unsolved clinical problem, further investigation should consider the progressive inclusion of patients with advanced renal impairment to allow a better understanding of cardiorenal syndrome. The result of our research shows that if the values of BNP and Na significantly deviate from normal values, it is expected that EPI creatinine-cystatin C formula and EF indicate impaired organ function and that such patients are candidates for hospital treatment.

Background and Aims Renal function is important in congestive heart failure syndrome because existing or secondary-induced renal weakness contributes to the worsening and progression of heart failure. Decreased ejection fraction in acute heart failure leads to more acute kidney damage compared to patients with preserved ejection fraction. Also, heart failure with a drop in the ejection fraction of the left ventricle is not a dominant characteristic of patients with cardiorenal syndrome type 2. A significant risk factor in the first type of cardiorenal syndrome is, among others, age and diabetes. The prevalence of heart failure with preserved ejection fraction and increased left ventricular mass is higher in the elderly. The aim of the work is how to differentiate and which factors predispose the occurrence of the first and second types of primary cardiorenal syndrome. Method 42 subjects, 24 men and 18 women, with an average age of 70.72±9.26 years, with a diagnosis of worsening heart function that led to kidney dysfunction, were analyzed. The first type of cardiorenal syndrome accounted for 57.14% and the second type of cardiorenal syndrome accounted for 42.86%. The study was designed as a cross-sectional comparative study, and the main criterion for the inclusion of subjects was the existence of a new or previously diagnosed clinically manifest cardiovascular disease. Continuous variables are presented with mean values, standard deviations and medians, and categorical variables with frequencies and percentages. The normality of the distribution of continuous variables was determined by the Shapiro-Wilk test. Depending on the normality of the distribution of continuous variables, the comparison of continuous variables between two groups was performed by the student's t-test of unknown samples in the case of normality, or by the Mann-Whitney test in the case that the distribution deviates from normality. Determining the difference in the representation of categorical variable modalities between groups was determined by the chi-squared test. Values of p&lt;0.05 were considered statistically significant. Results Based on everything is done, the following was determined as statistically significant:Patients with CRS2 are statistically significantly older than patients with CRS1 (p&lt;0.05, Student's t-test of independent samples), and they also have a statistically significantly higher value of HDL-C (p&lt;0.05).Patients with diabetes (p = 0.0488) and with sinus rhythm (p = 0.0442) were statistically significantly more represented in patients with CRS1.Patients with CRS1 had statistically significantly higher values of serum urea and serum creatinine compared to patients with CRS2 (p&lt;0.05, Mann-Whitney test).In patients with CRS2, the value of AOPP was statistically significantly higher than in patients with CRS1 (p&lt;0.01, Student's t-test of independent samples). Conclusion The results obtained in our study are related to the assessment of the functional state of the heart and kidneys in primary cardiorenal syndrome type one and two in which the main predisposing factors are age, diabetes and reduction of renal function. By correlation analysis in the second type of cardiorenal syndrome, HDL-C particles were significantly elevated. Although the values of nitrogen products were lower in the second type of cardiorenal syndrome, AOPP stood out as statistically significant in the lower functional class.