AHA Scientific Statement on Cardiorenal Syndrome

Rangaswami J, Bhalla V, Blair JE, et al.
Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation 2019;Mar 11:[Epub ahead of print].

The following are key points to remember from this American Heart Association (AHA) Scientific Statement about cardiorenal syndrome (CRS):

  1. CRS includes a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ.
  2. It represents the confluence of heart-kidney interactions across several interfaces. These include the hemodynamic cross-talk between the failing heart and the response of the kidneys and vice versa, as well as alterations in neurohormonal markers and inflammatory molecular signatures characteristic of its clinical phenotypes.
  3. This Scientific Statement describes the epidemiology and pathogenesis of cardiorenal syndrome in the context of the continuously evolving nature of its clinicopathological description over the past decade.
  4. Distinguishing true acute kidney injury from functional causes of fluctuations in serum creatinine in the context of diuresis for acute decompensated heart failure (HF) is critical in ensuring delivery of goal-directed medical therapies.
  5. Fluid retention and congestion are hallmarks of acute HF, and diuretics are a cornerstone of the management of patients with or without CRS. Furthermore, identifying the factors contributing to diuretic resistance is a key step in optimizing decongestion in CRS.
  6. Biomarkers of cardiac and kidney injury represent a new dimension in the diagnostic algorithm in evaluating HF with impaired kidney function, and offer prognostic value in acute and chronic CRS.
  7. High-quality data for goal-directed medical therapy in chronic CRS with moderate to severe decline in kidney function are lacking. They represent areas of research in future studies.
  8. A multidisciplinary approach is required for cardiac device therapies to reduce arrhythmia burden in patients with HF and chronic kidney disease (CKD).
  9. Palliative care is an underused strategy at this time in patients with the dual burden of HF and advanced CKD.
  10. Finally, a cardionephrology multidisciplinary approach is indicated in the joint management of patients with CRS with an emphasis on core outcome measures based on patient and physician priorities.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Chronic Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Acute Kidney Injury, Arrhythmias, Cardiac, Biological Markers, Cardio-Renal Syndrome, Creatinine, Diuresis, Diuretics, Geriatrics, Heart Failure, Hemodynamics, Metabolic Syndrome X, Primary Prevention, Palliative Care, Renal Insufficiency, Chronic

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