Mechanistic Insights in Cardiorenal Syndrome

Lo, Kevin Bryan; Rangaswami, Janani

doi:10.1056/evidra2200053

Cited by 5 publications

(3 citation statements)

References 64 publications

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“…126,130 Fluctuations in serum creatinine with decongestion and GDMT use are driven largely by expected and intended changes in glomerular hemodynamics and should not prompt immediate discontinuation of these medications. 131 Atrial Fibrillation Management in Stage 4 CKM Several CKM factors are linked to a greater likelihood and burden of atrial fibrillation, including hypertension, obesity, CKD and dyslipidemia. 57 Therefore, major guidelines recommend comprehensive risk factor control in patients with atrial fibrillation.…”

Section: Ckd and Hfmentioning

confidence: 99%

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Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association

Ndumele,

Rangaswami,

Chow

et al. 2023

Circulation

Self Cite

211

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Cardiovascular-kidney-metabolic health reflects the interplay among metabolic risk factors, chronic kidney disease, and the cardiovascular system and has profound impacts on morbidity and mortality. There are multisystem consequences of poor cardiovascular-kidney-metabolic health, with the most significant clinical impact being the high associated incidence of cardiovascular disease events and cardiovascular mortality. There is a high prevalence of poor cardiovascular-kidney-metabolic health in the population, with a disproportionate burden seen among those with adverse social determinants of health. However, there is also a growing number of therapeutic options that favorably affect metabolic risk factors, kidney function, or both that also have cardioprotective effects. To improve cardiovascular-kidney-metabolic health and related outcomes in the population, there is a critical need for (1) more clarity on the definition of cardiovascular-kidney-metabolic syndrome; (2) an approach to cardiovascular-kidney-metabolic staging that promotes prevention across the life course; (3) prediction algorithms that include the exposures and outcomes most relevant to cardiovascular-kidney-metabolic health; and (4) strategies for the prevention and management of cardiovascular disease in relation to cardiovascular-kidney-metabolic health that reflect harmonization across major subspecialty guidelines and emerging scientific evidence. It is also critical to incorporate considerations of social determinants of health into care models for cardiovascular-kidney-metabolic syndrome and to reduce care fragmentation by facilitating approaches for patient-centered interdisciplinary care. This presidential advisory provides guidance on the definition, staging, prediction paradigms, and holistic approaches to care for patients with cardiovascular-kidney-metabolic syndrome and details a multicomponent vision for effectively and equitably enhancing cardiovascular-kidney-metabolic health in the population.

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Section: Ckd and Hfmentioning

confidence: 99%

Section: Approach To Ckm Prevention and Managementmentioning

confidence: 99%

Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association

Ndumele,

Rangaswami,

Chow

et al. 2023

Circulation

Self Cite

211

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“…It carries high morbidity and mortality, increasing up to 5 times the risk of dying within 28 days ( 2 ), being the most lethal of the five types of cardiorenal syndromes ( 3 , 4 ). This is not surprising when observing the intricate pathophysiological mechanism that it possesses, but today it can be established that congestion is one of the main determinants of kidney disfunction, secondary to neurohormonal, inflammatory, and hemodynamic activation, which worsens the kidney inability to excrete sodium and water ( 5 , 6 ), promoting compression of the kidney parenchyma, an entity recently described as “congestive nephropathy” ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

How to interpret serum creatinine increases during decongestion

Chávez-Íñiguez

Ivey‐Miranda

Vega-Mendez

et al. 2023

Front. Cardiovasc. Med.

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During decongestion in acute decompensated heart failure (ADHF), it is common to observe elevations in serum creatinine (sCr) values due to vascular congestion, a mechanism that involves increased central venous pressure that has a negative impact on the nephron, promoting greater absorption of water and sodium, increased interstitial pressure in an encapsulated organ developing “renal tamponade” which is one of main physiopathological mechanism associated with impaired kidney function. For the treatment of this syndrome, it is recommended to use diuretics that generate a high urinary output and natriuresis to decongest the venous system, during this process the sCr values can rise, a phenomenon that may bother some cardiologist and nephrologist, since raise the suspicion of kidney damage that could worsen the prognosis of these patients. It is recommended that increases of up to 0.5 mg/dL from baseline are acceptable, but some patients have higher increases, and we believe that an arbitrary number would be impractical for everyone. These increases in sCr may be related to changes in glomerular hemodynamics and true hypovolemia associated with decongestion, but it is unlikely that they are due to structural injury or truly hypoperfusion and may even have a positive connotation if accompanied by an effective decongestion and be associated with a better prognosis in the medium to long term with fewer major cardiovascular and renal events. In this review, we give a comprehensive point of view on the interpretation of creatinine elevation during decongestion in patients with ADHF.

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Diuretic strategies in acute decompensated heart failure

Lo,

Nohria

2024

Heart Fail Rev

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Mechanistic Insights in Cardiorenal Syndrome

Cited by 5 publications

References 64 publications

Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association

Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association

How to interpret serum creatinine increases during decongestion

Diuretic strategies in acute decompensated heart failure

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