Obesity represents a serious and growing disease worldwide. The pathophysiological changes secondary to chronic inflammation lead to the development of diseases that increase the morbidity and mortality of individuals. Chronic kidney disease (CKD) is a condition with deleterious effects that acts bidirectionally with obesity. From approximately 20% to 30% of individuals share phenotypes of CKD and obesity, increasing their cardiovascular risk and the risk of other complications. Obesity and CKD form a vicious cycle in which inflammation is the central axis of multiorgan damage. Despite increasing the risk of cardiac and renal mortality, CKD progresses in relation to body mass index and albuminuria. Nowadays, the implementation of the new medications aimed at mitigating the peak of inflammation is becoming a cornerstone of treatments for obesity, diabetes, cardiovascular diseases, and renal disease.

Obesity represents a serious and growing disease worldwide. The pathophysiological changes secondary to chronic inflammation led to the development of diseases that increase the morbidity and mortality of individuals. Chronic kidney disease (CKD) is a condition with deleterious effects that acts bidirectionally with obesity. Approximately 20% to 30% of individuals share phenotypes of CKD and obesity, increasing their cardiovascular risk and the risk of other complications. Obesity and CKD form a vicious cycle in which inflammation is the central axis of multiorgan damage. Despite increasing the risk of cardiac and renal mortality, CKD progresses in relation to body mass index and albuminuria. Nowadays, the implementation of the new medications aimed at mitigating the peak of inflammation are becoming as cornerstone treatments for obesity, diabetes, cardiovascular diseases, and renal disease.

Patients with diabetes and chronic kidney disease (CKD-DM) often have residual albuminuria despite pharmacological treatment. Finerenone targets mineralocorticoid overactivation, but real-world evidence remains limited. This study evaluated the impact of finerenone in a cohort of patients with CKD-DM. This was a real-life study including patients with CKD-DM and an estimated glomerular filtration rate (eGFR) ≥ 20 mL/min/1.73 m², treated with finerenone, aged ≥ 18 years, and followed at the Nephrology Department of Vall d’Hebron Hospital. Clinical and laboratory data were collected at baseline and at 1, 3, and 6 months of treatment. Changes in albuminuria and eGFR were analyzed in patients who completed 6 months of follow-up. A total of 60 patients were included in the analysis; 39 (65%) were male, with a median age of 79 ± 10.12 years. Finerenone was initiated at 10 mg daily in 57 patients (95%), with 38.3% escalating to 20 mg after 1 month. After 6 months, the urinary albumin-to-creatinine ratio (UACR) decreased by 37.1% (p = 0.012, n = 34). Patients with an initial eGFR drop > 20% showed a greater UACR decrease of around 43% at 3 (p = 0.012) and 6 months (p = 0.013). A significant 9.5% decline in eGFR was observed at 1 month, followed by stabilization at 3 and 6 months. Finerenone was discontinued in 10% of the patients due to adverse events. Hyperkalemia occurred in 18.3% of the patients, but no hospitalizations for adverse events or heart failure were reported. In summary, finerenone induced a significant 37.1% reduction in albuminuria after 6 months of treatment. This reduction was more pronounced in patients who experienced an initial eGFR dip ≥ 20%. Finerenone was generally well tolerated and appears to be a promising therapeutic strategy for reducing albuminuria in this population.

