Cardiovascular Alterations and Structural Changes in the Setting of Chronic Kidney Disease: a Review of Cardiorenal Syndrome Type 4

Abstract

Cardiovascular and renal physiology are interrelated. More than a decade ago this was codified in guidelines defining the five subtypes of the cardiorenal syndrome. Morbidity and mortality for those with the cardiorenal syndrome is high compared to demographically matched individuals without cardiorenal disease, acute or chronic. The focus of this review will be the epidemiology, the impact of chronic kidney disease on cardiac structure and function, and associated clinical symptoms, outcomes, and potential treatments for patients with chronic reno-cardiac syndrome, or cardiorenal syndrome type 4. Cardiac structural changes can be profound and are described in detail both at a cellular and physiologic level. Integrating therapies for the treatment of causative or resulting comorbidities may ultimately slow progression of both cardiac and renal disease as well as minimize symptoms and death.

Mitochondrial Impairment: A Link for Inflammatory Responses Activation in the Cardiorenal Syndrome Type 4

“…DAMPs and mtDAMPs can also trigger endothelial dysfunction and affect cellular membranes and mitochondria of the heart cells, resulting in premature cell death in the form of apoptosis and necrosis [132]. In cardiac diseases, necrotic cell death further exacerbates the upregulation of proinflammatory cytokines and chemokines and the recruitment of inflammatory cells such as neutrophils, macrophages, and mast cells, thereby worsening inflammation [133].…”

Cardiac transcriptomic changes induced by early CKD in mice reveal novel pathways involved in the pathogenesis of Cardiorenal syndrome type 4

“…CKD affects more than 10% of the general population worldwide and is a significant cause of mortality [ 4 ]. Cardiovascular disease (CVD) is more prevalent among the CKD population, with many patients dying from CVD complications [ [5] , [6] , [7] , [8] ]. Hence, understanding the pathophysiological processes associated with CKD and its cardiac consequences is vital to improving the prevention, diagnosis, and treatment of CRS type 4.…”