Practical approaches to building up a cardiorenal clinic

Abstract

The population with concomitant heart and kidney disease (often termed “cardiorenal” disease) is expected to grow, significantly impacting public health and health care utilization. Moreover, the cardiorenal nexus encompasses a bidirectional relationship that worsens prognosis and may complicate pharmacological management in often elderly and frail patients. Therefore, a more cohesive multidisciplinary team approach aiming to provide holistic, coordinated, and specialized care would be a positive shift toward improving patient outcomes and optimizing healthcare resources. This document aims to define the organizational aspects and the key elements for setting up a multidisciplinary cardiorenal clinical program as a potential healthcare model adapted to the particular characteristics of patients with cardiorenal disease.

Practical requirements for the development of an advanced cardiorenal unit

“…This necessitates training in heart and kidney disease and the creation of specific units to treat affected patients in a more complete and comprehensive manner. Multidisciplinary units, comprising mainly cardiologists and nephrologists, could fulfill an unmet medical need, with a considerable impact on healthcare [23][24][25][26][27].…”

Cardiorenal syndrome and diabetes: an evil pairing

“…Although CRS definition and its subtypes has not changed, several authors have been published about its pathophysiology, diagnostic tools—including biomarkers and imaging tests—as well as pharmacological treatment and the need for a multidisciplinary approach through cardiorenal units (CRU) ( 9 , 10 ).…”

Hospitalizations for fluid overload and heart failure among individuals with diabetes: healthcare utilization and guideline-directed medical therapy

“…In ‘Practical approaches to building up a cardiorenal clinic’ by Espriella et al ., the authors recognized the burgeoning population with concomitant cardiovascular and kidney disease which will require significant healthcare resources [ 1 ]. Such cardiorenal disease is prevalent in diabetes.…”

“…Additionally, interactions between deranged organ systems can further exacerbate cardiovascular and kidney dysfunction bidirectionally, and result in cardiorenal syndrome. Common complications of the cardiorenal syndrome are kidney sodium avidity and fluid retention which may manifest as fluid overload and/or decompensated heart failure [ 2 ], and differentiating these conditions in kidney disease remains challenging [ 1 , 2 ].…”

“…The cardiorenal program implemented by Espriella et al . similarly emphasized optimization of pharmacological treatment and patient-centered care in transitioning between different levels of care [ 1 ]. In addition to the outcome and process indicators described, cardiorenal programs should also use patient-reported outcome measures related to health literacy, self-management and health-related quality of life to reflect the quality of patient-centered care.…”