The Cardiorenal Syndrome: A Narrative Review
Cardiorenal Syndrome
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https://doi.org/10.5281/zenodo.13339945Keywords:
Cardiorenal syndrome, heart failure, kidney disease, heart, kidneyAbstract
Cardiorenal syndrome is a multifaceted condition characterized by the interdependent dysfunction of the heart and kidneys, where pathology in one organ may precipitate or exacerbate dysfunction in the other, whether in acute or chronic forms. This syndrome underscores the complex bidirectional interactions between the cardiac and renal systems, including the hemodynamic interplay and the reciprocal physiological responses. It also involves alterations in neurohormonal and inflammatory biomarkers that are pertinent to its various clinical manifestations. This review offers a comprehensive analysis of CRS, focusing on its pathophysiological mechanisms, diagnostic approaches, and therapeutic strategies.
References
National Heart, Lung and BINWG. cardiorenal connections in heart failure and cardiovascular disease, 2004. Published 2004. https://www.nhlbi.nih.gov/events/2004/cardio-renal-connections-heartfailure-and-cardiovascular-disease.
Ronco C, McCullough P, Anker SD, et al. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J. 2010;31(6):703-711. doi:10.1093/eurheartj/ehp507
Georgopoulou T, Petrakis I, Dermitzaki K, et al. Cardiorenal Syndrome: Challenges in Everyday Clinical Practice and Key Points towards a Better Management. J Clin Med. 2023;12(12):4121. Published 2023 Jun 18. doi:10.3390/jcm12124121
Thind GS, Loehrke M, Wilt JL. Acute cardiorenal syndrome: Mechanisms and clinical implications. Cleve Clin J Med. 2018;85(3):231-239. doi:10.3949/ccjm.85a.17019
Rangaswami J, Bhalla V, Blair JEA, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. 2019;139(16):e840-e878. doi:10.1161/CIR.0000000000000664
Thanapongsatorn P, Tanomchartchai A, Assavahanrit J. Long-term outcomes of acute kidney injury in acute decompensated heart failure: identifying true cardiorenal syndrome and unveiling prognostic significance. Kidney Res Clin Pract. 2024;43(4):480-491. doi:10.23876/j.krcp.23.323
Savira F, Magaye R, Liew D, et al. Cardiorenal syndrome: Multi-organ dysfunction involving the heart, kidney and vasculature. Br J Pharmacol. 2020;177(13):2906-2922. doi:10.1111/bph.15065
Hatamizadeh P, Fonarow GC, Budoff MJ, Darabian S, Kovesdy CP, Kalantar-Zadeh K. Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol. 2013;9(2):99-111. doi:10.1038/nrneph.2012.279
Ricci Z, Cruz DN, Ronco C. Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria. Nat Rev Nephrol. 2011;7(4):201-208. doi:10.1038/nrneph.2011.14
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-c184. doi:10.1159/000339789
Mahenthiran A, Wilcox J, Tang WHW. Heart Failure: a Punch from the Gut. Curr Heart Fail Rep. 2024;21(2):73-80. doi:10.1007/s11897-024-00648-y
Kopp UC. Role of renal sensory nerves in physiological and pathophysiological conditions. Am J Physiol Regul Integr Comp Physiol. 2015;308(2):R79-R95. doi:10.1152/ajpregu.00351.2014
Carey RM. Update on angiotensin AT2 receptors. Curr Opin Nephrol Hypertens. 2017;26(2):91-96. doi:10.1097/MNH.0000000000000304
Gallo G, Lanza O, Savoia C. New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy. Int J Mol Sci. 2023;24(6):5089. Published 2023 Mar 7. doi:10.3390/ijms24065089
Rademaker MT, Pilbrow AP, Ellmers LJ, et al. Acute Decompensated Heart Failure and the Kidney: Physiological, Histological and Transcriptomic Responses to Development and Recovery. J Am Heart Assoc. 2021;10(18):e021312. doi:10.1161/JAHA.121.021312
Forrester SJ, Booz GW, Sigmund CD, et al. Angiotensin II Signal Transduction: An Update on Mechanisms of Physiology and Pathophysiology. Physiol Rev. 2018;98(3):1627-1738. doi:10.1152/physrev.00038.2017
Haase M, Müller C, Damman K, et al. Pathogenesis of cardiorenal syndrome type 1 in acute decompensated heart failure: workgroup statements from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol. 2013;182:99-116. doi:10.1159/000349969
Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol. 2009;53(7):582-588. doi:10.1016/j.jacc.2008.08.080
Balcı E, Özay HY. Age, body mass index, and diabetes mellitus are associated with an increased risk of acute kidney injury after coronary surgery: Retrospective cohort study. J Surg Med. 2022;6(6):619-622. doi:10.28982/josam.1112206
Pokhrel N, Maharjan N, Dhakal B, Arora RR. Cardiorenal syndrome: A literature review. Exp Clin Cardiol. 2008;13(4):165-170.
