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Cardiorenal syndrome in children with heart failure

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Abstract

Concomitant cardiac and renal dysfunction has been termed the cardiorenal syndrome (CRS). This clinical condition usually manifests as heart failure with worsening renal function and occurs frequently in the acute care setting. A consistent definition of CRS has not been universally agreed upon, although a recent classification of CRS describes several subtypes depending on the primary organ injured and the chronicity of the injury. CRS may develop in adults and children and is a strong predictor of morbidity and mortality in hospitalized and ambulatory patients. The underlying physiology of CRS is not well understood, creating a significant challenge for clinicians when treating heart failure patients with renal insufficiency. This review summarizes recent data characterizing the incidence, physiology, and management of children who have heart failure and acute kidney injury.

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References and Recommended Reading

  1. Weinfeld MS, Chertow GM, Stevenson LW, et al.: Aggravated renal dysfunction during intensive therapy for advanced heart failure. Am Heart J 1999, 138:285–290.

    Article  PubMed  CAS  Google Scholar 

  2. Hillege HL, Girbes AR, de Kam PJ, et al.: Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000, 102:203–210.

    PubMed  CAS  Google Scholar 

  3. Mahon NG, Blackstone EH, Francis GS, et al.: The prognostic value of estimated creatinine clearance alongside functional capacity ambulatory patients with chronic congestive heart failure. J Am Coll Cardiol 2002, 40:1106–1113.

    Article  PubMed  CAS  Google Scholar 

  4. Gottlieb SS, Abraham W, Butler J, et al.: The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002, 8:136–141.

    Article  PubMed  Google Scholar 

  5. Forman DE, Butler J, Wang Y, et al.: Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004, 43:61–67.

    Article  PubMed  Google Scholar 

  6. Krumholtz HM, Chen YT, Vaccarino V, et al.: Correlates and impact on outcomes of worsening renal function in patients 65 years of age with heart failure. Am J Cardiol 2000, 85:1110–1113.

    Article  Google Scholar 

  7. Smith GL, Vaccarino V, Kosiborod M, et al.: Worsening renal function: what is a clinically meaningful change in creatinine during hospitalization with heart failure? J Card Fail 2003, 9:13–25.

    Article  PubMed  CAS  Google Scholar 

  8. Dries DL, Exner DV, Domanski MJ, et al.: The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2000, 35:681–689.

    Article  PubMed  CAS  Google Scholar 

  9. Hui-Stickle S, Brewer ED, Goldstein SL: Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis 2005, 45:96–101.

    Article  PubMed  Google Scholar 

  10. Bailey D, Phan V, Litalien C, et al.: Risk factors of acute renal failure in critically ill children: a prospective descriptive epidemiological study. Pediatr Crit Care Med 2007, 8:29–35.

    Article  PubMed  Google Scholar 

  11. Akcan-Arikan A, Zappitelli M, Loftis LL, et al.: Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007, 71:1028–1035.

    Article  PubMed  CAS  Google Scholar 

  12. Mullens W, Zuheir A, Francis GS, et al.: Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 2009, 53:589–596.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  14. Ronco C, Haapio M, House A, et al.: Cardiorenal syndrome. J Am Coll Cardiol 2008, 52:1527–1539.

    Article  PubMed  Google Scholar 

  15. Price JF, Mott AR, Dickerson HA, et al.: Worsening renal function in children hospitalized with decompensated heart failure: evidence for a pediatric cardiorenal syndrome? Ped Crit Care Med 2008, 9:279–284.

    Article  Google Scholar 

  16. Fonarow GC, Stough WG, Abraham WT, et al.: Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF registry. J Am Coll Cardiol 2007, 50:768–777.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  18. Chertow GM, Burdick E, Honour M, et al.: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005, 16:3365–3370.

    Article  PubMed  Google Scholar 

  19. Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E: Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics 2006, 118:e786–e791.

    Article  PubMed  Google Scholar 

  20. Chan KL, Ip P, Chiu CS, Cheung YF: Peritoneal dialysis after surgery for congenital heart disease in infants and young children. Ann Thorac Surg 2003, 76:1443–1449.

    Article  PubMed  Google Scholar 

  21. Skippen PW, Krahn GE: Acute renal failure in children undergoing cardiopulmonary bypass. Crit Care Resusc 2005, 7:286–291.

    PubMed  CAS  Google Scholar 

  22. Mishra J, Dent C, Tarabish R, et al.: Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005, 365:1231–1238.

    Article  PubMed  CAS  Google Scholar 

  23. Bellomo R, Ronco C, Kellum JA, et al.: Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care 2004, 8:R204–212.

    Article  PubMed  Google Scholar 

  24. Plotz FB, Bouma AB, van Wijk JA, et al.: Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria. Intensive Care Med 2008, 34:1713–1717.

    Article  PubMed  Google Scholar 

  25. Abosaif NY, Toba YA, Heap M, et al.: The outcome of acute renal failure in the intensive care unit according to RIFLE: model application, sensitivity, and predictability. Am J Kidney Dis 2005, 46:1038–1048.

    Article  PubMed  Google Scholar 

  26. Bibbins-Domingo K, Lin F, Vittinghoff E, et al.: Renal insufficiency as an independent predictor of mortality among women with heart failure. J Am Coll Cardiol 2004, 44:1593–1600.

    Article  PubMed  Google Scholar 

  27. McAlister FA, Ezekowitz J, Tonelli M, et al.: Renal insufficiency and heart failure: Prognostic and therapeutic implications from a prospective cohort study. Circulation 2004, 109:1004–1009.

