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The International Journal of Medical Science and Health Research

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ISSN : 30481376 EISSN : 30481368 DOI : -

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The International Journal of Medical Science and Health Research, published by International Medical Journal Corp. Ltd. is dedicated to providing physicians with the best research and important information in the world of medical research and science and to present the information in a format that is understandable and clinically useful. Committed to publishing multidisciplinary research that spans the entire spectrum of healthcare and medicine access, The American Journal of Medical Science and Health Research aims at an international audience of pharmacists, clinicians, medical ethicists, regulators, and researchers, providing an online forum for the rapid dissemination of recent research and perspectives in this area.

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Articles 400 Documents

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The Association of Vitamin D Deficiency with Disease Activity in Rheumatoid Arthritis: A Systematic Review Caroline Johansyah; I Putu Oka Yudaswara Pande; Maria Johansyah
The International Journal of Medical Science and Health Research Vol. 18 No. 6 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/01pf3g54

Introduction: Rheumatoid Arthritis (RA) is a chronic, systemic autoimmune disease characterized by persistent synovitis. Vitamin D, a secosteroid hormone with potent immunomodulatory properties, is frequently observed to be deficient in this patient population. This systematic review aims to comprehensively evaluate and synthesize the evidence linking vitamin D deficiency to the multifaceted measures of disease activity in RA. Methods: A systematic literature search was conducted across PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library for observational studies published up to December 2024. Studies were included if they assessed serum 25-hydroxyvitamin D levels and at least one validated measure of disease activity in adult patients with RA. Data on study characteristics and over 15 distinct clinical, laboratory, and patient-reported outcomes were extracted. The methodological quality and risk of bias of included studies were assessed using the Cochrane ROBINS-I (Risk Of Bias In Non-randomized Studies – of Interventions) tool. Results: Seventeen observational studies, comprising a total of 5,618 RA patients, met the inclusion criteria. The findings revealed a high prevalence of vitamin D deficiency and insufficiency across diverse RA cohorts. A statistically significant inverse correlation between serum 25(OH)D levels and the Disease Activity Score in 28 joints (DAS28) was the most consistent finding across the majority of studies. Furthermore, lower vitamin D levels were significantly associated with higher levels of inflammatory markers, including Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP), increased tender and swollen joint counts, and worse patient-reported outcomes such as pain, functional disability (Health Assessment Questionnaire), and reduced quality of life. Discussion: The synthesized evidence strongly supports an association between lower vitamin D status and heightened disease activity in RA. This relationship is biologically plausible, given vitamin D's established role in suppressing pro-inflammatory Th1/Th17 pathways and promoting regulatory T-cell function, both of which are central to RA pathogenesis. While the cross-sectional nature of most studies precludes definitive causal inference, the data suggest a potential bidirectional relationship where deficiency may contribute to immune dysregulation, and active disease may in turn exacerbate the deficiency. Conclusion: A substantial body of evidence demonstrates a significant association between vitamin D deficiency and higher disease activity across multiple domains in RA. These findings underscore the clinical importance of monitoring and correcting vitamin D status in patients with RA, which may serve as a valuable, low-cost adjunct to standard therapeutic strategies to help mitigate the overall disease burden.

Detection of Psychobiological, Environmental, and Behavioral Risk Factors on Hypertension Prevention Efforts in Agro-Industrial Communities Alestya Putri Jathy; Febri Endra Budi Setyawan; Indra Wahyu Saputra
The International Journal of Medical Science and Health Research Vol. 18 No. 6 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/s78ew448

Background : Hypertension is one of the leading non-communicable diseases that contributes significantly to global mortality and imposes a major economic and public health burden, including in Indonesia. The agro-industrial community has a high level of vulnerability to hypertension due to the complex interplay of psychobiological, environmental, and behavioral risk factors. Effective hypertension prevention strategies need to consider these factors to ensure that interventions are well-targeted and sustainable. Objective : To determine the influence of psychobiological, environmental, and behavioral risk factors on hypertension prevention efforts among the agro-industrial community in Trenggalek Regency. Methods: This study employed an analytical observational design with a cross-sectional approach. A total of 348 respondents, representing the agro-industrial community, were selected using a systematic random sampling technique. Data were collected using a structured questionnaire that had been tested for validity and reliability. Data analysis was performed using the Structural Equation Modeling–Partial Least Squares (SEM–PLS) method. Results: : The results showed that the three main factors—psychobiological (age, sex, and genetics), environmental (stress and social well-being), and behavioral (dietary habits, smoking, and physical activity)—significantly influenced hypertension prevention efforts. Primary and secondary prevention had a greater impact on reducing hypertension risk compared to tertiary prevention. Age, educational level, and smoking habits were the most dominant factors affecting hypertension prevention. Conclusion: The study concludes that psychobiological, environmental, and behavioral factors significantly affect hypertension prevention efforts among the agro-industrial community.

