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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


Sources

1. Ronco C, House AA, Haapi M. Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong. Intensive Care Med 2008; 34(5): 957–962.

2. Pernický M, Murín J. Pacienti v ústavnej pohotovostnej službe na internej klinike. Vnit Lek 2010; 56(5): 47.

3. Pernický M, Murín J. Pacienti v pohotovostnej službe na internej klinike. Cardiology Lett 2010; 19(4): 287–292.

4. Pernický M, Karabová M, Murín J. Diabetes in acute heart failure and acute coronary syndrome – insight from a routine clinical practice in an Internal department with high volume of patients. Cardiology Lett 2012; 21(Suppl 1): S55

5. Pernický M, Karabová M, Murín J. Diabetes in acute heart failure and acute coronary syndrome. Eur J Heart Fail Supplements 2012; 14(Suppl A): S69.

6. Mc Alister FA, Ezekowitz J, Tonelli M et al. Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation 2004; 109(8): 1004–1009.

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

8. Sarnak MJ. Cardiovascular complications in chronic kidney disease. Am J Kidney Dis 2003; 41 (Suppl 5): 11–17.

9. Henry RM, Kostense PJ, Bos G et al. Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study. Kidney Int 2002; 62(4): 1402–1407.

10. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 1998; 9(12 Suppl): S16-S23.

11. Fried LF, Shlipak MG, Crump C et al. Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals. J Am Coll Cardiol 2003; 41(8): 1364–1372.

12. Weinfeld MS, Chertow GM, Stevenson LW. Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure. Am Heart J 1999; 138(2 Pt 1): 285–290.

13. Nohria A, Hasselblad V, Stebbins A et al. Cardiorenal interactions: insights frome the ESCAPE trial. J Am Coll Cardiol 2008; (3)51: 300–306.

14. Mullens W, Abrahams T, Skouri HN et al. Elevated intra-abdominal pressure in acute decomensated heart failure. J Am Coll Cardiol 2008; 51(3): 300–306.

15. Mullens W, Abrahams Z, Francis GS et al. Importance of venous congestion for worsening renal function in advaced decompensated heart failure. J Am Coll Cardiol 2009; 53(7):589–596.

16. Petersson M, Friberg P, Eisenhofer G et al. Long-term outcome in relation to renal sympathetic aktivity in patients with chronic heart failure. Eur Heart J 2005; 26(9): 906–913.

17. Remuzzi G, Perico N, Mancia M et al. The role of the renin-angiotensin-aldosteron system in the progression of chronic kidney disease. Kidney Int Suppl 2005; (99): S57-S65.

18. Tojo A, Onozato ML, Kobayashi N et al. Angiotensin II and oxidative stress in Dahl-sensitive rat with heart failure. Hypertension 2002; 40(6): 834–839.

19. Jie KE, Verhaar MC, Cramer MJ et al. Erythropoetin and the cardiorenal syndrome: cellular mechanisms on the cardiorenal conectors. Am J Physiol Renal Physiol 2006; 291(5): F932-F944.

20. Kostam MA, Gheorghiade M, Burnett JC Jr et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA 2007; 297(12): 1319–1331.

21. Funaya H., Kitakaze M, Node K et al. Plasma adenosine levels increase in patients with chronic heart failure. Circulation 1997; 95(6): 1363–1365.

Labels
Diabetology Endocrinology Internal medicine
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