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Intensive Care Medicine

, Volume 44, Issue 6, pp 908–910 | Cite as

What’s new in cardiorenal syndrome?

  • Michael DarmonEmail author
  • Miet Schetz
What's New in Intensive Care

Introduction

Cardiorenal syndrome (CRS) is a bidirectional disorder in which heart and kidney may induce or perpetuate disease in the other organ [1, 2]. Five subtypes reflecting the primary dysfunction and its chronicity have been described. This “what’s new” paper will focus on CRS type 1 in which acute heart failure (AHF) (mostly in the setting of cardiogenic shock or acute decompensated heart failure) induces renal dysfunction and/or injury. CRS type 1 is common, may affect 25–33% of patients with AHF, and is associated with a grim prognosis [2, 3].

Definition and pathophysiology

The pathophysiological mechanisms underlying CRS type 1 include renal hypoperfusion due to hypotension and low cardiac output, renal congestion, maladaptive activation of the renin–angiotensin–aldosterone and the sympathetic nervous system, and inflammation [1, 2]. Recent literature has shifted from low cardiac output to venous congestion (causing increased renal backpressure and compartment syndrome) as...

Abbreviations

AHF

Acute heart failure

AKI

Acute kidney injury

CRS

Cardiorenal syndrome

GFR

Glomerular filtration rate

WRF

Worsening renal function

Notes

Compliance with ethical standards

Conflicts of interest

None to declare.

Supplementary material

134_2018_5190_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)

References

  1. 1.
    Schefold JC, Filippatos G, Hasenfuss G et al (2016) Heart failure and kidney dysfunction: epidemiology, mechanisms and management. Nat Rev Nephrol 12:610–623.  https://doi.org/10.1038/nrneph.2016.113 CrossRefPubMedGoogle Scholar
  2. 2.
    Haase M, Müller C, Damman K et al (2013) 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 182:99–116.  https://doi.org/10.1159/000349969 CrossRefPubMedGoogle Scholar
  3. 3.
    Dar O, Cowie MR (2008) Acute heart failure in the intensive care unit: epidemiology. Crit Care Med 36:S3–S8.  https://doi.org/10.1097/01.CCM.0000296264.41365.80 CrossRefPubMedGoogle Scholar
  4. 4.
    Chen C, Lee J, Johnson AE et al (2017) Right ventricular function, peripheral edema, and acute kidney injury in critical illness. Kidney Int Rep 2:1059–1065.  https://doi.org/10.1016/j.ekir.2017.05.017 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mullens W, Abrahams Z, Skouri HN et al (2008) Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol 51:300–306.  https://doi.org/10.1016/j.jacc.2007.09.043 CrossRefPubMedGoogle Scholar
  6. 6.
    Grande D, Terlizzese P, Iacoviello M (2017) Role of imaging in the evaluation of renal dysfunction in heart failure patients. World J Nephrol 6:123–131.  https://doi.org/10.5527/wjn.v6.i3.123 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    van Vark LC, Lesman-Leegte I, Baart SJ et al (2017) Prognostic value of serial ST2 measurements in patients with acute heart failure. J Am Coll Cardiol 70:2378–2388.  https://doi.org/10.1016/j.jacc.2017.09.026 CrossRefPubMedGoogle Scholar
  8. 8.
    Shirakabe A, Hata N, Kobayashi N et al (2018) Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure. ESC Heart Fail.  https://doi.org/10.1002/ehf2.12264 PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Brisco MA, Zile MR, Hanberg JS et al (2016) Relevance of changes in serum creatinine during a heart failure trial of decongestive strategies: insights from the DOSE trial. J Card Fail 22:753–760.  https://doi.org/10.1016/j.cardfail.2016.06.423 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Vaduganathan M, Greene SJ, Fonarow GC et al (2014) Hemoconcentration-guided diuresis in heart failure. Am J Med 127:1154–1159.  https://doi.org/10.1016/j.amjmed.2014.06.009 CrossRefPubMedGoogle Scholar
  11. 11.
    Ahmad T, Jackson K, Rao VS et al (2018) Worsening renal function in acute heart failure patients undergoing aggressive diuresis is not associated with tubular injury. Circulation.  https://doi.org/10.1161/CIRCULATIONAHA.117.030112 CrossRefPubMedGoogle Scholar
  12. 12.
    Legrand M, De Berardinis B, Gaggin HK et al (2014) Evidence of uncoupling between renal dysfunction and injury in cardiorenal syndrome: insights from the BIONICS study. PLoS One 9:e112313.  https://doi.org/10.1371/journal.pone.0112313 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Damman K, Valente MAE, van Veldhuisen DJ et al (2017) Plasma neutrophil gelatinase-associated lipocalin and predicting clinically relevant worsening renal function in acute heart failure. Int J Mol Sci.  https://doi.org/10.3390/ijms18071470 PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Maisel AS, Wettersten N, van Veldhuisen DJ et al (2016) Neutrophil gelatinase-associated lipocalin for acute kidney injury during acute heart failure hospitalizations: the AKINESIS study. J Am Coll Cardiol 68:1420–1431.  https://doi.org/10.1016/j.jacc.2016.06.055 CrossRefPubMedGoogle Scholar
  15. 15.
    Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975.  https://doi.org/10.1002/ejhf.592 CrossRefPubMedGoogle Scholar
  16. 16.
    Ishihara S, Gayat E, Sato N et al (2016) Similar hemodynamic decongestion with vasodilators and inotropes: systematic review, meta-analysis, and meta-regression of 35 studies on acute heart failure. Clin Res Cardiol 105:971–980.  https://doi.org/10.1007/s00392-016-1009-6 CrossRefPubMedGoogle Scholar
  17. 17.
    Fedele F, Karason K, Matskeplishvili S (2017) Pharmacological approaches to cardio-renal syndrome: a role for the inodilator levosimendan. Eur Heart J Suppl 19:C22–C28.  https://doi.org/10.1093/eurheartj/sux002 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Grodin JL, Stevens SR, de Las Fuentes L et al (2016) Intensification of medication therapy for cardiorenal syndrome in acute decompensated heart failure. J Card Fail 22:26–32.  https://doi.org/10.1016/j.cardfail.2015.07.007 CrossRefPubMedGoogle Scholar
  19. 19.
    McMurray JJV, Packer M, Desai AS et al (2014) Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993–1004.  https://doi.org/10.1056/NEJMoa1409077 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  1. 1.Medical ICU, Saint-Louis University Hospital, AP-HPParisFrance
  2. 2.Faculté de MédecineUniversité Paris-Diderot, Sorbonne-Paris-CitéParisFrance
  3. 3.ECSTRA Team, Biostatistics and Clinical EpidemiologyUMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERMParisFrance
  4. 4.Clinical Department and Laboratory of Intensive Care Medicine, Division of Cellular and Molecular MedicineKU Leuven UniversityLouvainBelgium

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