Cardiology Letters 2023, 32(4):281-291

Chronic cardiorenal syndrome

Vaszilyová L

II. kardiologickej klinika VÚSCH, a. s. a LF UPJŠ, Košice, Slovenská republika

The coexistence of cardiac and renal diseases is becoming more common in clinical practice. Patients with current cardiac and renal impairment have significantly higher morbidity and mortality. Cardiorenal syndrome is defined as impaired heart and kidney function, where acute or chronic dysfunction of one organ can induce acute or chronic dysfunction in the other, and it is divided into five subtypes. In chronic cardiorenal syndrome, chronic heart failure leads to damage or dysfunction of the kidneys. Several mechanisms are involved in the pathophysiology of cardiorenal syndrome: increased central venous and intraabdominal pressure, decreased cardiac output and cardiac index, neurohormonal dysregulation (activation of the sympathetic nervous system, renin-angiotensin-aldosterone system), oxidative stress, anemia, endocrine dysregulation, pro-inflammatory mediators and protein-binding uremic toxins. The cooperation of cardiologist and nephrologist is necessary in the diagnostic process and treatment of cardiorenal syndrome, while echocardiographic examination and ultrasonographic examination of the kidneys are the gold standard among imaging methods. The management and treatment of heart failure is based on the recommendations of the European Society of Cardiology for the diagnosis and treatment of acute and chronic heart failure. The treatment of chronic heart failure with concomitant renal impairment is not based on sufficient evidence, as these patients are generally excluded from the studies. Diuretic resistance is a clinical problem, which is common in these patients. Patients with advanced cardiorenal syndrome have a low quality of life and high mortality. They require a multidisciplinary approach, which should include palliative care.

Keywords: cardiorenal syndrome; heart failure; chronic kidney disease

Published: April 1, 2023  Show citation