Neglected Care Leading to Generalised Tuberculosis Verrucosa Cutis in a 25-Year-Old Immunocompetent Patient: A Rare Case Report from Bangka Belitung and Literature Review David Herryanto; Andriansyah Bonorusid
The International Journal of Medical Science and Health Research Vol. 18 No. 6 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ghgprf77

Introduction: Tuberculosis (TB) remains a significant global health issue. Cutaneous tuberculosis (CTB) is a rare extrapulmonary manifestation, accounting for only 1–2% of all extrapulmonary TB cases. Tuberculosis verrucosa cutis (TVC) is a unique, paucibacillary form of CTB, typically presenting as a solitary lesion in a previously sensitised individual with good immunity. Generalised TVC in an immunocompetent patient is an exceptionally rare presentation and poses a considerable diagnostic challenge. Case Illustration: A 25-year-old, immunocompetent male patient presented with a 20-year history of progressive, painful verrucous skin lesions. The condition began as a single papule on his knee at age 5 and gradually disseminated to involve nearly the entire body surface, including the trunk, extremities, head, and all 20 nails (total onychodystrophy). Laboratory investigations revealed significant neutrophilic leukocytosis and progressive anaemia of chronic disease, Laboratory investigations revealed significant neutrophilic leukocytosis, progressive anaemia of chronic disease, and normal baseline liver and kidney function, while serology for HIV was negative. A chest radiograph showed no evidence of active pulmonary tuberculosis, pointing towards an exogenous inoculation form of the disease. Literature Review and Discussion: TVC results from the exogenous inoculation of Mycobacterium tuberculosis into the skin of an individual with pre-existing cell-mediated immunity. This immunity prevents systemic dissemination but allows for local persistence of the bacilli, resulting in a paucibacillary lesion that is difficult to diagnose microbiologically. This case represents an extreme spectrum of neglected disease, where a two-decade diagnostic delay allowed for extensive local spread via autoinoculation and contiguous extension, culminating in a severe and debilitating clinical presentation. The diagnosis often relies on clinicopathological correlation and the response to anti-tubercular therapy. Conclusion: This case report highlights the severe consequences of delayed diagnosis and inadequate management of TVC. It underscores the critical importance of maintaining a high index of clinical suspicion for chronic verrucous lesions, particularly in TB-endemic regions, to prevent significant long-term morbidity and permanent disability.

Occupational Community-Acquired Pneumonia in a Fitter-Splicer with a Significant Smoking History: A Case Report and Expanded Review of the Literature Anthony Suranta Surbakti; Agus Juanda
The International Journal of Medical Science and Health Research Vol. 18 No. 7 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/ssc4s696

