Background: Acute kidney injury (AKI) is associated with increased risks of incidence or progression of chronic kidney disease (CKD), kidney failure (KF), or major adverse kidney events (MAKE), however, it remains unclear which individuals have higher risks. Hence, we systematically reviewed the literature to explore differences in kidney dysfunction risks between AKI stages, AKI durations, and clinical settings. Methods: We performed a systematic search in PubMed and Embase to identify studies that examined at least one outcome of interest in individuals with AKI versus without AKI, with a minimum follow-up of one year. Hazard/odds ratios (HR/OR) were pooled using random effects models. Heterogeneity across patient and disease characteristics was examined using subgroup and meta-regression analyses. Results: We searched 70 studies, encompassing 1 838 668 individuals, including 165 715 with AKI. All studies were of moderate to high quality. Individuals with AKI had higher risks of CKD incidence [AKI 25.8%/no AKI 8.7%; HR 2.36 [95% confidence interval (CI) 1.77–2.94)]], CKD progression [AKI 43.1%/no AKI 35.6%; HR 1.83 (95%CI 1.26–2.40)], KF [AKI 2.9%/no AKI 0.5%; HR 2.64 (95%CI 2.03–3.25)], and MAKE [AKI 59.0%/no AKI 32.7%; OR 2.77 (95%CI 2.01–3.53)]. The pooled effect estimates for CKD incidence after AKI lasting <3 days remained significant [OR 2.37 (95%CI 1.68–3.07)], even in individuals with AKI stage 1 only [HR 1.49 (95%CI 1.44–1.55)]. Diabetes mellitus, hypertension, requiring acute dialysis, cardiovascular surgery, or coronary artery disease were associated with higher CKD incidence or progression risks. Conclusions: Risks for kidney dysfunction were higher for all individuals with AKI. Risk estimates were heterogeneous between patient subgroups, based on AKI stage, AKI duration, and clinical setting, yet even individuals with the lowest stage or shortest duration of AKI remained at higher risk for CKD incidence or progression. This highlights the need to develop tailored follow-up strategies to recognize kidney function decline post-AKI and initiate kidney protective measures in a timely fashion.

Left ventricular diastolic dysfunction (LVDD) commonly coexists with kidney dysfunction. In this study, we investigated the presence of abnormalities in echocardiography parameters indicative of LVDD across stages of kidney function. Methods: We selected patients who visited a university hospital and had a serum creatinine and echocardiography reported in their medical records. Participants were categorized based on their kidney function: normal (estimated glomerular filtration rate [eGFR] ≥ 90 mL/min/1.73 m²), mildly decreased (eGFR: 60–90), moderately decreased (eGFR: 30–60), and severely decreased (eGFR < 30). The relationship between kidney function and echocardiography parameters was examined using logistic and linear regressions. Results: Among 4022 patients (age: 66.5 years [SD: 12.1], 41% women), 26%, 50%, 20%, and 4% had a normal, mildly, moderately, and severely decreased kidney function, respectively. Compared to patients with normal kidney function, patients with mildly decreased kidney function had higher odds for an abnormal E/e′ ratio (OR: 1.51 [95% CI: 1.13, 2.02]). Patients with moderately decreased kidney function presented a higher risk of abnormal E/e′ (OR: 2.90 [95% CI: 2.08, 4.04]), LAVI (OR: 1.62 [95% CI: 1.13, 2.33]), TR velocity (OR: 2.31 [95% CI: 1.49, 3.57]), and LVMI (OR: 1.70 [95% CI: 1.31, 2.20]), while patients with severely decreased kidney function had higher odds for abnormal E/e′ (OR: 2.95 [95% CI: 1.68, 5.17]) and LVMI > 95 g/m² in women or >115 g/m² in men (OR: 2.07 [95% CI: 1.27, 3.38]). The linear regression showed a significant inverse association between eGFR and echocardiography parameters, meaning that with worse kidney function, the parameters for LVDD worsened as well. Conclusions: Abnormal echocardiography parameters of LVDD were present even in patients with mildly decreased kidney function. As the kidney function worsened, there was a gradual increase in the risk of abnormal parameters of LVDD.

Background. Women with lower-extremity arterial disease (LEAD) are often underdiagnosed, present themselves with more advanced disease at diagnosis, and fare worse than men. Objective. To investigate to what extent potential gender differences exist in the frequency and reasons for general practitioner (GP) consultation six months prior to the diagnosis of LEAD, as potential indicators of diagnostic delay. Methods. Individuals older than 18 years diagnosed with LEAD, sampled from the Julius General Practitioner’s Network (JGPN), were included and compared with a reference population, matched (1:2.6 ratio) in terms of age, sex, and general practice. We applied a zero-inflated negative binomial (ZINB) regression model. Results. The study population comprised 4044 patients with LEAD (43.5% women) and 10,486 subjects in the reference population (46.3% women). In the LEAD cohort, the number of GP contacts was 2.70 (95% CI: 2.42, 3.02) in women and 2.54 (2.29, 2.82) in men. In the reference cohort, 1.77 (95% CI: 1.62, 1.94) in women and 1.63 (95% CI: 1.50, 1.78) in men. In the LEAD cohort, 21.9% of GP contacts occurred one month prior to diagnosis. In both cohorts and both sexes, the most common cause of consultation during the last month before the index date was cardiovascular problems. Conclusions. Six months preceding the initial diagnosis of LEAD, patients visit the GP more often than a similar population without LEAD, regardless of gender. Reported gender differences in the severity of LEAD at diagnosis do not seem to be explained by a delay in presentation to the GP.

