Background: A bidirectional kidney–gut axis was described in patients with chronic kidney disease (CKD). On the one hand, gut dysbiosis could promote CKD progression, but on the other hand, studies reported specific gut microbiota alterations linked to CKD. Therefore, we aimed to systematically review the literature on gut microbiota composition in CKD patients, including those with advanced CKD stages and end-stage kidney disease (ESKD), possibilities to shift gut microbiota, and its impact on clinical outcomes. Materials and methods: We performed a literature search in MEDLINE, Embase, Scopus, and Cochrane databases to find eligible studies using pre-specified keywords. Additionally, key inclusion and exclusion criteria were pre-defined to guide the eligibility assessment. Results: We retrieved 69 eligible studies which met all inclusion criteria and were analyzed in the present systematic review. Microbiota diversity was decreased in CKD patients as compared to healthy individuals. Ruminococcus and Roseburia had good power to discriminate between CKD patients and healthy controls (AUC = 0.771 and AUC = 0.803, respectively). Roseburia abundance was consistently decreased in CKD patients, especially in those with ESKD (p < 0.001). A model based on 25 microbiota dissimilarities had an excellent predictive power for diabetic nephropathy (AUC = 0.972). Several microbiota patterns were observed in deceased ESKD patients as compared to the survivor group (increased Lactobacillus, Yersinia, and decreased Bacteroides and Phascolarctobacterium levels). Additionally, gut dysbiosis was associated with peritonitis and enhanced inflammatory activity. In addition, some studies documented a beneficial effect on gut flora composition attributed to synbiotic and probiotic therapies. Large randomized clinical trials are required to investigate the impact of different microbiota modulation strategies on gut microflora composition and subsequent clinical outcomes. Conclusions: Patients with CKD had an altered gut microbiome profile, even at early disease stages. Different abundance at genera and species levels could be used in clinical models to discriminate between healthy individuals and patients with CKD. ESKD patients with an increased mortality risk could be identified through gut microbiota analysis. Modulation therapy studies are warranted.

Psychological stress is a well-established risk factor for cardiovascular disease (CVD). Heart rate variability (HRV)-biofeedback could significantly reduce stress levels and improve autonomic nervous system function and cardiovascular endpoints. We aimed to systematically review the literature to investigate the impact of HRV modulation through HRV-biofeedback on clinical outcomes in patients with CVD. A literature search was performed in the following databases: MEDLINE (PubMed), Embase, and Cochrane from the inception until 1 October 2021. Patients in the HRV-biofeedback group had significantly lower rates of all-cause readmissions than patients who received psychological education (respectively, p = 0.028 and p = 0.001). Heart failure following HRV-biofeedback displayed an inverse association with stress and depression (respectively, p = 0.022 and p = 0.033). When stratified according to left ventricular ejection fraction (LVEF), patients with LVEF ≥ 31% showed improved values of the 6 min walk test after HRV-biofeedback interventions (p = 0.05). A reduction in systolic and diastolic blood pressure associated with HRV-biofeedback was observed (p < 0.01) in pre-hypertensive patients. HRV-biofeedback had beneficial effects on different cardiovascular diseases documented in clinical trials, such as arterial hypertension, heart failure, and coronary artery disease. A standard breathing protocol should be applied in future studies to obtain equivalent results and outcomes. However, data regarding mortality in patients with coronary artery disease are scarce and need further research.

Background and objectives: Ischemic heart disease represents the leading cause of death, emphasizing risk stratification and early therapeutic intervention. Heart rate variability (HRV), an indirect marker of autonomic nervous system activity, was investigated extensively as a risk factor for adverse cardiovascular events following acute myocardial infarction. Thus, we systematically reviewed the literature to investigate the association of HRV parameters with mortality and adverse cardiovascular events in patients presenting with ST-elevation myocardial infarction (STEMI). Materials and methods: Following the search process in the MEDLINE (PubMed), Embase, and Cochrane databases, nine studies were included in the final analysis. Results: Lower time-domain HRV parameters and a higher ratio between power in the low-frequency (LF) band and power in the high-frequency (HF) band (LF/HF) were associated with higher all-cause mortality during follow-up, even in patients treated mainly with percutaneous coronary interventions (PCI). Although most studies measured HRV on 24 h ECG recordings, short- and ultra-short-term measures (1 min and 10 s, respectively) were also associated with an increased risk of all-cause mortality. Although data were discrepant, some studies found an association between HRV and cardiac mortality, reinfarction, and other major adverse cardiovascular events. Conclusions: In conclusion, HRV measurement in patients with STEMI could bring crucial prognostic information, as it was associated with an increased risk of all-cause mortality documented in clinical studies. More and larger clinical trials are required to validate these findings in contemporary patients with STEMI in the context of the new generation of drug-eluting stents and current antithrombotic and risk-modifying therapies.