Introduction: Community-acquired pneumonia (CAP) is a primary driver of global morbidity and mortality, with its incidence heavily influenced by host and environmental factors. While the roles of age, comorbidities, and smoking are well-established, the contribution of occupational exposures—particularly the complex and synergistic hazards faced by industrial workers—remains a critical and often under-appreciated component of risk assessment. This report presents an in-depth analysis of a fitter-splicer, a profession with a unique combination of respiratory hazards, who developed CAP, providing a platform to explore the intricate relationship between workplace environment, lifestyle factors, and infectious disease susceptibility. Case Illustration: A 50-year-old male with a 30-pack-year smoking history presented with a one-week history of a worsening productive cough, persistent fever, right-sided pleuritic chest pain, and a significant episode of hemoptysis. Physical examination revealed focal findings over the right lower lung, including decreased tactile fremitus, diminished breath sounds, and localized rhonchi, indicative of parenchymal consolidation. Laboratory investigations showed marked neutrophilic leukocytosis and a profoundly elevated C-reactive protein level (165 mg/L). A chest radiograph confirmed dense consolidation in the right lower lobe, consistent with lobar pneumonia. Despite being stratified as low severity by both the CURB-65 and Pneumonia Severity Index (PSI) scores, he was hospitalized due to his clinical presentation and occupational context. He was managed with a dual antibiotic regimen of intravenous ceftriaxone and oral levofloxacin. The patient demonstrated a favorable clinical response and was discharged after a nine-day hospital stay. Discussion: This case serves as a paradigm for the critical interplay between a patient's multifaceted occupational exposures and his extensive smoking history. The role of a "fitter-splicer" is deconstructed to reveal a dual-threat exposure profile: inhalation of metal fumes and inorganic dusts (e.g., silica) from fitting, grinding, and welding, combined with exposure to chemical vapors and organic dusts from conveyor belt splicing and vulcanization processes. These exposures are known to synergistically impair pulmonary immune defenses. This chronic occupational insult, compounded by decades of smoking-induced lung damage, created a state of profound susceptibility to infection. This decision represents a significant deviation from current evidence-based guidelines, which now strongly recommend against their routine use in non-severe CAP, reserving them for patients with severe disease characterized by a hyperinflammatory state. The differential diagnoses of tuberculosis and underlying malignancy are explored in detail, emphasizing the necessity of post-discharge radiological follow-up in this high-risk patient. Conclusion: This case underscores the clinical imperative to obtain a detailed occupational and environmental history in all patients presenting with CAP. It vividly demonstrates how combined industrial exposures and smoking can dramatically amplify pneumonia risk by overwhelming the lung's clearance and immune mechanisms. Furthermore, it highlights the urgent need for robust preventive strategies in high-risk occupations, including the stringent implementation of the hierarchy of controls in the workplace, targeted and accessible smoking cessation programs, and the proactive, guideline-driven administration of pneumococcal vaccination to this vulnerable population.

Effectiveness of Early Detection Programs for Chronic Kidney Disease in Children: A Systematic Review Fauzan Azim; Ade Rahma Anggraini
The International Journal of Medical Science and Health Research Vol. 18 No. 7 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/szf0em66

Background:Chronic Kidney Disease (CKD) in children poses a significant global health challenge, often progressing silently until advanced stages. Early detection is critical to initiate timely interventions that can prevent irreversible renal damage, reduce morbidity, and improve long-term outcomes. Despite advances in diagnostics, the effectiveness and implementation of pediatric CKD early detection programs vary globally. Objective:This systematic review aimed to evaluate the effectiveness of early detection programs for CKD in children, focusing on their impact on early diagnosis, disease progression, and clinical outcomes across different healthcare settings. Methods:Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, Web of Science, Embase, and Cochrane Library from January 2015 to September 2025. Eligible studies included randomized controlled trials, cohort, cross-sectional, and case-control studies evaluating early detection or screening programs for pediatric CKD. Data were extracted on study design, screening type, outcomes, and implementation characteristics. Quality assessment was performed using Cochrane RoB 2.0, Newcastle–Ottawa Scale, and JBI tools. Results:Out of 2,161 identified records, 28 studies met inclusion criteria. Most studies originated from Asia (Japan, Korea, India, Iran) and Europe. School-based urinary screening and risk-targeted screening programs demonstrated effectiveness in detecting asymptomatic CKD at earlier stages and facilitating timely nephrology referrals. Biomarker-based approaches—such as cystatin C, netrin-1, NGAL, and KIM-1—significantly improved diagnostic accuracy compared to serum creatinine alone. Integrating biomarker screening with school and primary-care programs improved early detection rates and reduced CKD progression risk. However, cost-effectiveness and sustainability remain major challenges, especially in low- and middle-income countries. Conclusion:Early detection programs for pediatric CKD are effective in identifying renal impairment at subclinical stages, enabling early intervention and slowing disease progression. The combination of population-based screening and biomarker-guided testing offers the best balance between sensitivity and practicality. Future research should prioritize standardizing screening protocols, integrating digital tools and AI-based risk prediction, and evaluating long-term cost-effectiveness to inform global pediatric nephrology policies.