Levey AS, Eckardt KU, Dorman NM, et al. Nomenclature for kidney function and disease: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int. 2020;97(6):1117-1129. doi:10.1016/j.kint.2020.02.010
Mullens W, Damman K, Testani JM, et al. Evaluation of kidney function throughout the heart failure trajectory - a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020;22(4):584-603. doi:10.1002/ejhf.1697
Benoit SW, Ciccia EA, Devarajan P. Cystatin C as a biomarker of chronic kidney disease: latest developments. Expert Rev Mol Diagn. 2020;20(10):1019-1026. doi:10.1080/14737159.2020.1768849
Chen DC, Potok OA, Rifkin D, Estrella MM. Advantages, Limitations, and Clinical Considerations in Using Cystatin C to Estimate GFR. Kidney360. 2022;3(10):1807-1814. Published 2022 Aug 23. doi:10.34067/KID.0003202022
Figurek A, Luyckx VA, Mueller TF. A Systematic Review of Renal Functional Reserve in Adult Living Kidney Donors. Kidney Int Rep. 2020;5(4):448-458. Published 2020 Jan 20. doi:10.1016/j.ekir.2019.12.021
Nayor M, Larson MG, Wang N, et al. The association of chronic kidney disease and microalbuminuria with heart failure with preserved vs. reduced ejection fraction. Eur J Heart Fail. 2017;19(5):615-623. doi:10.1002/ejhf.778
Seliger S. The Cardiorenal Syndrome: Mechanistic Insights and Prognostication with Soluble Biomarkers. Curr Cardiol Rep. 2020;22(10):114. Published 2020 Aug 8. doi:10.1007/s11886-020-01360-8
Goffredo G, Barone R, Di Terlizzi V, Correale M, Brunetti ND, Iacoviello M. Biomarkers in Cardiorenal Syndrome. J Clin Med. 2021;10(15):3433. Published 2021 Jul 31. doi:10.3390/jcm10153433
Ozyildirim S, Dogan O, Barman HA, et al. Galectin-3 as a Biomarker to Predict Cardiorenal Syndrome in Patients with Acute Heart Failure. Acta Cardiol Sin. 2023;39(6):862-870. doi:10.6515/ACS.202311_39(6).20230903A
Marakala V. Neutrophil gelatinase-associated lipocalin (NGAL) in kidney injury - A systematic review. Clin Chim Acta. 2022;536:135-141. doi:10.1016/j.cca.2022.08.029
Khawaja S, Jafri L, Siddiqui I, Hashmi M, Ghani F. The utility of neutrophil gelatinase-associated Lipocalin (NGAL) as a marker of acute kidney injury (AKI) in critically ill patients. Biomark Res. 2019;7:4. Published 2019 Feb 22. doi:10.1186/s40364-019-0155-1
Noiri E, Doi K, Negishi K, et al. Urinary fatty acid-binding protein 1: an early predictive biomarker of kidney injury. Am J Physiol Renal Physiol. 2009;296(4):F669-F679. doi:10.1152/ajprenal.90513.2008
Chen K, Chen QJ, Wang LJ, et al. Increment of HFABP Level in Coronary Artery In-Stent Restenosis Segments in Diabetic and Nondiabetic Minipigs: HFABP Overexpression Promotes Multiple Pathway-Related Inflammation, Growth and Migration in Human Vascular Smooth Muscle Cells. J Vasc Res. 2016;53(1-2):27-38. doi:10.1159/000446652
Wen X, Zhang J, Wan X, Frank AA, Qu X, Kellum JA. Tissue Inhibitor of Metalloproteinases-2 Mediates Kidney Injury during Sepsis. Nephron. 2020;144(12):644-649. doi:10.1159/000511165
Okamoto R, Ali Y, Hashizume R, Suzuki N, Ito M. BNP as a Major Player in the Heart-Kidney Connection. Int J Mol Sci. 2019;20(14):3581. Published 2019 Jul 22. doi:10.3390/ijms20143581
Gembillo G, Visconti L, Giusti MA, et al. Cardiorenal Syndrome: New Pathways and Novel Biomarkers. Biomolecules. 2021;11(11):1581. Published 2021 Oct 26. doi:10.3390/biom11111581
Tasic D, Furundzic D, Djordjevic K, Galovic S, Dimitrijevic Z, Radenkovic S. Data Analysis of Impaired Renal and Cardiac Function Using a Combination of Standard Classifiers. J Pers Med. 2023;13(3):437. Published 2023 Feb 28. doi:10.3390/jpm13030437
