Carmine Zoccali

Aldosterone and Residual Cardiorenal Risk: Pathophysiology and Emerging Therapeutic Strategies.

Aldosterone, the terminal effector of the renin-angiotensin-aldosterone system, regulates sodium retention, potassium excretion, and blood pressure. Beyond these classical effects, aldosterone-associated and mineralocorticoid receptor (MR)-mediated signaling is implicated in inflammation, oxidative stress, fibrosis, al...

Heart failure in chronic kidney disease: what the second universal definition changes.

PRO/CON debate: nonsteroidal versus steroidal mineralocorticoid receptor antagonists in chronic kidney disease: progress, pragmatism, and remaining uncertainties.

Mineralocorticoid receptor antagonists (MRAs) are a central component of contemporary cardiorenal protection in chronic kidney disease (CKD). Classic steroidal MRAs, spironolactone and eplerenone, have long been used to treat hypertension and heart failure and to reduce albuminuria, but their wider use in CKD has been...

Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Inflammatory Biomarkers: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS Sodium-glucose cotransporter-2 inhibitors (SGLT2is) improve cardiovascular and kidney outcomes, but their effects on circulating inflammatory biomarkers remain uncertain. We systematically reviewed randomized evidence on the effects of SGLT2is on peripheral-blood inflammatory biomarkers. METHODS P...

Reframing kidney outcomes in CKD trials: eGFR slopes, competing risks, and pragmatic trial design.

In both clinical research and study design, the definition of outcomes for chronic kidney disease (CKD) is changing. New molecules available for testing in humans, and the fact that kidney diseases are best treated earlier in their course, make the duration of studies requiring 'hard endpoints' longer than is feasible...

Beyond Kt/V: Redefining Dialysis Adequacy as Targeted Cardiovascular Risk Reduction.

BACKGROUND Cardiovascular disease remains the leading cause of death in patients receiving maintenance dialysis, whereas conventional thrice-weekly hemodialysis was developed primarily around small-solute clearance rather than cardiovascular protection. AIM This narrative review examines dialysis strategies intended...

Endothelin receptor antagonism for resistant hypertension in chronic kidney disease: where does aprocitentan fit?

Resistant hypertension, defined as blood pressure (BP) above target despite maximally tolerated doses of at least three antihypertensive agents, including a diuretic, after excluding pseudo-resistance, is common in chronic kidney disease (CKD), and is associated with persistently low rates of BP control [ 1 , 2 ]. Unco...

Personalizing cardiovascular prevention in chronic kidney disease: an operational framework for risk-treatment mapping.

Patients with chronic kidney disease (CKD) bear a disproportionate burden of cardiovascular (CV) morbidity and mortality, yet preventive strategies in clinical practice remain remarkably conservative and largely therapy-centered. The 2024 KDIGO guideline on CKD evaluation and management advocates the systematic use of...

The nephrologist in the present and near future: between algorithms and autonomy.

Overall, AI can support proactive, person-centred kidney care only if clinicians help design, govern, evaluate, and critically supervise these emerging technologies within robust, learning healthcare systems.