Predicting adverse outcomes in patients with peripheral arterial disease (PAD) is a complex task owing to the heterogeneity in patient and disease characteristics. This systematic review aimed to identify prognostic factors and prognostic models to predict mortality outcomes in patients with PAD Fontaine stage I - III or Rutherford category 0 - 4. PubMed, Embase, and Cochrane Database of Systematic Reviews were searched to identify studies examining individual prognostic factors or studies aiming to develop or validate a prognostic model for mortality outcomes in patients with PAD. Information on study design, patient population, prognostic factors, and prognostic model characteristics was extracted, and risk of bias was evaluated. Sixty nine studies investigated prognostic factors for mortality outcomes in PAD. Over 80 single prognostic factors were identified, with age as a predictor of mortality in most of the studies. Other common factors included sex, diabetes, and smoking status. Six studies had low risk of bias in all domains, and the remainder had an unclear or high risk of bias in at least one domain. Eight studies developed or validated a prognostic model. All models included age in their primary model, but not sex. All studies had similar discrimination levels of > 70%. Five of the studies on prognostic models had an overall high risk of bias, whereas two studies had an overall unclear risk of bias. This systematic review shows that a large number of prognostic studies have been published, with heterogeneity in patient population, outcomes, and risk of bias. Factors such as sex, age, diabetes, hypertension, and smoking are significant in predicting mortality risk among patients with PAD Fontaine stage I - III or Rutherford category 0 - 4.

Lower extremity peripheral arterial disease (PAD) is a severe condition that increases the risk of major adverse cardiovascular events, major adverse limb events, and all cause mortality. This study aimed to investigate the mortality risk among females and males hospitalised for the first time due to lower extremity PAD. Three cohorts of patients who were admitted for the first time due to lower extremity PAD in 2007 - 2010, 2011 - 2014, and 2015 - 2018 were constructed. For the 2007 - 2010 and 2011 - 2014 cohorts, the 28 day, one year, and five year mortality were calculated, assessing survival time from date of hospital admission until date of death, end of study period, or censoring. For the 2015 - 2018 cohort, only 28 day and one year mortality were investigated due to lack of follow up data. Mortality of these cohorts was compared with the general population using standardised mortality rates (SMRs), and the risk of mortality between sexes was evaluated using Cox proportional hazards models. Cox models were adjusted for age, cardiovascular disease, and diabetes mellitus to account for potential confounding factors. In total, 7 950, 9 670, and 13 522 patients were included in the 2007 - 2010, 2011 - 2014, and 2015 - 2018 cohorts, respectively. Over 60% of individuals in each cohort were male. Mortality rates at 28 day and one year remained stable across all cohorts, while the five year mortality rate increased both for males and females in the 2011 - 2014 cohort. The SMRs both of females and males with PAD were significantly higher than in the general population. Multivariable regression analyses found no significant differences in mortality risk between sexes at 28 days and one year. However, the five year mortality risk was lower in females, with a hazard ratio of 0.89 (95% confidence interval [CI] 0.83 - 0.97) in the 2007 - 2010 cohort and 0.88 (95% CI 0.82 - 0.94) in the 2011 - 2014 cohort. The five year mortality risk has increased, and females face a lower mortality risk than males. Lower extremity PAD still carries unfavourable long term consequences compared with the general population.

Background: Left ventricular diastolic dysfunction is frequently observed in patients with chronic kidney disease. Nevertheless, the relationship between chronic kidney disease and left ventricular diastolic dysfunction over time is poorly understood. This study aims to assess whether the association between chronic kidney disease and left ventricular diastolic dysfunction varies over time. Methods: We included outpatients from the Utrecht Patient‐Oriented Database, who underwent at least 2 echocardiographic assessments and had a measurement of kidney function. Linear mixed‐effects models were used to estimate the associations of estimated glomerular filtration rate (eGFR) and echocardiographic parameters. Results: A total of 1812 patients were included and stratified into 3 groups on the basis of eGFR: >90 (491), 60–90 (923), and <60 (398). The mean age was 66.7 years, with 62.3% being men. At baseline, patients with lower eGFR exhibited a higher prevalence of hypertension (62.3% versus 55.2%) and diabetes (19.6% versus 11.6%). Linear mixed‐effects models showed that declining eGFR was significantly associated with increased E/e′ ratio, left atrial volume index, tricuspid regurgitation velocity, and left ventricular mass index, with respective estimates of −0.03 ( P <0.001), −0.04 ( P =0.005), −0.00 ( P <0.001), and −0.16 ( P 0.20). Conclusions: This study shows that lower kidney function was consistently associated with a more adverse diastolic echocardiographic phenotype, characterized by higher filling pressures, greater structural remodeling, and increased hemodynamic burden. This phenotype was already established at initial clinical assessment and did not show measurable further divergence on serial routine echocardiograms.