Skip to main content

Advertisement

SpringerLink
Log in

Cardio-renal syndromes: from foggy bottoms to sunny hills

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

“Cardio-renal syndromes” (CRS) are disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The current definition has been expanded into five subtypes whose etymology reflects the primary and secondary pathology, the time-frame and simultaneous cardiac and renal co-dysfunction secondary to systemic disease: CRS type I: acute worsening of heart function (AHF-ACS) leading to kidney injury and/or dysfunction. CRS type II: chronic abnormalities in heart function (CHF-CHD) leading to kidney injury or dysfunction. CRS type III: acute worsening of kidney function (AKI) leading to heart injury and/or dysfunction. CRS type IV: chronic kidney disease (CKD) leading to heart injury, disease and/or dysfunction. CRS type V: systemic conditions leading to simultaneous injury and/or dysfunction of heart and kidney. These different subtypes may have a different pathophysiological mechanism and they may represent separate entities in terms of prevention and therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Dar O, Cowie MR (2008) Acute heart failure in the intensive care unit: epidemiology. Crit Care Med 36(1 Suppl):S3–S8

    Article  PubMed  Google Scholar 

  2. Schrier RW (2007) Cardiorenal versus reno-cardiac syndrome: is there a difference? Nat Clin Pract Nephrol 3:637

    Article  PubMed  Google Scholar 

  3. Ronco C (2008) Cardiorenal and reno-cardiac syndromes: clinical disorders in search of a systematic definition. Int J Artif Organs 31:1–2

    PubMed  CAS  Google Scholar 

  4. Liang KV, Williams AW, Greene EL, Redfield MM (2008) Acute decompensated heart failure and the cardio-renal syndrome. Crit Care Med 36(Suppl):S75–S88

    Article  PubMed  Google Scholar 

  5. Ronco C, House AA, Haapio M (2008) Cardio-renal syndrome: refining the definition of a complex symbiosis gone wrong. Intensive Care Med 34(5):957–962 Epub 2008 Feb 5

    Article  PubMed  Google Scholar 

  6. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R (2008) Cardiorenal syndrome. J Am Coll Cardiol 52(19):1527–1539

    Article  PubMed  Google Scholar 

  7. Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM, Bellomo R, Berl T, Bobek I, Cruz DN, Daliento L, Davenport A, Haapio M, Hillege H, House AA, Katz N, Maisel A, Mankad S, Zanco P, Mebazaa A, Palazzuoli A, Ronco F, Shaw A, Sheinfeld G, Soni S, Vescovo G, Zamperetti N, Ponikowski P, for the Acute Dialysis Quality Initiative (ADQI) Consensus Group (2009) Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 31:703–711

  8. Bongartz LG, Cramer MJ, Doevendans PA, Joles JA, Braam B (2005) The severe cardio-renal syndrome: ‘Guyton revisited’. Eur Heart J 26:11–17

    Article  PubMed  Google Scholar 

  9. Kelly KJ (2006) Acute renal failure: much more than a kidney disease. Semin Nephrol 26:105–113

    Article  PubMed  CAS  Google Scholar 

  10. Berl T, Henrich W (2006) Kidney–heart interactions: epidemiology, pathogenesis, and treatment. Clin J Am Soc Nephrol 1:8–18

    Article  PubMed  CAS  Google Scholar 

  11. Kramer BK, Schweds F, Riegger GA (1999) Diuretic treatment and diuretic resistance in heart failure. Am J Med 106:90–96

    Article  PubMed  CAS  Google Scholar 

  12. Mebazaa A, Gheorghiade M, Pina IL (2008) Practical recommendations for prehospital and early in-hospital management of patients presentign with acute heart failure syndromes. Crit Care Med 36(Suppl):S129–S139

    Article  PubMed  Google Scholar 

  13. Haldeman GA (1999) Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995. Am Heart J 137:352–360

    Article  PubMed  CAS  Google Scholar 

  14. Adams KF, Fonarow GC, Emerman CL (2005) Characteristics and outcome of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100, 000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149:209–216

    Article  PubMed  Google Scholar 

  15. Fonarow GC, Gattis Stough W, Abraham WT et al (2007) Characteristics, treatments and outcomes of patients with preserved systolic function hospitalized for heart failure. J Am Coll Cardiol 50:768–777

    Article  PubMed  Google Scholar 

  16. Jose P, Skali H, Anavekar N et al (2006) Increase in creatinine and cardiovascular risk in patients with systolic dysfunction after myocardial infarction. J Am Soc Nephrol 17:2886–2891

    Article  PubMed  CAS  Google Scholar 

  17. Goldberg A, Hammerman H, Petcherski S et al (2005) In-hospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction. Am Heart J 150:330–337

