Citations

ABSTRACT Introduction Sodium‐glucose cotransporter‐2 inhibitors (SGLT2i), initially developed for type 2 diabetes, have shown promise in improving renal outcomes in patients with and without diabetes. However, their effect on lithium‐associated kidney dysfunction remains unknown. Methods This historical cohort study included patients from Mayo Clinic (2001–2023) with mood disorders who received lithium for ≥ 6 months and later used SGLT2i for ≥ 1 month. Data on SGLT2i use and lithium treatment were extracted from electronic health records. Serum creatinine values were used to calculate estimated glomerular filtration rate (eGFR) trajectories. Linear mixed‐effects models with piecewise linear splines were used to estimate eGFR slopes before and after SGLT2i initiation, adjusted for age and sex. Results Fifty‐six patients (mean age 57.4 years, 46.4% female), predominantly with bipolar disorder (87.5%), were included. The mean eGFR, measured nearest to SGLT2i initiation, was 77.9 ± 26.0 mL/min/1.73 m 2 , and the mean duration of SGLT2i use was 19.5 ± 17.8 months. Before SGLT2i initiation, eGFR declined at a rate of −1.43 mL/min/1.73 m 2 per year ( p < 0.001). After initiation, eGFR increased by 0.69 mL/min/1.73 m 2 per year, reflecting a + 2.13 change ( p = 0.025). Sensitivity analyses, including only patients on lithium at SGLT2i initiation ( n = 22) or who had > 1 year of SGLT2i use ( n = 29) showed similar, though non‐significant, changes in slopes. Conclusion SGLT2i treatment was associated with a significant improvement in eGFR trajectory in patients with mood disorders who received long‐term lithium therapy. These findings suggest a potential role for SGLT2is in mitigating lithium‐associated kidney dysfunction and highlight the need for randomized controlled trials in this population.

Background: Bipolar disorder (BD) is associated with a higher prevalence of chronic kidney disease (CKD) and increased mortality, yet individuals with both BD and CKD are less likely to receive kidney replacement therapy (KRT). Sodium-glucose cotransporter-2 inhibitors (SGLT2is) provide renal protection in diabetes, but their long-term effects in this high-risk population remain unknown. Objectives: To evaluate whether SGLT2i use reduces the risk of KRT and all-cause mortality in adults with BD and mild-to-moderate CKD (stage ⩽ 3). Design: Observational cohort study with propensity score matching (PSM). Method: In this study using TriNetX (2009–2024) real-world database, 89,369 adults with BD and mild-to-moderate CKD were classified as SGLT2i users ( n = 12,736) or nonusers ( n = 76,633). Primary outcomes were progression to KRT and all-cause mortality over 5 years. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models, and 1:1 PSM reduced confounding. Subgroup analyses examined sex, race/ethnicity, diabetes status, CKD stage, and mood stabilizer use. Results: SGLT2i use was associated with lower risk of KRT (aHR 0.47 (95% CI, 0.42–0.53)) and all-cause mortality (aHR 0.69 (95% CI, 0.65–0.73); both p < 0.001). Protective effects were consistent across subgroups, including individuals receiving lithium, lamotrigine, valproate, or antipsychotics. After PSM (10,967 matched pairs), 5-year KRT-free survival was 94.61% versus 90.99%, and overall survival was 78.67% versus 67.53% (both p < 0.001). Given the observational design, the possibility of residual or unmeasured confounding canot be excluded. Conclusion: SGLT2i therapy in individuals with BD and mild-to-moderate CKD is associated with substantially lower risks of KRT and all-cause mortality. Prospective trials are needed to confirm these findings.

Resistant hypertension (RH) is a high-risk phenotype characterized by blood pressure readings ≥130/80 mmHg despite maximally tolerated therapy with three antihypertensive agents, including a diuretic, or controlled blood pressure requiring four or more medications. The diagnosis of RH requires a structured evaluation that confirms accurate blood pressure measurement, excludes pseudoresistance—particularly nonadherence and white coat hypertension—and identifies secondary causes such as obstructive sleep apnea, primary aldosteronism, renovascular disease, pheochromocytoma, and Cushing syndrome. RH arises from overlapping mechanisms, including activation of the renin–angiotensin–aldosterone system (RAAS), sympathetic overactivity, arterial stiffness, volume expansion, and immune-mediated pathways. Management begins with lifestyle modification and optimized triple therapy, followed by mineralocorticoid receptor antagonists as the preferred fourth-line treatment. Emerging pharmacological options, such as sodium–glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, endothelin receptor antagonists, aldosterone synthase inhibitors, and angiotensin receptor and neprilysin inhibitors (ARNIs), offer additional therapeutic potential; meanwhile, device-based interventions, including renal denervation and baroreflex activation therapy, have shown sustained blood pressure reductions in selected patients. Future directions highlight precision medicine, digital health technologies, and artificial intelligence as methods to improve diagnosis, guide individualized therapy, and enhance long-term blood pressure control.