Vitamin D Supplementation and its Effect on Modified Rankin Scale and National Institutes of Health Stroke Scale Outcomes in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis Andra Danika; Paulus Alexander Supit; Maria Stefanny Setiawan
The International Journal of Medical Science and Health Research Vol. 18 No. 7 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/99rg7932

Introduction: The role of vitamin D in functional recovery after acute ischemic stroke remains unclear due to inconsistent evidence. This systematic review and meta-analysis aim to evaluate the effect of vitamin D supplementation on functional and neurological recovery, as measured by the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS), in adult patients with acute ischemic stroke. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Google Scholar, and Semantic Scholar for randomized controlled trials and meta-analyses since 2015. Eligible studies included adult ischemic stroke patients receiving vitamin D supplementation with reported mRS or NIHSS outcomes. Data were synthesized, and random-effects meta-analyses calculated pooled hazard ratios (HRs). Results: Vitamin D supplementation was associated with significant improvements in mRS (HR 1.32) and NIHSS (HR 1.30). However, substantial heterogeneity was observed (mRS I² = 78.4%; NIHSS I² = 77%). Variability largely stemmed from differences in supplementation regimens (single high-dose injection vs. daily oral) and the baseline vitamin D status of participants. Discussion: Findings suggest vitamin D may enhance post-stroke recovery, though the benefit is not consistent across populations. Improvements were most evident among patients with pre-existing deficiency, indicating supplementation may be particularly effective as corrective therapy. Variation in dosage and timing complicates the formulation of a single treatment recommendation Conclusion: Vitamin D supplementation is associated with a statistically significant improvement in functional and neurological outcomes for patients with acute ischemic stroke, as measured by the mRS and the NIHSS. The pooled data suggests a beneficial role for vitamin D in post-stroke recovery

The Impact of Glycemic Control and Variability (HbA1c) on the Rate of Glomerular Filtration Rate Decline in Diabetes Mellitus: A Systematic Review Cut Lisa Afrianna; Irmayani; T Iskandar Rizal
The International Journal of Medical Science and Health Research Vol. 18 No. 8 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/c4f3ze23

Introduction: Diabetic Kidney Disease (DKD) is a leading cause of end-stage renal disease (ESRD) globally. While mean glycated hemoglobin (HbA1c) is an established risk factor for DKD progression, the impact of long-term glycemic variability remains less clearly synthesized. This review systematically evaluates the association of both mean HbA1c and HbA1c variability with the rate of glomerular filtration rate (GFR) decline in individuals with type 1 (T1DM) and type 2 diabetes (T2DM). Methods: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted for longitudinal cohort studies published up to March 2024. Studies were included if they reported on mean HbA1c or long-term HbA1c variability (measured by standard deviation, coefficient of variation [CV], or variability score) and the primary outcome of GFR decline. The methodological quality of included studies was assessed using the Cochrane ROBINS-I tool for non-randomized studies. Results: A total of 16 longitudinal studies met the inclusion criteria. The findings consistently demonstrated that both higher mean HbA1c and greater HbA1c variability were significantly and independently associated with a more rapid decline in GFR. A "moderate-increasing" HbA1c trajectory was associated with a more than twofold increased risk of CKD progression (Hazard Ratio 2.23) (Critchley et al., 2019). High HbA1c variability, as measured by the highest versus lowest quartiles, was associated with an HR for renal function decline ranging from 1.26 to 1.47 across different metrics (Wang et al., 2024). Notably, this association persisted even in patients with well-controlled mean glycemia (HbA1c < 7.0%), where high variability still predicted a faster GFR decline (Tsai et al., 2020). Discussion: The evidence supports a "dual threat" model where both the absolute level and the instability of glycemia contribute to nephropathy progression. The independent role of HbA1c variability suggests that glycemic fluctuations may induce renal damage through distinct pathways, such as heightened oxidative stress and inflammation, beyond that of sustained hyperglycemia (Gorst et al., 2015). These findings underscore the need to look beyond a single HbA1c value and consider the entire glycemic trajectory in clinical risk assessment. Conclusion: Glycemic stability, in addition to achieving mean HbA1c targets, is a crucial therapeutic goal in diabetes management to preserve long-term renal function. Monitoring HbA1c variability may identify high-risk individuals who would otherwise be missed by conventional glycemic metrics.

