Cardiovascular–renal axis disorders in the domestic dog and cat: a veterinary consensus statement

Abstract

OBJECTIVESThere is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term “cardiorenal syndrome” (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with “cardiovascular-renal disorders” (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised.METHODSFollowing a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species.RESULTSOf the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD.DISCUSSIONThe resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine.

A prospective, randomized, double‐blind, placebo‐controlled pilot study of sacubitril/valsartan (Entresto) in dogs with cardiomegaly secondary to myxomatous mitral valve disease

“…Increased NEP concentrations are present in human patients with end‐stage renal dysfunction, suggesting an additional indication for use of S/V in patients with renal disease 51. Because of these beneficial effects that the NPs have on the cardiovascular and renal systems, drugs such as S/V may have important implications for cardiovascular‐renal disorders in dogs 19, 52. The addition of exogenous NPs to furosemide administration causes more profound diuresis and natriuresis and has the potential to allow for decreases in diuretic dosages, while preventing furosemide‐induced RAAS activation 40, 46, 53, 54.…”

Systemic hypertension in cats with acute kidney injury

“…Suggested aetiologies in humans have included volume-impaired excretion of sodium, leading to volume overload, excessive activation of the renin-angiotensinaldosterone system, stimulation of the sympathetic nervous system, reduced bioavailability of the endothelial vasodilator, nitric oxide and increased production of the vasoconstrictor endothelin and increase in reactive oxygen species (Campese et al . 2006, Pouchelon et al 2015. To date there have been no studies of pathogenesis of SH in AKI in cats and even in CKD the pathogenesis remains poorly explained.…”

Current Understanding of the Pathogenesis of Progressive Chronic Kidney Disease in Cats

“…33 Potential mechanisms by which CvRD may be detrimental to the kidney include cardiac shock, low cardiac output and hypotension resulting in reduced renal perfusion, AKI and azotemia, activation of the renin-angiotensin aldosterone system (RAAS), systemic arterial thromboembolism resulting in renal infarction and passive congestion of the kidney during congestive heart failure. In particular, inciting renal injuries that result in ischemia provide an interesting link to the development of tubulointerstitial inflammation and fibrosis (See Chapter 3).…”