A Call to Action to Develop Integrated Curricula in Cardiorenal Medicine

Abstract

With the adoption of the new definition and classification of cardiorenal syndrome (CRS) and its relevant subtypes, much attention has been placed on elucidating the mechanisms of heart and kidney interactions. Of great interest are the pathophysiological pathways by which acute heart failure may result in acute kidney injury (AKI; type 1), chronic heart failure accelerating the progression of chronic kidney disease (CKD; type 2), AKI provoking cardiac events (type 3), and CKD increasing the risk and severity of cardiovascular disease (type 4). A remarkable interest has also been placed on the acute and chronic systemic conditions, such as sepsis and diabetes, which simultaneously affect heart and kidney function (type 5). Furthermore, the physiology of acute and chronic heart-kidney cross talk is drawing attention to hemodynamics (fluids, pressures, flows, resistances, perfusion), physiochemical (electrolytes, pH, and toxins), and biological (inflammation, immune system activation, neurohormonal signals) processes. Common clinical scenarios call for recognition, knowledge, and skill in managing CRS. There is a clear need for medical and surgical specialists that are well versed in the pathophysiology and the clinical manifestations that arise in the setting of CRS. With this editorial, we are making a call to action to stimulate universities, medical schools, and teaching hospitals to create a core curriculum for cardiorenal medicine to better equip the physicians of the future for these common, serious, and frequently fatal syndromes.

Key Updates in Cardio-Nephrology from 2018: Springboard to a Bright Future

“…Obtaining high-quality data unique to this subset of patients is the biggest service that can ultimately be provided by cardiologists and nephrologists caring for patients with cardiorenal disease. Given the widening scope of the field of cardio-nephrology, efforts to create center-specific cardio-renal teams to accelerate and spearhead clinical care and research in this field are necessary to be able to train physician- scientists of the future to integrate the care of these patients in the best possible way [30, 31]. To that end, the growth of the field witnessed in 2018 is very encouraging.…”

Common but Underrated – Are we Neglecting these Hypertensive Subsets in India?

“…: Major adverse renal and cardiac events (MARCE) are strongly associated with AKI and raise the possibility of strategies that reduce AKI, translating into improved clinical outcomes as measured by the time to first MARCE event in clinical trials. Reproduced with permission from reference [18]…”

“…[17] One possibility is a dedicated cardionephrology training track for fellows, involving nephrology/cardiology fellow cross rotations. [17,18] This would revive the currently declining interest in the nephrology field as well as optimize care for cardiorenal patients [ Figure 6]. [17]…”

Cardionephrology: Proposal for a Futuristic Educational Approach to a Contemporary Need

“…Previously, a proposal was made for an innovative program to enhance the education of both cardiology and nephrology training [7]. As knowledge and confidence in cardiorenal medicine are critical for the physicians providing care for these complex patients, it is important to develop comprehensive, practical, and widely accepted cardionephrology curricula and incorporate these into existing nephrology training programs.…”