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The role of the kidney in acute and chronic heart failure

  • Gaetano RuoccoEmail author
  • Alberto Palazzuoli
  • Jozine M. ter Maaten
Article
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Abstract

Renal dysfunction affects approximately 30 to 50% of heart failure (HF) patients. The unfavourable relationship between heart and kidney dysfunction contributes to worse outcomes through several mechanisms such as inflammation, oxidative stress, impaired hydrosaline homeostasis, and diuretic resistance. Renal dysfunction not only carries important prognostic value both in acute and in chronic HF, but also is a potential precipitating factor after the first diagnosis. Because renal dysfunction encompasses different etiologies, a better understanding of its definition, incidence, and pathophysiology provides additional information. Although old and novel available biomarkers for the detection of renal dysfunction have been recently proposed, there is no general consensus regarding the terminology and definition of renal dysfunction in HF. Due to some specific pathophysiological mechanisms, renal impairment seems to be different on an individual patient level and, recognizing it in acute and chronic settings, could be useful to optimize decongestive treatment. For these reasons, in this review, we aim to describe and evaluate different phenotypes of renal dysfunction in acute and chronic HF and the possible management in these settings.

Key messages

• Chronic kidney dysfunction and worsening renal function are highly prevalent in acute heart failure and chronic heart failure and associated with poor outcomes.

• This association is modified by the context in which it occurs, i.e. worsening renal function in the context of adequate decongestion in acute heart failure, or worsening renal function after initiation of neurohormonal blockers in chronic heart failure.

• Future research should be aimed at elucidating the mechanisms involved in these differenct contexts, as well as alternative treatment approaches in the case of true worsening renal function.

Keywords

Renal dysfunction Worsening renal function Acute heart failure Chronic heart failure Pathophysiology Outcome 

Abbreviations

ACEi

Angiotensin-converting enzyme inhibitors

AHF

Acute heart failure

AVP

Arginine vasopressin

BUN

Blood urea nitrogen

CHF

Chronic heart failure

CKD

Chronic kidney disease

eGFR

Estimated glomerular filtration rate

HF

Heart failure

HFmrEF

Heart failure with a mid-range ejection fraction

HFpEF

Heart failure with a preserved ejection fraction

HFrEF

Heart failure with a reduced ejection fraction

MRA

Mineralocorticoid receptor antagonist

NGAL

Neutrophil gelatinase–associated lipocalin

RAAS

Renin-angiotensin-aldosterone system

RBF

Renal blood flow

sCr

Serum creatinine

WRF

Worsening renal function

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cardiovascular Diseases Unit, Department of Internal Medicine, Le Scotte HospitalUniversity of SienaSienaItaly
  2. 2.Cardiology SectionRegina Montis Regalis HospitalCuneoItaly
  3. 3.Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands

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