    Article  PubMed  Google Scholar 

  18. Tokuyama H, Kelly DJ, Zhang Y et al (2007) Macrophage infiltration and cellular proliferation in the non-ischemic kidney and heart following prolonged unilateral renal ischemia. Nephron Physiol 106:p54–p62

    Article  PubMed  Google Scholar 

  19. Ellison DH (1999) Diuretic resistance: physiology and therapeutics. Semin Nephrol 19:581–597

    PubMed  CAS  Google Scholar 

  20. Almeshari K, Ahlstrom NG, Capraro FE et al (1993) A volume independent component to post diuretic sodium retention in humans. J Am Soc Nephrol 102:450–458

    Google Scholar 

  21. Howard PA, Dunn MI (2001) Aggressive diuresis for severe heart failure in the elderly. Chest 119:807–810

    Article  PubMed  CAS  Google Scholar 

  22. Ronco C, Costanzo MR, Bellomo R, Maisel AS (2010) Diagnosis and management of fluid overload in heart failure and cardio-renal syndromes. Contr to Nephrol Karger Basel 164

  23. Mayer J, Boldt J, Wolf MW, Lang J, Sutton S (2008) Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery. Validity of a second generation device. Anesth Analg 106:867–872

    Article  PubMed  Google Scholar 

  24. Wan L, Naka T, Uchino S, Bellomo R (2005) A pilot study of pulse contour cardiac output monitoring in patients with septic shock. Crit Care Resusc 7:165–169

    PubMed  CAS  Google Scholar 

  25. Nguyen BH, Losey T, Rasmussen BA et al (2006) Interrater reliability of cardiac output measurements by transcutaneous Doppler ultrasound: implications for non-invasive hemodynamic monitoring in the ED. Am J Emerg Med 24:828–835

    Article  PubMed  Google Scholar 

  26. Costanzo MR, Guglin ME, Saltzberg MT et al (2007) Ultrafiltration versus diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49:675–683

    Article  PubMed  CAS  Google Scholar 

  27. Verma A, Solomon SD (2007) Optimizing care of heart failure after acute myocardial infarction with an aldosterone receptor antagonist. Curr Heart Fail Rep 4:183–189

    Article  PubMed  CAS  Google Scholar 

  28. Chen ZM, Pan HC, Chen YP et al (2005) Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: a randomized placebo-controlled trial. Lancet 366:1622–1632

    Article  PubMed  CAS  Google Scholar 

  29. Yorgun H, Deniz A, Aytemir K (2008) Cardiogenic shock secondary to combination of diltiazem and sotalol. Intern Med J 38:221–222

    Article  PubMed  CAS  Google Scholar 

  30. Tessone A, Gottlieb S, Barbash IM et al (2007) Underuse of standard care and outcome of patients with acute myocardial infarction and chronic renal insufficiency. Cardiology 108:193–199

    Article  PubMed  Google Scholar 

  31. McCullough PA (2003) Beyond serum creatinine: defining the patient with renal insufficiency and why? Rev Cardiovasc Med 4(Suppl 1):S2–S6

    PubMed  Google Scholar 

  32. Damman K, Navis G, Voors AA et al (2007) Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail 13(8):599–608

    Article  PubMed  Google Scholar 

  33. Hillege HL, Nitsch D, Pfeffer MA et al (2006) Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 113:671–678

    Article  PubMed  Google Scholar 

  34. Bhatia RS, Tu JV, Lee DS et al (2006) Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 355:260–269

    Article  PubMed  CAS  Google Scholar 

  35. Jie KE, Verhaar MC, Cramer MJ et al (2006) Erythropoietin and the cardio-renal syndrome: cellular mechanisms on the cardio-renal connectors. Am J Physiol Renal Physiol 291:F392–F944

    Article  Google Scholar 

  36. Palazzuoli A, Silverberg DS, Iovine F et al (2007) Effects of beta-erythropoietin treatment of left ventricular remodelling, systolic function, and B-type natriuretic peptide levels in patients with the cardio-renal anemia syndrome. Am Heart J 154:e9–e15

    Article  PubMed  Google Scholar 

  37. Butler J, Forman DE, Abraham WT et al (2004) Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J 147:331–339

    Article  PubMed  Google Scholar 

  38. McCullough PA (2002) Cardiorenal risk: an important clinical intersection. Rev Cardiovasc Med 3:71–76

    PubMed  Google Scholar 

  39. Wright RS, Reeder GS, Herzog CA et al (2002) Acute myocardial infarction and renal dysfunction: a high-risk combination. Ann Intern Med 137:563–570

    PubMed  Google Scholar 

  40. Beattie JN, Soman SS, Sandberg KR et al (2001) Determinants of mortality after myocardial infarction in patients with advanced renal dysfunction. Am J Kidney Dis 37:1191–1200