Background: Heart failure (HF) prevalence is increasing, and its prognosis worsens in the presence of other comorbidities. Up to 70% of patients develop cardiorenal syndrome (CRS), which is associated with diuretic resistance or kidney deterioration over time. Peritoneal dialysis (PD) for ultrafiltration (PD-UF) could be a potential therapeutic option in CRS, although its long-term outcomes have not been described. Methods: Retrospective registry study of the Catalan Renal Registry on patients with PD-UF indication between 2013 and 2022. Baseline clinical characteristics and follow-up until December/2022 was studied. Results: Of the 1,874 incident patients on PD, 198 (10.6%) were PD-UF, 73.2% of the patients were male, and the mean age was 70.7 ± 9.3 years. Median estimated glomerular filtration rate (eGFR) at start was 22.6 (IQR: 14.8–32.8) mL/min×1.73 m2 and 75.0% have an eGFR above 15 mL/min×1.73 m2. Previous history of ischemic heart disease, arrhythmia, or cardiac surgery was recorded, and 57.6% of patients had ≥2 of these pathologies. The most common HF etiology was ischemic heart disease in 21.7% of patients. Median overall patient survival was 21 (IQR: 17.3–24.3) months. Technique survival at 1 year was 94.8%, and 27 patients were transferred to other renal replacement therapy (hemodialysis or kidney transplantation). In the Cox multivariate analysis, age ≥75 years (HR: 1.76 [95% CI: 1.20–2.59]), mild frailty (HR: 2.18 [95% CI: 1.17–2.59]), severe frailty (HR: 17.62 [95% CI: 1.20–55.48]), and the burden of cardiac disease (2 categories HR: 2.17 [95% CI: 1.05–4.47]; 3 categories HR: 2.26 [95% CI: 1.05–4.89]) were associated with poor overall survival. Technique survival was associated with eGFR (<30 mL/min×1.73 m2 HR: 5.64 [95% CI: 1.32–24.18]) and body mass index (<20 kg/m2 HR: 6.53 [95% CI: 1.06–40.12]) at baseline. Conclusion: PD-UF is a feasible option in patients with advanced HF and CRS. The complexity of this population increases with older age, frailty, and higher cardiac burden.

Chronic kidney disease (CKD) is a major complication of diabetes, affecting approximately 30–40% of patients. In many cases, CKD progresses to end-stage renal disease (ESRD). The peptide apelin and its receptor, APLNR, which is expressed in the endothelial cells of renal blood vessels, play a key role in glucose uptake and the regulation of vasodilation in the afferent and efferent glomerular arterioles. Numerous studies have demonstrated that the apelinergic system is dysregulated in various pathologies, including CKD in people with diabetes. In recent years, the apelinergic system has emerged as a promising therapeutic target for several diseases, with various apelin analogs and inhibitors being developed. In this review, we summarize the most recent literature on apelin and its cellular mechanisms of action, highlighting the role of the apelinergic system in various pathologies and its impact on patients with CKD and diabetes. Additionally, we explore the currently available analogs and inhibitors and discuss their potential therapeutic applications.

Background: Evidence guiding dialysis modality decisions in very elderly patients is limited, and real-world outcomes remain poorly characterized. This study evaluates long-term survival in octogenarians initiating kidney replacement therapy (KRT) by dialysis modality. Methods: We used data from the Catalan Renal Registry to identify all patients aged ≥80 years who started dialysis between 2000 and 2022. Patients were classified according to initial dialysis modality [hemodialysis (HD) vs peritoneal dialysis (PD)]. A 1:3 propensity score-matched analysis was performed. Transition from PD to HD was modeled as a time-dependent covariate in Cox proportional hazards models to account for modality switching and minimize immortal-time bias. Results: Among 4205 octogenarians, 239 initiated PD, 3966 initiated HD. After matching, 213 PD patients were compared to 637 HD controls. Five-year survival did not differ significantly by initial modality after adjustment. However, switching from PD to HD was independently associated with increased mortality (HR 1.46; 95% CI 1.02–2.08; P = .038), suggesting a potential association with clinical deterioration. PD without switching was not significantly associated with mortality (HR 1.19; P = .120; 95% CI 0.95–1.48). Older age and KRT initiation in 2000–07 were also associated with worse outcomes. Conclusions: In this large population-based cohort of octogenarians, initial dialysis modality was not associated with differences in survival after adjustment. However, transition from PD to HD was associated with higher mortality, underscoring the importance of dynamic monitoring and ongoing clinical reassessment in peritoneal dialysis.