Cardiorenal syndrome: Prognosis and treatment
- Michael S Kiernan, MD
Michael S Kiernan, MD
- Assistant Professor of Medicine
- Tufts University Medical School
- James E Udelson, MD, FACC
James E Udelson, MD, FACC
- Professor of Medicine and Radiology
- Tufts University School of Medicine
- Mark Sarnak, MD
Mark Sarnak, MD
- Professor of Medicine
- Tufts University School of Medicine
- Marvin Konstam, MD
Marvin Konstam, MD
- Professor of Medicine
- Tufts University School of Medicine
DEFINITION AND CLASSIFICATION
There are a number of important interactions between heart disease and kidney disease. The interaction is bidirectional as acute or chronic dysfunction of the heart or kidneys can induce acute or chronic dysfunction in the other organ. The clinical importance of such relationships is illustrated by the following observations:
●Mortality is increased in patients with heart failure (HF) who have a reduced glomerular filtration rate (GFR). (See 'Reduced GFR and prognosis' below.)
●Patients with chronic kidney disease (CKD) have an increased risk of both atherosclerotic cardiovascular disease and heart failure, and cardiovascular disease is responsible for up to 50 percent of deaths in patients with renal failure [1,2]. (See "Chronic kidney disease and coronary heart disease", section on 'Introduction'.)
●Acute or chronic systemic disorders can cause both cardiac and renal dysfunction.
The term “cardiorenal syndrome” (CRS) has been applied to these interactions, but the definition and classification have not been clear. A 2004 report from the National Heart, Lung, and Blood Institute defined CRS as a condition in which therapy to relieve congestive symptoms of HF is limited by a decline in renal function as manifested by a reduction in GFR . The reduction in GFR was initially thought to result from a reduction in renal blood flow. However, various studies have demonstrated that cardiorenal interactions occur in both directions and by a variety of mechanisms . (See "Cardiorenal syndrome: Definition, prevalence, diagnosis, and pathophysiology", section on 'Pathophysiology'.)
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- DEFINITION AND CLASSIFICATION
- REDUCED GFR AND PROGNOSIS
- Reduced baseline GFR
- Change in GFR during therapy for HF
- Blood urea nitrogen
- Improvement in cardiac function
- Renin-angiotensin-aldosterone-system antagonism
- Inotropic drugs
- Investigational therapies