Eﬀicacy of Decompressive Craniectomy in Managing Severe Stroke : A Systematic Review Restiko Maleo Fibullah; Adistia Maulidiah; Hambali Humam Macan
The International Journal of Medical Science and Health Research Vol. 18 No. 8 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/2dfj7t27

Introduction: Severe stroke, particularly malignant middle cerebral artery infarction, is a neurological emergency with high mortality under conservative care. Decompressive craniectomy is a life-saving surgical intervention designed to mitigate high intracranial pressure. However, its efficacy is complex, with benefits in reducing mortality often challenged by poor functional outcomes and varying effectiveness across different stroke types. This systematic review aims to synthesize the current evidence on the efficacy of decompressive craniectomy in managing severe stroke. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines, a comprehensive search was conducted across PubMed, Springer, Semantic Scholar, and Google Scholar. The search used PICO-based keywords to identify randomized controlled trials, prospective studies, and meta-analyses published since 2015 that evaluated decompressive craniectomy in adults with severe ischemic or hemorrhagic stroke. Data regarding study design, patient characteristics, intervention timing, mortality, and functional outcomes were extracted from the 17 studies that met the inclusion criteria. Results: The evidence demonstrates that for severe ischemic stroke, early decompressive craniectomy (typically <48 hours) significantly reduces mortality, with rates dropping from approximately 70% in control groups to around 30% in surgical groups. Despite this survival benefit, a substantial proportion of survivors are left with moderate to severe functional disability (modified Rankin Scale score of 4). Conversely, in patients with supratentorial intracerebral hemorrhage, decompressive craniectomy was associated with worse functional outcomes and higher mortality compared to more conservative surgical interventions. Discussion: The findings underscore a critical clinical and ethical dilemma: the trade-off between survival and the quality of that survival. The decision to perform a decompressive craniectomy is complex and must be highly individualized, carefully considering the stroke etiology (ischemic versus hemorrhagic), patient age, and the timing of the intervention. Open communication with families regarding the high likelihood of survival with significant dependency is essential for shared decision-making. Conclusion: The evidence synthesized in this systematic review unequivocally establishes decompressive craniectomy as a life-saving intervention for patients with severe ischemic stroke, particularly malignant middle cerebral artery infarction. The procedure dramatically reduces mortality rates when compared to conservative medical management, a finding that is robust across numerous high-quality studies. This survival benefit is most pronounced when surgery is performed early, ideally within 48 hours of stroke onset, cementing its role as a critical and time-sensitive treatment in the neurocritical care setting for this specific patient population.

The Socioeconomic Landscape of Gestational Trophoblastic Disease: A Systematic Review of Risk, Presentation, and Outcomes Syahrianty Usman; Trisna Aulia Surya
The International Journal of Medical Science and Health Research Vol. 18 No. 8 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/9k8gd573

Introduction: Gestational Trophoblastic Disease (GTD) encompasses a spectrum of pregnancy-related disorders, from premalignant hydatidiform moles to malignant Gestational Trophoblastic Neoplasia (GTN). While highly curable with timely diagnosis and management, significant global disparities in incidence and mortality suggest a powerful role for socioeconomic factors. However, the precise nature of this relationship remains poorly defined in the literature. This systematic review aims to comprehensively examine and synthesize the evidence on the association between socioeconomic status (SES) and the etiological risk, clinical course, and ultimate outcomes of GTD. Methods: A systematic search was conducted in PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library for observational studies published in English up to January 2024. The search included studies that evaluated an association between at least one SES indicator (e.g., income, education, occupation, marital status, insurance) and a GTD-related risk or outcome. Data were extracted and synthesized narratively due to study heterogeneity. The methodological quality of included studies was rigorously assessed using the Newcastle-Ottawa Scale (NOS) for case-control and cohort studies and the Joanna Briggs Institute (JBI) checklist for cross-sectional studies. Results: Seventeen studies met the inclusion criteria, comprising case-control, cohort, and cross-sectional designs from diverse global settings. The evidence linking low SES to an increased primary risk of developing GTD was inconsistent and contradictory. While multiple descriptive studies in low- and middle-income countries (LMICs) reported a high proportion of cases among women with low income and education, a high-quality US-based case-control study found a significantly increased risk among women in professional occupations. In stark contrast, a strong and consistent association was found between lower SES and a wide array of adverse clinical outcomes. Indicators of socioeconomic disadvantage—including unemployment, unmarried/widowed status, low income, and residence in low-resource settings—were significantly associated with poorer prognosis, higher rates of loss to follow-up (up to 27%), delayed diagnosis, increased risk of chemoresistance, and decreased overall survival in patients with GTN. Discussion: The primary impact of SES in GTD appears to be as a powerful determinant of prognosis rather than a direct etiological risk factor. The link between SES and GTD risk is likely confounded by mediating factors such as nutrition and reproductive age patterns, which vary across socioeconomic strata. However, socioeconomic barriers directly impede a patient's ability to navigate the complex, costly, and prolonged clinical management required for a cure. Key mechanisms include financial toxicity from treatment and surveillance, lack of social and logistical support, structural barriers to accessing specialized healthcare, and lower health literacy, which collectively contribute to treatment non-adherence, disease progression, and worse survival outcomes. Conclusion: Socioeconomic deprivation is a critical and independent determinant of adverse outcomes in Gestational Trophoblastic Disease. While the disease is highly curable under optimal conditions, poverty and lack of social capital can transform it into a fatal condition by obstructing access to and completion of essential care. Clinical protocols and public health strategies must be designed to proactively identify and address these socioeconomic disparities to ensure equitable outcomes for all women affected by GTD.

