Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative

Ronco, Claudio; McCullough, P. R.; Anker, Stefan D.; Anand, Inder S.; Aspromonte, Nadia; Bagshaw, Sean M.; Bellomo, Rinaldo; Berl, Tomás; Bobek, Ilona; Cruz, Dinna N.; Daliento, Luciano; Davenport, Andrew; Haapio, Mikko; Hillege, Hans L.; House, Andrew A.; Katz, Nevin M.; Maisel, Alan S.; Mankad, Sunil; Zanco, Pierluigi; Mebazaa, Alexandre; Palazzuoli, Alberto; Ronco, Federico; Shaw, Andrew; Sheinfeld, Geoff; Soni, Sachin; Vescovo, Giorgio; Zamperetti, Nereo; Ponikowski, Piotr

doi:10.1093/eurheartj/ehp507

Cited by 826 publications

(682 citation statements)

References 132 publications

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“…Age, baseline renal dysfunction, and clinical evidence of heart failure or hemodynamic instability were major determinants of AKI risk in all STEMI patients. These results suggest CM‐independent renal insults can explain most post‐pPCI AKI events14; therefore, AKI in the setting of pPCI likely represents 1 facet of the spectrum of the type 1 cardiorenal syndrome 15…”

Section: Discussionmentioning

confidence: 92%

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Caspi

Habib

Cohen

et al. 2017

JAHA

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BackgroundAcute kidney injury (AKI) following primary percutaneous coronary intervention (pPCI) is frequently interpreted as contrast‐induced AKI but may result from other insults. We aimed to determine the causal association of contrast material exposure and the incidence of AKI following pPCI using a control group of propensity score–matched patients with ST‐segment–elevation myocardial infarction who were not exposed to contrast material.Methods and ResultsWe studied 2025 patients with ST‐segment–elevation myocardial infarction who underwent pPCI and 1025 patients receiving fibrinolysis or no reperfusion who were not exposed to contrast material during the first 72 hours of hospital stay (control group). AKI was defined as creatinine of ≥0.5 mg/dL or >25% rise within 72 hours. AKI rates were similar in the pPCI and control groups (10.3% versus 12.1%, respectively; P=0.38). Propensity score matching resulted in 931 matched pairs with PCI and no PCI, with balanced baseline covariates (standardized difference <0.1). Among propensity score–matched patients, AKI rates were not significantly different with and without PCI (8.6% versus 10.9%, P=0.12). In the pPCI cohort, independent predictors of AKI included age ≥70 years, insulin‐treated diabetes mellitus, diuretic therapy, anterior infarction, baseline estimated glomerular filtration rate, and variables related to the presence of pump failure (higher Killip class, intra‐aortic balloon pump use) and reduced left ventricular ejection fraction but not contrast material dose. A risk score based on the PCI cohort had similar discriminatory capacity for AKI in the control group (C statistic 0.81±0.02 and 0.78±0.02, respectively; P=0.26).ConclusionsThe development of AKI in patients with ST‐segment–elevation myocardial infarction undergoing pPCI is mainly related to older age, baseline estimated glomerular filtration rate, heart failure, and hemodynamic instability. Risk for AKI is similar among ST‐segment–elevation myocardial infarction patients with and without contrast material exposure.

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Section: Discussionmentioning

confidence: 92%

Acute Kidney Injury After Primary Angioplasty: Is Contrast‐Induced Nephropathy the Culprit?

Caspi

Habib

Cohen

et al. 2017

JAHA

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“…40,52 Cardio-renal syndrome Kidney and cardiac disease are common, increasingly prevalent, and frequently co-exist. 53 Evidence has accrued to show that acute/chronic cardiac disease can contribute directly to acute/chronic worsening kidney function and vice versa. Recently, a novel consensus definition/classification scheme was proposed for the cardio-renal syndrome (CRS) and its specific subtypes.…”

Section: Syndromes Of Acute Kidney Injurymentioning

confidence: 99%

“…Recently, a novel consensus definition/classification scheme was proposed for the cardio-renal syndrome (CRS) and its specific subtypes. 53 Below is a brief description of the proposed definitions and epidemiology of the CRS subtypes that overlap with AKI. Discussion of prevention and management are beyond the scope of this review.…”

Section: Syndromes Of Acute Kidney Injurymentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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“…CRS which is an interaction between cardiovascular and renal systems was described by the National Heart, Lung, and Blood Institute in 2004 as worsening of the renal function due to deterioration in left ventricular function (13). However, the classification was made with consideration of chronicity of disease and affected organs, because this description do not include details about different clinical conditions affecting the heart and kidney (14).…”

Section: Cardiorenal Syndromementioning

confidence: 99%