    Article  PubMed  CAS  Google Scholar 

  41. Gibson CM, Pinto DS, Murphy SA et al (2003) Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality. J Am Coll Cardiol 42:1535–1543

    Article  PubMed  CAS  Google Scholar 

  42. Berger AK, Duval S, Krumholz HM (2003) Aspirin, beta-blocker, and angiotensin-converting enzyme inhibitor therapy in patients with end-stage renal disease and an acute myocardial infarction. J Am Coll Cardiol 42:201–208

    Article  PubMed  CAS  Google Scholar 

  43. French WJ, Wright RS (2003) Renal insufficiency and worsened prognosis with STEMI: a call for action. J Am Coll Cardiol 42:1544–1546

    Article  PubMed  Google Scholar 

  44. Levin A, Foley RN (2000) Cardiovascular disease in chronic renal insufficiency. Am J Kidney Dis 36(6 Suppl 3):S24–S30

    Article  PubMed  CAS  Google Scholar 

  45. Keltai M, Tonelli M, Mann JF et al (2007) Renal function and outcomes in acute coronary syndrome: impact of clopidogrel. Eur J Cardiovasc Pre Rehab 14:312–318

    Article  Google Scholar 

  46. Ruggenenti P, Perna A, Remuzzi G (2001) ACE inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. ramipril efficacy in nephropathy. J Am Soc Nephrol 12:2832–2837

    PubMed  CAS  Google Scholar 

  47. Fung JW, Szeto CC, Cahn JY et al (2007) Prognostic value of renal function in patients with cardiac resynchronization therapy. In J Cardiol 122:10–16

    Google Scholar 

  48. Gheorghiade M, Niazi I, Ouyang J et al (2003) Vasorpessin-V-2 receptor blockade with tolvaptan in patients with chronic heart failure: results of a double-blind randomized trial. Circulation 107:2690–2696

    Article  PubMed  CAS  Google Scholar 

  49. Konstan MA, Gheorghiade M, Burnett JC Jr et al (2007) Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA 297:1319–1331

    Article  Google Scholar 

  50. Uchino S, Bellomo R, Goldsmith D, Bates S (2006) An assessment of the RIFLE criteria for ARF in hospitalized patients. Crit Care Med 34:1913–1917

    Article  PubMed  Google Scholar 

  51. Bagshaw SM, George C, Dinu I, Bellomo R (2007) A multicenter evaluation of the RIFLE criteria of early acute kidney injury in critically ill patients. Nephrol Dial Transpl 23:1203–1210

    Article  Google Scholar 

  52. Blake P, Hasegawa Y, Khosla MC et al (1996) Isolation of myocardial depressant factor(s) from the ultrafiltrate of heart failure patients with acute renal failure. ASAIO J 42:M911–M915

    Article  PubMed  CAS  Google Scholar 

  53. Meyer TW, Hostetter TH (2007) Uremia. N Engl J Med 357:1316–1325

    Article  PubMed  CAS  Google Scholar 

  54. Figueras J, Stein L, Diez V et al (1976) Relationship between pulmonary hemodynamics and arterial pH and carbon dioxide tension in critically ill patients. Chest 70:466–472

    Article  PubMed  CAS  Google Scholar 

  55. Brady JP, Hasbargen JA (2000) A review of the effects of acidosis on nutrition in dialysis patients. Semin Dial 13:252–255

    Article  PubMed  CAS  Google Scholar 

  56. McCullough PA, Sandberg KR (2004) Chronic kidney disease and sudden death: strategies for prevention. Blood Purif 22:136–142

    Article  PubMed  Google Scholar 

  57. Selby NM, McIntyre CW (2007) The acute cardiac effects of dialysis. Semin Dial 20:220–228

    Google Scholar 

  58. Ronco C, Bellomo R, Ricci Z (2001) Continuous renal replacement therapy in the critically ill patients. Nephrol Dial Transpl 16(Suppl):67–72

    Google Scholar 

  59. Sarnak MJ, Levey AS, Schoolwerth AC et al (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 42:1050–1065

    Article  PubMed  CAS  Google Scholar 

  60. Chertow GM, Normand SL, Silva LR, McNeil BJ (2000) Survival after acute myocardial infarction in patients with end-stage renal disease: results from the cooperative cardiovascular project. Am J Kidney Dis 35:1044–1051

    Article  PubMed  CAS  Google Scholar 

  61. Herzog CA (2002) Dismal long-term survival of dialysis patients after acute myocardial infarction: can we alter the outcome? Nephrol Dial Transpl 17:7–10

    Article  Google Scholar 

  62. KDOQI group (2003) Diagnosis and evaluation of patients with chronic kidney disease: recommendations from the National Kidney Foundation. Ann Intern Med 139:I36