The Gut-Kidney-Heart Axis in Uremia: A Systematic Review of the Association Between Gut Dysbiosis and Cardiovascular Complications in End-Stage Renal Disease Anggreini Oktavia Trisno; Chelsia Ernes
The International Journal of Medical Science and Health Research Vol. 18 No. 9 (2025): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/efkwmg60

Background: Patients with End-Stage Renal Disease (ESRD) experience an exceptionally high burden of cardiovascular morbidity and mortality that is not fully explained by traditional risk factors. The gut-kidney-heart axis has emerged as a critical pathophysiological paradigm, implicating gut dysbiosis and the resultant accumulation of gut-derived uremic toxins as key non-traditional risk factors for cardiovascular disease (CVD) in this population. Methods: A systematic literature search was conducted in PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library to identify observational studies investigating the association between markers of gut dysbiosis (microbial composition, diversity, and gut-derived metabolites including indoxyl sulfate, p-cresyl sulfate, trimethylamine N-oxide, indole-3-acetic acid [IAA], and phenylacetylglutamine [PAGln]) and cardiovascular complications in adult patients with ESRD. Study selection followed PRISMA guidelines. Data on study design, population characteristics, dysbiosis markers, and cardiovascular outcomes were extracted. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale. Results: Seventeen primary observational studies, comprising over 4,100 patients, were included. The evidence consistently demonstrated significant associations between gut dysbiosis and adverse cardiovascular outcomes. Lower gut microbial diversity was a strong predictor of all-cause and cardiovascular mortality. Elevated serum levels of IS, PCS, TMAO, IAA, and PAGln were independently associated with increased risks of all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), heart failure, arterial stiffness, and vascular calcification. Furthermore, circulating endotoxin, a marker of intestinal barrier dysfunction, was linked to systemic inflammation, atherosclerosis, and myocardial injury. Discussion: The synthesized evidence supports a mechanistic cascade wherein the uremic milieu of ESRD drives profound gut dysbiosis. This leads to the overproduction of uremic toxins and compromises intestinal barrier integrity, facilitating the systemic translocation of these toxins and other pro-inflammatory bacterial products. These circulating factors subsequently promote cardiovascular pathology through the induction of systemic inflammation, oxidative stress, endothelial dysfunction, and direct cellular toxicity in vascular and myocardial tissues. Conclusion: Gut dysbiosis is significantly and consistently associated with a wide spectrum of adverse cardiovascular outcomes in patients with ESRD. These findings underscore the gut as a central organ in the pathophysiology of uremic cardiovascular disease and highlight the gut-kidney-heart axis as a crucial therapeutic target for mitigating the excessive cardiovascular risk in this vulnerable population.

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Indra Hadi

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profesionaljournalmedicine@gmail.com

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Journal Mail Official
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Editorial Address
Equity Tower. 49th Floor. Sudirman Street. Special Region of Jakarta, Indonesia

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Kota adm. jakarta selatan,

Dki jakarta

INDONESIA