Role of a cardio‐renal multi‐disciplinary team meeting in managing cardiovascular risk in patients on kidney transplant waitlists

Junarta, Joey; Fernández, María Cespón; Chung, Isaac; Salha, Ahmad; Francheska, Bayiha D. Klaud; Lowe-Jones, Racquel; Sharma, Rajan; Firoozi, Sami; Banerjee, Debasish

doi:10.1111/ctr.14061

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…A multidisciplinary cardiology-nephrology service with doctors and specialist nurses in the United Kingdom has demonstrated better utilization of evidence-based therapy and health care resources (51). A similar multidisciplinary meeting for prekidney transplant patients, with cardiologists, nephrologists, transplant surgeons, and specialist nurses, showed that high-cardiac-risk patients can be safely transplanted (52).…”

Section: Multidisciplinary Carementioning

confidence: 99%

Management of Heart Failure Patient with CKD

Banerjee

Rosano

Herzog

2021

CJASN

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CKD is common in patients with heart failure, associated with high mortality and morbidity, which is even higher in people undergoing long-term dialysis. Despite increasing use of evidence-based drug and device therapy in patients with heart failure in the general population, patients with CKD have not benefitted. This review discusses prevalence and evidence of kidney replacement, device, and drug therapies for heart failure in CKD. Evidence for treatment with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor neprilysin inhibitors, and sodium-glucose cotransporter inhibitors in mild-to-moderate CKD has emerged from general population studies in patients with heart failure with reduced ejection fraction (HFrEF). β-Blockers have been shown to improve outcomes in patients with HFrEF in all stages of CKD, including patients on dialysis. However, studies of HFrEF selected patients with creatinine <2.5 mg/dl for ACE inhibitors, <3.0 mg/dl for angiotensin-receptor blockers, and <2.5 mg/dl for mineralocorticoid receptor antagonists, excluding patients with severe CKD. Angiotensin receptor neprilysin inhibitor therapy was successfully used in randomized trials in patients with eGFR as low as 20 ml/min per 1.73 m2. Hence, the benefits of renin-angiotensin-aldosterone axis inhibitor therapy in patients with mild-to-moderate CKD have been demonstrated, yet such therapy is not used in all suitable patients because of fear of hyperkalemia and worsening kidney function. Sodium-glucose cotransporter inhibitor therapy improved mortality and hospitalization in patients with HFrEF and CKD stages 3 and 4 (eGFR>20 ml/min per 1.73 m2). High-dose and combination diuretic therapy, often necessary, may be complicated with worsening kidney function and electrolyte imbalances, but has been used successfully in patients with CKD stages 3 and 4. Intravenous iron improved symptoms in patients with heart failure and CKD stage 3; and high-dose iron reduced heart failure hospitalizations by 44% in patients on dialysis. Cardiac resynchronization therapy reduced death and hospitalizations in patients with heart failure and CKD stage 3. Peritoneal dialysis in patients with symptomatic fluid overload improved symptoms and prevented hospital admissions. Evidence suggests that combined cardiology-nephrology clinics may help improve management of patients with HFrEF and CKD. A multidisciplinary approach may be necessary for implementation of evidence-based therapy.

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Section: Multidisciplinary Carementioning

confidence: 99%

Management of Heart Failure Patient with CKD

Banerjee

Rosano

Herzog

2021

CJASN

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“…[ 15 ] described the usefulness of a monthly cardio-nephrology meeting to provide expert consensus decision-making, reducing unnecessary outpatient visits. Specialized cardiorenal care has also been developed in other clinical scenarios with promising results, such as in hospitalized patients with concomitant heart and kidney disease or in high-risk kidney transplant candidates [ 16 , 17 ].…”

Section: The Need For Cardiorenal Programsmentioning

confidence: 99%

Practical approaches to building up a cardiorenal clinic

Espriella

Cobo

Ronco

et al. 2022

Clinical Kidney Journal

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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.

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“…Currently, the benefits of the multidisciplinary handling of patients with congestion and cardiorenal syndrome has been reported [ 19 , 20 ]. Moreover, in many hospitals, these patients are treated early by a team involving cardiologists and nephrologists in cardiorenal units.…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Congestive Nephropathy

D’Marco

2022

IJERPH

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The complex interaction between cardiac and renal functions is known. However, when these functions are disrupted, many intricate and sensitive interactions between these organs are failed by several pathophysiological ways. As a result, this malfunction is clinically evident by sign and symptoms associated to intravascular and interstitial congestion. In this sense, the adverse impact of venous congestion on renal function has long been recognized. Currently, the presence of a specific subtype of nephropathy associated to congestion has been suggested. Even though no diagnosis criteria has been clearly stablished, and no renal specific histological pattern were reported; studies regarding this issue may help to improve the handling and therapeutic principles in affected patients.

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Role of a cardio‐renal multi‐disciplinary team meeting in managing cardiovascular risk in patients on kidney transplant waitlists

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 8 publications

References 18 publications

Management of Heart Failure Patient with CKD

Management of Heart Failure Patient with CKD

Practical approaches to building up a cardiorenal clinic

Congestive Nephropathy

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