    Google Scholar 

  63. Johnson DW, Craven AM, Isbel NM (2007) Modification of cardiovascular risk in hemodialysis patients: an evidence-based review. Hemodial Int 11:1–14

    Article  PubMed  Google Scholar 

  64. Logar CM, Herzog CA, Beddhu S (2003) Diagnosis and therapy of coronary artery disease in renal failure, end-stage renal disease, and renal transplant populations. Am J Med Sci 325:214–227

    Article  PubMed  Google Scholar 

  65. Collins AJ, Li S, Gilbertson DT, Liu J, Chen SC, Herzog CA (2003) Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int 87(Suppl):S24–S31

    Article  Google Scholar 

  66. Go AS, Chertow GM, Fan D et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351:1296–1305

    Article  PubMed  CAS  Google Scholar 

  67. Coresh J, Astor BC, Greene T et al (2003) Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 41:1–12

    Article  PubMed  Google Scholar 

  68. Garg AX, Clark WF, Haynes RB, House AA (2002) Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int 61:1486–1494

    Article  PubMed  Google Scholar 

  69. Keith DS, Nichol GA, Guillon CM et al (2004) Longitudinal follow up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 164:659–663

    Article  PubMed  Google Scholar 

  70. Sarnak MJ, Coronado BE, Greene T et al (2002) Cardiovascular disease risk factors in chronic renal insufficiency. Clin Nephrol 57:327–335

    PubMed  CAS  Google Scholar 

  71. al Suwaidi J, Reddan DN, Williams K et al (2002) Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation 106:974–980

    Article  PubMed  Google Scholar 

  72. Al Ahmad A, Rand WM, Manjunath G et al (2001) Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol 38:955–962

    Article  PubMed  CAS  Google Scholar 

  73. Sorensen CR, Brendorp B, Rask-Madsen C et al (2002) The prognostic importance of creatinine clearance after acute myocardial infarction. Eur Heart J 23:948–952

    Article  PubMed  CAS  Google Scholar 

  74. Tokmakova MP, Skali H, Kenchaiah S et al (2004) Chronic kidney disease, cardiovascular risk, and response to angiotensin-converting enzyme inhibition after myocardial infarction: the Survival And Ventricular Enlargement (SAVE) study. Circulation 110:3667–3673

    Article  PubMed  CAS  Google Scholar 

  75. Anavekar NS, McMurray JJ, Velazquez EJ et al (2004) Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med 351:1285–1295

    Article  PubMed  CAS  Google Scholar 

  76. McAlister FA, Ezekowitz J, Tonelli M, Armstrong PW (2004) Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation 109:1004–1009

    Article  PubMed  Google Scholar 

  77. Hjalmarson A, Goldstein S, Fegerberg B et al (2000) Effects of controlled-release metoprolol on total mortality, hospitalization, and well-being in patients with heart failure. JAMA 283:1295–1302

    Article  PubMed  CAS  Google Scholar 

  78. Cunningham PN, Dyanov HM, Park P et al (2007) Acute renal failure in endotoxemia is caused by TNF acting directly on TNF-1 receptors in kidney. J Immunol 168:5817–5823

    Google Scholar 

  79. Kumar A, Paladugu B, Mensing J, Kumar A, Parrillo JE (2007) Nitric oxide-dependent and independent mechanisms are involved in TNF-alpha induced depression of cardiac myocyte contractility. Am J Physiol Regul Integr Comp Physiol 292:R1900–R1906

    Article  PubMed  CAS  Google Scholar 

  80. Honore PM, Jamez J, Wauthier M et al (2000) Prospective evaluation of short term high volume hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med 28:3581–3587

    Article  PubMed  CAS  Google Scholar 

  81. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, The ADQI Workgroup (2004) Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the ADQI Group. Crit Care 8:R204–R212

    Article  PubMed  Google Scholar 

  82. Duke GJ (1999) Renal protective agents: a review. Crit Care Resusc 1:265–275

    PubMed  CAS  Google Scholar 

  83. Bagshaw SM, Delaney A, Haase M et al (2007) Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis. Crit Care Resusc 9:60–68

    PubMed  Google Scholar 

  84. Brunkhorst FM, Engel C, Bloos F et al (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Ospedale San Bortolo, 361000, Vicenza, Italy

    Claudio Ronco

  2. International Renal Research Institute (IRRIV), Vicenza, Italy

    Claudio Ronco

Authors
  1. Claudio Ronco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudio Ronco.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ronco, C. Cardio-renal syndromes: from foggy bottoms to sunny hills. Heart Fail Rev 16, 509–517 (2011). https://doi.org/10.1007/s10741-011-9226-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-011-9226-6

Keywords

Search

Navigation