Background: Early detection and prediction of arterial hypertension (HTN) are vital to reduce cardiovascular morbidity and mortality. AI has enhanced ECG diagnostic capabilities, enabling detection of latent cardiovascular abnormalities. Aims: This systematic review evaluates current evidence on AI-enhanced ECG for detection and prediction of HTN in in both clinical and subclinical populations. Methods: A search was conducted on April 28, 2025, in PubMed, Scopus, and Web of Science. Gray literature and study reference lists, plus the first 10 pages of Google Scholar, were screened. The review followed PRISMA 2020 guidelines. Bias risk was assessed using PROBAST (for prediction models) and QUADAS-2 (for diagnostic studies). Two reviewers independently performed study selection and data extraction after pilot training. Results: A total of 26 studies were included: 16 focused on detection and 10 on prediction of HTN using AI-enhanced ECG. Overall, 96% reported successful outcomes, underscoring the strong diagnostic and prognostic potential of this approach. Among detection studies, 94% successfully identified hypertensive individuals, classified blood pressure (BP) levels, or evaluated cardiovascular risk. Most were retrospective in design (75%), with internal validation in 44% and external validation in 19%. Sample sizes ranged from 100 to over 120,000, including healthy and cardiovascular patients. Commonly used algorithms included deep Learning, random forest, and ensemble methods, often using single-lead ECG data, highlighting the feasibility of wearable technologies. QUADAS-2 identified 56% of studies had low risk of bias. All prediction studies achieved accurate estimation of systolic/diastolic BP or predicted future HTN onset. Designs were 40% experimental and 50% retrospective. All studies reported internal validation, and 50% included external validation. AI models such as CNNs, ResNet-LSTM, and U-Net were used across clinical and community-based populations, with follow-up periods of up to 6.8 years. Populations were predominantly normotensive or mixed. PROBAST assessments showed 60% low and 40% moderate risk of bias. Conclusion: AI-enhanced ECG is a promising, non-invasive tool for early detection and prediction of HTN. However, external validation and clinical trials are needed to support integration and generalizability.

Cancer therapy-induced hypertension (HTN) is an increasingly recognized complication associated with a wide range of anticancer agents, including vascular endothelial growth factor (VEGF) inhibitors, proteasome inhibitors, tyrosine kinase inhibitors, and alkylating agents. The pathogenesis of HTN in this setting is multifactorial, involving mechanisms such as endothelial dysfunction, nitric oxide (NO) suppression, sympathetic nervous system activation, and vascular remodeling. Additional factors, including paraneoplastic syndromes, poorly controlled pain, mood disturbances, and overlapping cardiovascular risk factors like obesity and diabetes, further contribute to the complexity of diagnosis and management. Despite its prevalence and clinical implications, cancer therapy-induced HTN is often addressed using general population guidelines, with limited oncology-specific protocols available. Accurate blood pressure measurement and individualized treatment plans are critical to optimize outcomes and avoid interruptions to cancer therapy. Antihypertensive agents such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), and calcium channel blockers have shown efficacy in both blood pressure control and, in some cases, oncologic outcomes. A multidisciplinary approach involving oncologists, cardiologists, and primary care providers is essential to navigate the interplay between cancer treatment and cardiovascular health. Ongoing research is needed to develop targeted guidelines and improve the long-term care of cancer patients affected by treatment-induced HTN.

