Cardiorenal Syndrome

Abstract

SummaryCardiorenal syndromes (CRSs) with bidirectional heart-kidney signaling are increasingly being recognized for their association with increased morbidity and mortality. In acute CRS, recognition of the importance of worsening kidney function complicating management of acute decompensated heart failure has led to the examination of this specific outcome in the context of acute heart failure clinical trials. In particular, the role of fluid overload and venous congestion has focused interest in the most effective use of diuretic therapy to relieve symptoms of heart failure while at the same time preserving kidney function. Additionally, many novel vasoactive therapies have been studied in recent years with the hopes of augmenting cardiac function, improving symptoms and patient outcomes, while maintaining or improving kidney function. Similarly, recent advances in our understanding of the pathophysiology of chronic CRS have led to reanalysis of kidney outcomes in pivotal trials in chronic congestive heart failure, and newer trials are including changes in kidney function as well as kidney injury biomarkers as prospectively monitored and adjudicated outcomes. This paper provides an overview of some new developments in the pharmacologic management of acute and chronic CRS, examines several reports that illustrate a key management principle for each subtype, and discusses opportunities for future research.

NT-ProBNP and Troponin T and Risk of Rapid Kidney Function Decline and Incident CKD in Elderly Adults

“…Cardiorenal syndrome is the complex bidirectional relationship between HF and kidney disease (45). Many mechanisms have been proposed to explain cardiorenal syndrome, including altered hemodynamics (from both poor cardiac output and venous congestion) (46), alterations in the sympathetic nervous system and the renin-angiotensin-aldosterone system, inflammation, oxidative stress, and atherosclerosis (47,48). Although we cannot determine the mechanism leading to elevations in NT-proBNP and/or TnT in our study population, it is plausible that elevations in these biomarkers reflect early changes in volume and cardiac stretch, venous congestion, subclinical atherosclerosis, or myocardial ischemia, which may contribute to decline in kidney function.…”

Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

“…More recent clinical data have focused on venous congestion in heart failure (3), where central venous pressures (CVP), but not cardiac output or pulmonary capillary wedge pressures, are associated with renal dysfunction (4). Consequently, the current concept of the cardiorenal syndrome, typically used to describe renal injury in the setting of poor arterial flow due to left ventricular dysfunction, is being modified to include venous congestion (5)(6)(7)(8)(9) and right ventricular function (10). Whether venous congestion is similarly associated with poor renal outcomes in other populations is not known.…”

The prevalence of renal dysfunction and its influence on the prognosis of patients with acute heart failure

“…(2015), ОПП ассоциировалось с увеличени-ем относительного риска смерти в 1,81 раза (ОР 95 % 1,81 [1,12]; р<0,001) [29]. Частота ОПП в нашем исследовании составила 9,9 % и ассоциировалась не толь-ко с увеличением частоты наступления комбинированной первичной точки (р=0,007) и повторных госпитализации в связи с ОСН (р=0,005), но также частоты случаев насту-пления смерти (p<0,001), ОПП увеличивала риск повтор-ной госпитализации в связи с ОСН в 8 раз (ОР 95 % 8,377 [1,996]; р=0,007) и многократно повышала риск смерти (ОР 95 % 9,956 [3,652]; р<0,001).…”

“…Increases in MAU to >300 mg / l were associated with an unfavorable prognosis; the endpoint was observed in 81.8 % of such patients and ОРИГИНАЛЬНЫЕ СТАТЬИ § Р аспространенность СН и хронических заболеваний почек неуклонно возрастает и будет увеличиваться в дальнейшем в связи со старением населения и улуч-шением лечения СН и заболеваний почек. Поражение почек как органа-мишени часто встречается у паци-ентов с ССЗ, что активирует каскад патологических механизмов в почках и усугубляет прогноз ССЗ [1][2][3][4][5]. Сердечная недостаточность является ФР для развития хронической болезни почек и наоборот, в то же время два этих состояния довольно часто сосуществуют [6].…”