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The health and proper functioning of the cardiovascular and renal systems largely depend on crosstalk in the gut-kidney-heart/vessel triangle. Recent evidence suggests that the gut microbiota has an integral function in this crosstalk. Mounting evidence indicates that the development of chronic kidney and cardiovascular diseases follows chronic inflammatory processes that are affected by the gut microbiota via various immune, metabolic, endocrine, and neurologic pathways. Additionally, deterioration of the function of the cardiovascular and renal systems has been reported to disrupt the original gut microbiota composition, further contributing to the advancement of chronic cardiovascular and renal diseases. Considering the interaction between the gut microbiota and the renal and cardiovascular systems, we can infer that interventions for the gut microbiota through diet and possibly some medications can prevent/stop the vicious cycle between the gut microbiota and the cardiovascular/renal systems, leading to a decrease in chronic cardiovascular and renal diseases.

Chronic kidney disease (CKD) has been shown to result in profound changes in the composition and functions of the gut microbial flora which by disrupting intestinal epithelial barrier and generating toxic by-products contributes to systemic inflammation and the associated complications. On the other hand, emerging evidence points to the role of the gut microbiota in the development and progression of CKD by provoking inflammation, proteinuria, hypertension, and diabetes. These observations demonstrate the causal interconnection between the gut microbial dysbiosis and CKD. The gut microbiota closely interacts with the inflammatory, renal, cardiovascular, and endocrine systems via metabolic, humoral, and neural signaling pathways, events which can lead to chronic systemic inflammation, proteinuria, hypertension, diabetes, and kidney disease. Given the established role of the gut microbiota in the development and progression of CKD and its complications, favorable modification of the composition and function of the gut microbiome represents an appealing therapeutic target for prevention and treatment of CKD. This review provides an overview of the role of the gut microbial dysbiosis in the pathogenesis of the common causes of CKD including hypertension, diabetes, and proteinuria as well as progression of CKD.

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). Optimal glycemic control contributes to improved outcomes in patients with DM, particularly for microvascular damage, but blood glucose levels are too variable to provide an accurate assessment and instead markers averaging long-term glycemic load are used. The most established glycemic biomarker of long-term glycemic control is HbA1c. Nevertheless, HbA1c has pitfalls that limit its accuracy to estimate glycemic control, including the presence of altered red blood cell survival, hemoglobin glycation and suboptimal performance of HbA1c assays. Alternative methods to evaluate glycemic control in patients with DM include glycated albumin, fructosamine, 1–5 anhydroglucitol, continuous glucose measurement, self-monitoring of blood glucose and random blood glucose concentration measurements. Accordingly, our aim was to review the advantages and pitfalls of these methods in the context of CKD. •Achieving glycemic control targets reduces morbidity and mortality in CKD patients with diabetes•HbA1c has pitfalls that could decrease its accuracy to estimate glycemic control, particularly in CKD patients.•Several alternative methods are present to evaluate glycemic control.

A difficult airway is one of the main causes of morbidity and mortality in patients who undergo surgical interventions. Therefore, many devices and algorithms have been developed for the management of a difficult airway. However no study has been conducted comparing Frova catheter (FC) and a Bonfils fiberoscope (BF) to date. To compare the effectiveness and success of two devices, a FC and BF, in difficult intubation cases. Design: Single-centre randomized controlled trial in patients with difficult airways. The assignment order was created by unplanned number charts, and the assignment was hidden in closed covers, which were not unlocked until case permission had been provided. Setting: The trial was undertaken in a university hospital in Turkey. The primary analysis was based on 60 participants (n = 30, n = 30) with difficult intubation. The main outcomes were the success rates of placement of the tracheal tube in the trachea and the duration of the tracheal intubation process. In the BF group, successful intubation was carried out in 25 of the 30 (83.3%) patients, whereas intubation was successful in 28 of the 30 patients (93.3%) in the FC group. Patients who could not be intubated with the first device were intubated with the other device. The mean duration of intubation was 109 (85-140) s in the BF group, whereas it was 38.8 (26-60) s in the FC group. Both devices were successful in difficult intubation cases. However, given the shorter duration of intubation using the FC and its lower cost as compared with that of the BF, the FC can be considered superior to the BF in difficult intubation cases.