{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:48:53Z","timestamp":1791996533377,"version":"4.4.0"},"reference-count":45,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiorenal Med"],"abstract":"<jats:p>Introduction: Ceramides and chronic kidney disease (CKD) independently associate with coronary microvascular dysfunction (CMD), but their combined association remains unestablished, warranting investigation. Methods: This cross-sectional analysis included coronary artery disease (CAD) patients from the CRUISE-MET trial (NCT06383208) who underwent coronary angiography and ceramide profiling measurement. The microvascular resistance was assessed in all patients using the angiography-derived microcirculatory resistance (AMR). CKD was classified based on both estimated glomerular filtration rate and urine albumin-to-creatinine ratio. The combined associations and statistical mediation of ceramides and renal dysfunction on CMD was examined, with sensitivity analyses to ensure the robustness. Results: In this analysis of 794 CAD patients, CKD patients demonstrated significantly higher AMR values (2.56 \u00b1 0.51 vs. 2.46 \u00b1 0.48, p = 0.003) and CMD prevalence (57.1% vs. 41.7%, p &lt; 0.001). Three ceramide species \u2013 Cer(18:1\/16:0), Cer(18:1\/18:0), and Cer(18:1\/24:1) \u2013 showed strong positive correlations with AMR (all p &lt; 0.05). LASSO regression identified 14 factors associated with CMD, with E\/e\u2032, CKD, and Cer(18:1\/16:0) emerging as top correlates. Cer(18:1\/16:0) demonstrated superior predictive performance (area under the curve [AUC] = 0.609, 95% CI: 0.570\u20130.648, p &lt; 0.001), with its addition to baseline models significantly improving reclassification (\u03b4AUC = 0.03, p = 0.010; cNRI&gt;0 = 0.23, p &lt; 0.001; integrated discrimination improvement = 0.03, p &lt; 0.001). Notably, patients with concurrent CKD and elevated Cer(18:1\/16:0) exhibited significantly higher odds of CMD (OR = 3.74, 95% CI: 2.39\u20135.84). Statistical mediation analysis suggested that Cer(18:1\/16:0) mediated 13.8% of the association between CKD and CMD. Conclusion: Ceramides, particularly Cer(18:1\/16:0), partially mediated the statistical association between CKD and CMD. These findings highlight the potential role of sphingolipid metabolism in cardiorenal pathophysiology.<\/jats:p>","DOI":"10.1159\/000552268","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T16:01:17Z","timestamp":1777564877000},"page":"321-333","source":"Crossref","is-referenced-by-count":3,"title":["Chronic Kidney Disease, Circulating Ceramides, and Coronary Microvascular Dysfunction: Insights from the CRUISE-MET 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