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Acute Cardiorenal Syndrome in Heart Failure: from Dogmas to Advances

  • Heart Failure (HJ Eisen, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review aims to summarize our current understanding and management strategies of acute cardiorenal syndrome (CRS).

Recent Findings

The definition of acute CRS remains debated, in part due to the lack of reliable insights into salt and water handling of the kidneys beyond impairment in glomerular filtration. Protocolized use of loop diuretics to ensure adequate delivery to their target of action, as well as segmental tubular blockade with adjunctive use of thiazide diuretics, acetazolamide, amiloride, or sodium-glucose transporter 2 (SGLT2) inhibitors, may result in more effective natriuresis in patients with acute CRS who exhibit diuretic resistance. Other strategies, such as modulating renal sodium avidity with the use of hypertonic saline, reduction of intra-abdominal pressure, or device-based salt and volume removal, are promising and warrant further investigation.

Summary

Acute CRS remains a significant contributor of morbidity and mortality for the acute heart failure population. New strategies have challenged current dogmas in our understanding of its pathophysiology, which may lead to potential new treatment approaches.

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Funding

Dr. Tang is partially supported by grants from the National Institutes of Health and the Office of Dietary Supplements (R01HL103931, R01DK106000, R01HL126827).

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  1. Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA

    W. H. Wilson Tang & Alan Kiang

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Correspondence to W. H. Wilson Tang.

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Alan Kiang declares that he has no conflict of interest.

W.H. Wilson Tang is a consultant for Sequana Medical A.G., has received honorarium from Springer Nature for authorship/editorship, and has received personal fees from the American Board of Internal Medicine.

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Tang, W.H.W., Kiang, A. Acute Cardiorenal Syndrome in Heart Failure: from Dogmas to Advances. Curr Cardiol Rep 22, 143 (2020). https://doi.org/10.1007/s11886-020-01384-0

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