    Article  PubMed  Google Scholar 

  28. Nguyen MT, Dent CL, Ross GF, et al.: Urinary aprotinin as a predictor of acute kidney injury after cardiac surgery in children using aprotinin therapy. Pediatr Nephrol 2008, 23:1317–1326.

    Article  PubMed  Google Scholar 

  29. Beger RD, Holland RD, Sun J, et al.: Metabonomics of acute kidney injury in children after cardiac surgery. Pediatr Nephrol 2008, 23:977–984.

    Article  PubMed  Google Scholar 

  30. Loef BG, Epema AH, Smilde TB, et al.: Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 2005, 16:195–200.

    Article  PubMed  Google Scholar 

  31. Lok CE, Austin PC, Wanh H, Tu JV: Impact of renal insufficiency on short- and long-term outcomes after cardiac surgery. Am Heart J 2004, 148:430–438.

    Article  PubMed  Google Scholar 

  32. Mangano CM, Diamondstone LS, Ramsay JG, et al.: Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 1998, 128:194–203.

    PubMed  CAS  Google Scholar 

  33. Dent CL, Ma Q, Dastrala S, et al.: Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Crit Care 2007, 11:R127.

    Article  PubMed  Google Scholar 

  34. Goldstein SL, Somers MJ, Baum MA, et al.: Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005, 67:653–658.

    Article  PubMed  Google Scholar 

  35. Schrier RW, Abraham WT: Hormones and hemodynamics in heart failure. N Engl J Med 1999, 34:577–585.

    Article  Google Scholar 

  36. Bayliss J, Norell M, Canepa-Anelson et al.: Untreated heart failure: clinical and neuroendocrine effects of introducing diuretics. Br Heart J 1987, 57:17–22.

    Article  PubMed  CAS  Google Scholar 

  37. Butler J, Forman DE, Abraham WT, et al.: Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J 2004, 147:331–338.

    Article  PubMed  Google Scholar 

  38. Gottlieb SS, Brater DC, Thomsas I, et al.: BG9719 (CVT-124), and A1 adenosine receptor antagonist, protects against the decline in renal function observed with diuretic therapy. Circulation 2002, 105:1348–1353.

    Article  PubMed  CAS  Google Scholar 

  39. Liang KV, Williams AW, Greene EL, Redfield MM: Acute decompensated heart failure and the cardiorenal syndrome. Crit Care Med 2008, 36:S75–S88.

    Article  PubMed  Google Scholar 

  40. Ljungman S, Laragh JH, Cody RJ: Role of the kidney in congestive heart failure: relationship of cardiac index to kidney function. Drugs 1990, 39(Supp 4):10–21.

    Article  PubMed  Google Scholar 

  41. Heywood JT: The cardiorenal syndrome: lessons from the ADHERE database and treatment options. Heart Fail Rev 2004, 9:195–201.

    Article  PubMed  Google Scholar 

  42. Firth JD, Raine AE, Ledingham JG: Raised venous pressure: a direct cause of renal sodium retention in oedema? Lancet 1988, 1:1033–1035.

    Article  PubMed  CAS  Google Scholar 

  43. Swan SK: Diuretic strategies in patients with renal failure. Drugs 1994, 48:380–385.

    Article  PubMed  CAS  Google Scholar 

  44. Luciani GB, Nichani S, Chang AC, et al.: Continuous versus intermittent furosemide infusion in critically ill infants after open heart operations. Ann Thorac Surg 1997, 64:1133–1139.

    Article  PubMed  CAS  Google Scholar 

  45. Salvador DR, Rey NR, Ramos GC, Punzalan FE: Continuous infusion versus bolus injection of loop diuretics in congestive heart failure. Cochrane Database Syst Rev 2005, 3:CD003178.

    PubMed  Google Scholar 

  46. Colucci WS, Elkayam U, Horton DP, et al.: Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide study group. N Engl J Med 2000, 343:246–253.

    CAS  Google Scholar 

  47. Jefferies JL, Price JF, Denfield SW, et al.: Safety and efficacy of nesiritide in pediatric heart failure. J Cardiac Fail 2007, 13:541–548.

    Article  CAS  Google Scholar 

  48. Riter HG, Redfield MM, Burnet JC, Chen HH: Nonhypostensive low-dose nesiritide has differential renal effects compared with standard-dose in patients with acute decompensated heart failure and renal dysfunction. J Am Coll Cardiol 2006, 47:2334–2335.

    Article  PubMed  CAS  Google Scholar 

  49. Sackner-Bernstein JD, Skopicki HA, Aaronson KD: Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation 2005, 111:1487–1491.

    Article  PubMed  CAS  Google Scholar 

  50. Dormans TP, Gerla PG, Russel FG, Smits P: Combination diuretic therapy in severe congestive heart failure. Eur Heart J 1996, 17:1867–1874.

    PubMed  CAS  Google Scholar 

  51. Moffett BS, Mott AR, Nelson DP, et al.: Renal effects of fenoldopam in critically ill pediatric patients: a retrospective review. Pediatr Crit Care Med 2008, 9:403–406.

    Article  PubMed  Google Scholar 

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Correspondence to Jack F. Price.

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Price, J.F., Goldstein, S.L. Cardiorenal syndrome in children with heart failure. Curr Heart Fail Rep 6, 191–198 (2009). https://doi.org/10.1007/s11897-009-0027-3

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