Opinion Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2023; 15(3): 76-83
Published online Mar 26, 2023. doi: 10.4330/wjc.v15.i3.76
Redefying the therapeutic strategies against cardiorenal morbidity and mortality: Patient phenotypes
Dimitra Bacharaki, Ioannis Petrakis, Kostas Stylianou
Dimitra Bacharaki, Nephrology Unit, 2nd Department of Internal Medicine, Attikon University Hospital, Chaidari 12462, Greece
Ioannis Petrakis, Kostas Stylianou, Department of Nephrology, Heraklion University Hospital, University of Crete, Heraklion 71500, Greece
Author contributions: Bacharaki D conceived the idea for the manuscript; Bacharaki D and Petrakis I reviewed the literature and drafted the manuscript; Stylianou K supervised the manuscript; all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitra Bacharaki, MD, PhD, Consultant Physician-Scientist, Nephrology Unit, 2nd Department of Internal Medicine, Attikon University Hospital, Rimini 1, Chaidari 12462, Greece. bacharaki@gmail.com
Received: October 2, 2022
Peer-review started: October 2, 2022
First decision: November 25, 2022
Revised: December 31, 2022
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 26, 2023
Abstract

Chronic kidney disease (CKD) patients face an unacceptably high morbidity and mortality, mainly from cardiovascular diseases. Diabetes mellitus, arterial hypertension and dyslipidemia are highly prevalent in CKD patients. Established therapeutic protocols for the treatment of diabetes mellitus, arterial hypertension, and dyslipidemia are not as effective in CKD patients as in the general population. The role of non-traditional risk factors (RF) has gained interest in the last decades. These entail the deranged clinical spectrum of secondary hyperparathyroidism involving vascular and valvular calcification, under the term “CKD-mineral and bone disorder” (CKD-MBD), uremia per se, inflammation and oxidative stress. Each one of these non-traditional RF have been addressed in various study designs, but the results do not exhibit any applied clinical benefit for CKD-patients. The “crusade” against cardiorenal morbidity and mortality in CKD-patients is in some instances, derailed. We propose a therapeutic paradigm advancing from isolated treatment targets, as practiced today, to precision medicine involving patient phenotypes with distinct underlying pathophysiology. In this regard we propose two steps, based on current stratification management of corona virus disease-19 and sepsis. First, select patients who are expected to have a high mortality, i.e., a prognostic enrichment. Second, select patients who are likely to respond to a specific therapy, i.e., a predictive enrichment.

Keywords: Cardiorenal, Morbidity, Mortality, Phenotype, Precision medicine, Personalized medicine

Core Tip: Stagnation in the Nephrology field has to be overcome with a new perspective. This new vision takes lessons from the past as personalized medicine, adapts precision medicine from today’s lessons from corona virus disease-19 and sepsis and looks into the future with the aid of the big data. Our proposal is that cardiorenal management should be stratified according to patient phenotypes and not as an assembly of individual targets.