Background/Objectives: Chronic kidney disease (CKD) progression is strongly influenced by systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR), derived from routine blood counts, reflects the balance between innate and adaptive immunity and has been proposed as a marker of adverse renal outcomes. We hypothesized that elevated baseline NLR is associated with reduced kidney function and increased risk of progression to end-stage kidney disease (ESKD) in adults with non-dialysis CKD. Methods: Following PRISMA guidelines, we systematically searched MEDLINE, Embase, and Scopus for studies enrolling adults with CKD stages 1–4 that reported renal outcomes according to baseline NLR. The primary outcome was progression to ESKD or renal replacement therapy (RRT) initiation. Results: Six eligible studies were identified, of which four provided sufficient data for meta-analysis. Across cohorts, elevated baseline NLR was consistently associated with adverse renal outcomes. In pooled analyses, high NLR nearly doubled the risk of ESKD or RRT (RR 1.96, 95% CI 1.30–2.97). Leave-one-out sensitivity analysis strengthened the association while reducing heterogeneity. For kidney function, higher NLR was associated with lower baseline eGFR (SMD −1.59, 95% CI −2.38 to −0.80). Conclusions: Elevated NLR is a robust prognostic marker of renal function decline and progression to ESKD or RRT in non-dialysis CKD. As a simple and inexpensive biomarker, NLR offers additional predictive value beyond eGFR and albuminuria. Incorporating NLR into risk models may refine stratification, guide follow-up, and enable earlier therapeutic optimization. Prospective large studies are warranted to establish thresholds and validate its role in clinical practice.

Hypertension remains a critical global health challenge, significantly contributing to cardiovascular morbidity and mortality despite advancements in treatment. The 2024 ESC hypertension guidelines address persistent gaps in hypertension management by emphasizing comprehensive strategies encompassing early detection, socioeconomic barriers, lifestyle interventions, and personalized care. Enhanced screening protocols, including home and ambulatory blood pressure monitoring, aim for accurate diagnosis and risk stratification. Lifestyle recommendations now prioritize reducing sodium intake, increasing potassium consumption, and integrating tailored exercise regimens. Pharmacological updates advocate for single-pill combinations and stringent BP targets (<130/80 mmHg), emphasizing the benefits of sodium-glucose cotransporter-2 inhibitors for specific comorbidities. Minimally invasive therapies like renal denervation are explored for resistant hypertension, while digital tools such as telehealth and mobile applications enhance patient engagement and adherence. This multifaceted, patient-centered approach provides a roadmap for optimizing BP control, reducing cardiovascular risks, and addressing the complexities of hypertension in diverse populations.

The potential benefit of ferritin evaluation resides in its association with adverse outcomes in patients with various pathological conditions. We aimed to conduct the first systematic review evaluating the association between ferritin levels and adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI) during short- or long-term follow-up. Seven studies investigating various endpoints (mortality, major adverse cardiovascular events-MACE, the decline of the left ventricular ejection fraction-LVEF, left ventricular aneurysm development-LVA) were included. AMI patients with low or increased ferritin values tended to have higher in-hospital and 30-day mortality rates. Low and high ferritin levels and chronic kidney disease were independently associated with increased risk of LVA formation. High ferritin concentrations were linked to an accentuated LVEF decline in ST-elevation myocardial infarction patients treated by percutaneous coronary intervention. Both low and high ferritin values were also associated with the duration of hospitalization in patients with AMI during hospital stay and at more extended follow-up. Ferritin evaluation represents a simple investigation that could identify high-risk patients with AMI who might benefit from closer monitoring and specific therapeutic interventions. These data should be confirmed in large trials in the context of currently available therapies for heart failure and AMI.