Rasoul D, Zhang J, Farnell E, et al. Continuous infusion versus bolus injection of loop diuretics for acute heart failure. Cochrane Database Syst Rev. 2024;5(5):CD014811. Published 2024 May 22. doi:10.1002/14651858.CD014811.pub2
Magdy JS, McVeigh J, Indraratna P. Diuretics in the management of chronic heart failure: when and how. Aust Prescr. 2022;45(6):200-204. doi:10.18773/austprescr.2022.069
Testani JM, Kimmel SE, Dries DL, Coca SG. Prognostic importance of early worsening renal function after initiation of angiotensin-converting enzyme inhibitor therapy in patients with cardiac dysfunction. Circ Heart Fail. 2011;4(6):685-691. doi:10.1161/CIRCHEARTFAILURE.111.963256
Kluger AY, Tecson KM, Lee AY, et al. Class effects of SGLT2 inhibitors on cardiorenal outcomes. Cardiovasc Diabetol. 2019;18(1):99. Published 2019 Aug 5. doi:10.1186/s12933-019-0903-4
Salvatore T, Galiero R, Caturano A, et al. An Overview of the Cardiorenal Protective Mechanisms of SGLT2 Inhibitors. Int J Mol Sci. 2022;23(7):3651. Published 2022 Mar 26. doi:10.3390/ijms23073651
DeFronzo RA, Reeves WB, Awad AS. Pathophysiology of diabetic kidney disease: impact of SGLT2 inhibitors. Nat Rev Nephrol. 2021;17(5):319-334. doi:10.1038/s41581-021-00393-8
Verbrugge FH, Martens P, Ameloot K, et al. Spironolactone to increase natriuresis in congestive heart failure with cardiorenal syndrome. Acta Cardiol. 2019;74(2):100-107. doi:10.1080/00015385.2018.1455947
Stubnova V, Os I, Grundtvig M, Atar D, Waldum-Grevbo B. Spironolactone Treatment and Effect on Survival in Chronic Heart Failure Patients with Reduced Renal Function: A Propensity-Matched Study. Cardiorenal Med. 2017;7(2):128-136. doi:10.1159/000454933
Lee WC, Liao TW, Chen TY, et al. Sacubitril/valsartan improves all-cause mortality in heart failure patients with reduced ejection fraction and chronic kidney disease. Cardiovasc Drugs Ther. 2024;38(3):505-515. doi:10.1007/s10557-022-07421-0
Damman K, Gori M, Claggett B, et al. Renal Effects and Associated Outcomes During Angiotensin-Neprilysin Inhibition in Heart Failure. JACC Heart Fail. 2018;6(6):489-498. doi:10.1016/j.jchf.2018.02.004
González-Juanatey JR, Górriz JL, Ortiz A, Valle A, Soler MJ, Facila L. Cardiorenal benefits of finerenone: protecting kidney and heart. Ann Med. 2023;55(1):502-513. doi:10.1080/07853890.2023.2171110
D'Marco L, Puchades MJ, Gandía L, et al. Finerenone: A Potential Treatment for Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus. touchREV Endocrinol. 2021;17(2):84-87. doi:10.17925/EE.2021.17.2.84
Agarwal R, Kolkhof P, Bakris G, et al. Steroidal and non-steroidal mineralocorticoid receptor antagonists in cardiorenal medicine. Eur Heart J. 2021;42(2):152-161. doi:10.1093/eurheartj/ehaa736
Bakris GL, Agarwal R, Anker SD, et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020;383(23):2219-2229. doi:10.1056/NEJMoa2025845
Pitt B, Filippatos G, Agarwal R, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021;385(24):2252-2263. doi:10.1056/NEJMoa2110956
Wu MY, Chen TT, Chen YC, et al. Effects and safety of oral tolvaptan in patients with congestive heart failure: A systematic review and network meta-analysis [published correction appears in PLoS One. 2019 Apr 11;14(4):e0215624. doi: 10.1371/journal.pone.0215624]. PLoS One. 2017;12(9):e0184380. Published 2017 Sep 12. doi:10.1371/journal.pone.0184380
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