Abstract and Introduction
Abstract
Cardiorenal syndromes are disorders of the heart and kidneys whereby acute or long-term dysfunction in one organ may induce acute or long-term dysfunction of the other. The management of cardiovascular diseases and risk factors may influence, in a beneficial or harmful way, kidney function and progression of kidney injury. In this review, we assess therapeutic strategies and discuss treatment options for the management of patients with heart failure with decreased kidney function and highlight the need for future high-quality studies in patients with coexisting heart and kidney disease.
Introduction
Cardiac diseases are associated independently with a decrease in kidney function and progression of existing kidney diseases. Conversely, chronic kidney disease (CKD) represents an independent risk factor for cardiovascular events and outcomes. In both the acute setting and more long-term phase, even small decreases in GFR are associated with adverse outcome.
In patients with acute decompensated heart failure (ADHF), an acute increase in serum creatinine level >0.3 mg/dL (>26.5 μmol/L) is associated with increased mortality, longer hospital stays, and more frequent readmissions. An acute increase in serum creatinine level accompanies 21%-45% of hospitalizations for ADHF, depending on the time frame and magnitude of creatinine level increase. Decreased kidney function also is present as a significant comorbid condition in approximately 50% of patients with chronic heart failure. Clinical outcomes in heart failure populations are poor, and concomitant decreased kidney function with eGFR <60 mL/min/1.73 m significantly increases the risk of mortality. This has led to justifiable concern regarding our ability to not only prevent and manage these challenging conditions, but also cope with the huge demands on economic resources and health care workers.
The purpose of this article is to review possible therapeutic strategies in the management of patients with heart failure with decreased kidney function and highlight the need for future high-quality studies in this field to guide us. It is important to understand that the management of cardiovascular diseases and risk factors may influence, in a beneficial or harmful way, kidney function and progression of kidney injury. Anticipating and adapting to these influences may help optimize the function of both the heart and kidneys and improve patient outcomes.