The Cardiorenal Connection: Is Cardiac Output the Sole Determinant of Renal Dysfunction in Cirrhosis?

Abstract

Hemodynamic abnormalities are the hallmarks of advanced cirrhosis. An increased cardiac output maintains hemodynamic stability until the very late stage of cirrhosis, when the cardiac output starts to fall, which has been attributed to the development of renal dysfunction in these patients. The study by Daniesen showed that cardiac output was increased rather than decreased in patients with hepatorenal syndrome-acute kidney injury, potentially conflicting with previous understanding. It is possible that the authors were only assessing 1 aspect of cardiac dysfunction in a group of patients who were not at the very end stage of cirrhosis. Their unexpected findings will certainly stimulate further research into the role of cardiac dysfunction in the pathogenesis of acute kidney injury in cirrhosis.

Cardiac dysfunction in patients with cirrhosis and acute decompensation

“…In addition, those with HRS‐AKI and ACLF were characterised by an additional increase in CO and CI, although the sample size was only five patients 40 . A possible explanation for the contrasting results is that this study used phase‐contact magnetic resonance imaging (MRI) to quantify macrovascular flow which has been found to be comparable to right heart catheterisations, whereas previous imaging techniques may have underestimated CO 41 . The caveat for interpretation of this data is that the numbers with advanced ACLF and decompensation in this study were very small, and thereby the results may not be reflective of a larger, similar population.…”