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Management of the Cardiorenal Syndrome in Acute Heart Failure

  • Heart Failure (J Fang, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Interactions between the heart and kidney in the setting of acute heart failure are complex and have a substantial impact on patient care and outcomes. Further research is needed to better distinguish the different causes of kidney injury, allow its early and accurate prediction and detection, and identify therapeutic targets. Novel renal biomarkers could potentially provide a useful tool for this purpose. Restoration of optimal fluid status and resolution of renal venous congestion are important goals of therapy. Changes in serum creatinine, although an important marker of renal function, may not be associated with adverse outcomes, especially if they are transient and a consequence of more aggressive decongestion, or the appropriate titration of drugs affecting the renin-angiotensin-aldosterone axis. In addition to loop diuretics, a variety of drugs and strategies have been investigated in acute heart failure. Use of mineralocorticoid receptor antagonists and vasopressin antagonists may have potential benefits and should be further investigated. Inotropic agents should be limited in those clinical settings suggesting hypoperfusion. Ultrafiltration seems to provide a safe and effective tool to overcome diuretic resistance and optimize fluid status avoiding detrimental effects of diuretic therapy.

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Disclosures

Dr. V. Lazzarini: none. Dr. G. Michael Felker has served as a consultant for Amgen, Novartis, Trevana, Medtronic, and St. Jude’s, and has received grants from Roche Diagnostics, BG Medicine, Critical Diagnostics, Otsuka, and Amgen.

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  1. Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, 27705, USA

    Valentina Lazzarini MD & G. Michael Felker MD, MHS

  2. Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy

    Valentina Lazzarini MD

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Correspondence to G. Michael Felker MD, MHS.

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Lazzarini, V., Felker, G.M. Management of the Cardiorenal Syndrome in Acute Heart Failure. Curr Treat Options Cardio Med 14, 342–355 (2012). https://doi.org/10.1007/s11936-012-0186-5

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