Cardiorenal Syndromes: An Executive Summary from the Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

Ronco, Claudio; McCullough, Peter A.; Anker, Stefan D.; Anand, Inder S.; Aspromonte, Nadia; Bagshaw, Sean M.; Bellomo, Rinaldo; Berl, Tomás; Bobek, Ilona; Cruz, Dinna N.; Daliento, Luciano; Davenport, Andrew; Haapio, Mikko; Hillege, Hans L.; House, Andrew A.; Katz, Nevin M.; Maisel, Alan S.; Mankad, Sunil; Zanco, Pierluigi; Mebazaa, Alexandre; Palazzuoli, A.; Ronco, Federico; Shaw, Andrew; Sheinfeld, Geoff; Soni, Sachin; Vescovo, Giorgio; Zamperetti, Nereo; Ponikowski, Piotr

doi:10.1159/000313745

Cited by 129 publications

(91 citation statements)

References 79 publications

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“…Discussion of prevention and management are beyond the scope of this review. [54][55][56] Acute Cardio-Renal syndrome (Type 1 CRS) Type I CRS is characterized by an acute heart disorder leading to AKI. The incidence of AKI in acute decompensated heart failure and acute coronary syndrome is estimated to be 24-45% and 9-19%, respectively.…”

Section: Syndromes Of Acute Kidney Injurymentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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Section: Syndromes Of Acute Kidney Injurymentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

Self Cite

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“…20 Increasing evidence has revealed that the intrarenal renin-angiotensin system (RAS) plays a vital role in maintaining hemodynamic balance and cardiorenal interaction, which are often disrupted in patients with acute heart failure. 21,22 In animal studies, activation of the intrarenal RAS is an initial response to hypoperfusion in cardiac and renal injury, and is also an important contributor to the progression of the disease.…”

mentioning

confidence: 99%

Urinary Angiotensinogen Level Predicts AKI in Acute Decompensated Heart Failure

Yang

Chen²,

Tian

et al. 2015

Journal of the American Society of Nephrology

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A major challenge in prevention and early treatment of acute cardiorenal syndrome (CRS) is the lack of highperformance predictors. To test the hypothesis that urinary angiotensinogen (uAGT) is an early predictor for acute CRS and 1-year prognosis in patients with acute decompensated heart failure (ADHF), we performed a prospective, two-stage, multicenter cohort study in patients with ADHF. In stage I (test set), 317 patients were recruited from four centers. In stage II (validation set), 119 patients were enrolled from two other centers. Daily uAGT levels were analyzed consecutively. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines. In stage I, 104 (32.8%) patients developed AKI during hospitalization. Daily uAGT peaked on the first hospital day in patients who subsequently developed AKI. After multivariable adjustment, the highest quartile of uAGT on admission was associated with a 50-fold increased risk of AKI compared with the lowest quartile. For predicting AKI, uAGT (area under the receiveroperating characteristic curve [AUC]=0.84) outperformed urinary neutrophil gelatinase-associated lipocalin (AUC=0.78), the urinary albumin/creatinine ratio (AUC=0.71), and the clinical model (AUC=0.77). Survivors in stage I were followed prospectively for 1 year after hospital discharge. The uAGT level independently predicted the risk of 1-year mortality (adjusted odds ratio, 4.5; 95% confidence interval, 2.1 to 9.5) and rehospitalization (adjusted odds ratio, 3.6; 95% confidence interval, 1.6 to 5.7). The ability of uAGT in predicting AKI was validated in stage II (AUC=0.79). In conclusion, uAGT is a strong predictor for acute CRS and 1-year prognosis in ADHF.

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“…A precipitating event usually contributes to the development of CRS type 5 in a chronic patient, for example, a spontaneous bacterial peritonitis in a patient with cirrhosis. Therefore, we may find superimposition of acute CRS type 5 on an indolent chronic process with immediate relevance for intensive care physicians, nephrologists, and cardiologists [51].…”

Section: Chronic Kidney Disease -From Pathophysiology To Clinical Impmentioning

confidence: 99%

Fluid Overload in Peritoneal Dialysis

Pazarín-Villaseñor¹,

Yanowsky-Escatell²,

Andrade‐Sierra³

et al. 2018

Chronic Kidney Disease - From Pathophysiology to Clinical Improvements

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The prevalence of end-stage renal disease (ESRD) has increased globally to 10% due to diabetes mellitus, hypertension, and stroke. When chronic kidney disease (CKD) maintenance therapy fails, patients require renal replacement therapy (RRT) to survive, such as peritoneal dialysis (PD), hemodialysis, and renal transplantation. The most common therapy in Mexico is PD because it is a feasible, low-cost, and easy-to-perform procedure; however, fluid overload is a frequent condition in patients with this RRT modality.The usual adverse comorbidities in patients with PD are cardiovascular diseases (CVD) associated to atherosclerosis, uremia, inflammation, and oxidative stress. Fluid overload is intimately associated to hypertension, left ventricular hypertrophy, heart failure, and worsening of kidney failure, leading to increased hospital admissions, higher cardiovascular mortality, and reduced life expectancy. Two main pathologies are involved in the deterioration of both heart and kidney functions, namely, cardiorenal syndrome and uremic cardiomyopathy. Along with these phenomena, patients in PD with rapid peritoneal transport have reduced ultrafiltration, increased glucose absorption, and albumin loss in the dialysate, which lead to overhydration, hypertension, dyslipidemia, and malnutrition. This review focuses on the clinical, physiological, and biochemical mechanisms involved in fluid overload of patients with CKD undergoing PD.

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Cardiorenal Syndromes: An Executive Summary from the Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

Cited by 129 publications

References 79 publications

Review article: Acute kidney injury in critical illness

Review article: Acute kidney injury in critical illness

Urinary Angiotensinogen Level Predicts AKI in Acute Decompensated Heart Failure

Fluid Overload in Peritoneal Dialysis

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