A view on the cardiorenal syndrome


Authors: Ján Murín;  Miroslav Pernický;  Marta Filková
Authors‘ workplace: I. interná klinika LF UK a UN, Bratislava, Nemocnica Staré Mesto, prednostka doc. MUDr. Soňa Kiňová, PhD.
Published in: Forum Diab 2015; 4(3): 177-180
Category: Main Theme: Review

Overview

The cardiorenal syndrome was defined for the first time in the USA in 2004 (by workers of NHLBI – National Heart, Lung and Blood Institute) as follows: it is the condition of an organism affected by heart failure (HF), where the treatment of HF is limited in intensity due to impaired renal functions of the patient [1]. Today the incidence of HF is on a scale of an epidemic and it has reached approx. 2% of our populations in Europe, and approx. 10% of the people aged ≥ 65 and with advancing age it continues to rise exponentially (approx. 20% of people aged ≥ 80–85 [2,3]. The renal function disorder (dysfunction or insufficiency) is very frequent in individuals with HF, in part also in relation to the increasing life expectancy of citizens [4]. Regarding the acute HF the incidence of renal insufficiency reaches approx. 30–35% and it doubles for the chronic HF, approx. 60–70% [3,4]. The mutual incidence of HF and renal failure significantly worsens patients‘ prognosis, i.s. their morbidity, mortality and rehospitalizations as well as life quality [4,5]. The patients with chronic HF suffer from renal insufficiency (RI) more often than those with CRS, however without heart failure [4]. The incidence of HF correlates with the decrease in glomerular filtration in patients. RI is a strong and independent risk factor of mortality in patients with HF [5,6,7]. Our experience of the cardio­renal syndrome: In the period of 10th–12th months/2008 we analyzed the admissions of patients for emergency care at our establishment: (a) 1052 individuals were examined, (b) 302 were admitted for treatment, (c) the largest number of the admitted (45 individuals) suffered acute HF. 18 individuals (40 % among those admitted for the acute HF) had diabetes. Of the patients admitted all diabetic patients had chronic renal insufficiency (at average age of 77 years) while its presence was found in 3/4 nondiabetic patients (at average age of 80 years.) The patients with diabetes were more seriously ill than those without diabetes. The incidence of renal insufficiency/failure in people with HF, mainly chronic, is frequent. It will surely increase in future due to improvements in the treatment of CRS and increasing life expectancy. Extending of the knowledge about the syndrome pathophysiology is important for us to be able to improve the prevention and treatment of this complex disease.

Key words:
heart failure – renal insufficiency – diabetes – treatment – prognosis


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Labels
Diabetology Endocrinology Internal medicine
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