Negotiating renal dysfunction when treating patients with heart failure

Abstract

Chronic kidney disease (CKD) is one of the most prevalent comorbidities in HF, and no specific treatment is still available for the so-called cardiorenal syndrome. Areas covered: The aim of this review is to describe the interaction of heart and kidney function and the consequences of cardiorenal syndrome, focusing on the use of available therapeutics. Expert commentary: The presence of CKD has been associated with adverse outcomes in HF regardless of ejection fraction. On the other hand, cardiovascular events are the most common causes of morbidity and mortality among CKD patients, reflecting the close pathophysiological crosstalk between these organs. Multiple mechanisms are involved in the development of cardiorenal syndrome, including hemodynamic, neurohormonal and inflammatory mediators. The management of several HF drugs is a challenge in the presence of CKD mainly due to blunted diuretic response and increased risk of worsening of kidney function. Therefore, finding a balance between the optimization of cardiac and renal outcomes is a real negotiation in the everyday clinical practice.

Haemodynamic parameters associated with renal function prior to and following heart transplantation

“…Median time between right heart catheterization and HT was 4.5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) months. Mean eGFR decreased by 7.9 ± 29.7 mL/ min/1.73 m 2 at 6 months after HT, with substantial intergroup differences according to eGFR and cardiac index at the time of heart catheterization (Table 3).…”

“…1,2 The pathophysiology of renal impairment in the setting of HF reportedly includes age, underlying co-morbidities (especially hypertension and diabetes), and also specific HF factors such as reduced renal blood flow, ncreased central venous pressure (CVP), and reduced systemic blood pressure. 3 Central venous pressure has been deemed to be an independent key factor associated with impaired renal function in patients with a wide range of heart diseases and especially HF. [4][5][6] Surprisingly, low cardiac index, which has initially been emphasized as a central driver of cardiorenal interactions, 7 does not appear to be strongly associated with renal function 4,5 especially when competing with other haemodynamic variables.…”

“…Glomerular filtration rate (GFR) below 60 mL/min/1.73 m 2 is observed in 30–50% of patients with HF 1,2 . The pathophysiology of renal impairment in the setting of HF reportedly includes age, underlying co‐morbidities (especially hypertension and diabetes), and also specific HF factors such as reduced renal blood flow, ncreased central venous pressure (CVP), and reduced systemic blood pressure 3 …”

The ‘diamond’ approach to personalized drug treatment of heart failure with reduced ejection fraction

“…CKD and HF often coexist, with CKD being present in 40-50% of chronic HF patients [101]. In addition to hemodynamic disturbances, the continuous activation of the SNS and RAAS also played a crucial role in CKD [102,103].…”

Characteristics of the Chronic Heart Failure Course and Target Organ Condition in Cardiorenal Syndrome

“…Особенности ремоделирования артериальной стенки в условиях ХСН и ХБП иссле-дованы недостаточно и носят противоречивый харак-тер. Представленные спорные вопросы затрудняют адекватный выбор терапии больных ХСН и ИБС, который требует также обеспечения и нефропротек-тивного эффекта лечения [5]. Следовательно, меди-каментозные возможности влияния на прогноз боль-ных кардиоренальным синдромом ограничены.…”