Key Points Patient-centered care in an interdisciplinary CKD clinic addresses complex needs and supports comprehensive CKD management. Implementation of an interdisciplinary CKD clinic reduced hospital admissions by 26%, emergency department visits by 30%, and increased nephrology consultations. Comprehensive care models with integrated registries enhance tailored interventions, leading to improved CKD management outcomes. Background CKD is a significant public health issue globally. Its progressive nature calls for innovative care models to mitigate disease progression and enhance patient outcomes. An interdisciplinary clinic model may offer comprehensive care tailored to the needs of patients with CKD. The aim of this study was to evaluate the effect of an interdisciplinary CKD clinic on disease progression, health care utilization, and social determinants of health (SDOH). Methods We conducted a retrospective cohort study at the Mayo Clinic in Rochester, Minnesota. The study included 534 patients enrolled in the CKD clinic between March 5, 2021, and May 31, 2022, excluding those who opted out of research. The intervention involved a clinical registry and an interdisciplinary team delivering evidence-based care pathways, patient education, shared decision making, and care coordination. The primary outcomes assessed were CKD progression and health care utilization, while secondary outcomes examined the effect of SDOH. Results At entry, the median age was 73 (interquartile range, 64–79) years, with 60% at stage 4 or lower. Clinic implementation correlated with a 26% decrease in hospital admissions (incidence rate ratio [IRR], 0.74; 95% confidence interval [CI], 0.60 to 0.91; P = 0.004) and a 30% reduction in emergency visits (IRR, 0.70; 95% CI, 0.57 to 0.87; P = 0.001). Nephrology consultations increased by 46% (IRR, 1.46; 95% CI, 1.34 to 1.60; P < 0.001), reflecting enhanced specialized care. Lower exercise frequency and unemployment were linked to increased CKD progression and health care usage. Conclusions An interdisciplinary CKD clinic supported by a registry can potentially reduce health care utilization among patients with CKD, with SDOH playing a critical role in disease management.

This review explores the transformative role of artificial intelligence (AI) in hypertension care, summarizing and analyzing published works from the last three years in this field. Hypertension contributes to a significant healthcare burden both at an individual and global level. We focus on five key areas: risk prediction, diagnosis, education, monitoring, and management of hypertension, supplemented with a brief look into the works on hypertensive disease of pregnancy. For each area, we discuss the advantages and disadvantages of integrating AI. While AI, in its current rudimentary form, cannot replace sound clinical judgment, it can still enhance faster diagnosis, education, prevention, and management. The integration of AI in healthcare is poised to revolutionize hypertension care, although careful implementation and ongoing research are essential to mitigate risks.

Abstract Background Few antiviral therapies have been studied in patients with coronavirus disease 2019 (COVID-19) and kidney impairment. Herein, the efficacy, safety, and pharmacokinetics of remdesivir, its metabolites, and sulfobutylether-β-cyclodextrin excipient were evaluated in hospitalized patients with COVID-19 and severe kidney impairment. Methods In REDPINE, a phase 3, randomized, double-blind, placebo-controlled study, participants aged ≥12 years hospitalized for COVID-19 pneumonia with acute kidney injury, chronic kidney disease, or kidney failure were randomized 2:1 to receive intravenous remdesivir (200 mg on day 1; 100 mg daily up to day 5) or placebo (enrollment from March 2021 to March 2022). The primary efficacy end point was the composite of the all-cause mortality rate or invasive mechanical ventilation rate through day 29. Safety was evaluated through day 60. Results Although enrollment concluded early, 243 participants were enrolled and treated (remdesivir, n = 163; placebo, n = 80). At baseline, 90 participants (37.0%) had acute kidney injury (remdesivir, n = 60; placebo, n = 30), 64 (26.3%) had chronic kidney disease (remdesivir, n = 44; placebo, n = 20), and 89 (36.6%) had kidney failure (remdesivir, n = 59; placebo, n = 30); and 31 (12.8%) were vaccinated against COVID-19. Composite all-cause mortality or invasive mechanical ventilation rates through day 29 were 29.4% and 32.5% in the remdesivir and placebo group, respectively (P = .61). Treatment-emergent adverse events were reported in 80.4% for remdesivir versus 77.5% for placebo, and serious adverse events in 50.3% versus 50.0%, respectively. Pharmacokinetic plasma exposure to remdesivir was not affected by kidney function. Conclusions Although the study was underpowered, no significant difference in efficacy was observed between treatment groups. REDPINE demonstrated that remdesivir is safe in patients with COVID-19 and severe kidney impairment. Clinical Trials Registration EudraCT 2020-005416-22; Clinical Trials.gov NCT04745351.