The role of the kidney in heart failure

Abstract

Renal dysfunction is common in patients with heart failure and is associated with high morbidity and mortality. Cardiac and renal dysfunction may worsen each other through multiple mechanisms such as fluid overload and increased venous pressure, hypo-perfusion, neurohormonal and inflammatory activation, and concomitant treatment. The interaction between cardiac and renal dysfunction may be critical for disease progression and prognosis. Renal dysfunction is conventionally defined by a reduced glomerular filtration rate, calculated from serum creatinine levels. This definition has limitations as serum creatinine is dependent on age, gender, muscle mass, volume status, and renal haemodynamics. Changes in serum creatinine related to treatment with diuretics or angiotensin-converting enzyme inhibitors are not necessarily associated with worse outcomes. New biomarkers might be of additional value to detect an early deterioration in renal function and to improve the prognostic assessment, but they need further validation. Thus, the evaluation of renal function in patients with heart failure is important as it may reflect their haemodynamic status and provide a better prognostic assessment. The prevention of renal dysfunction with new therapies might also improve outcomes although strong evidence is still lacking.

Heart failure is the strongest predictor of acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

“…As yet we cannot differentiate the effect of contrast media administration from different mechanisms involved in AKI development in STEMI patients with HF including haemodynamic abnormalities (hypoperfusion with decreased renal preload, increased central venous pressure with increased renal afterload), sympathetic hyperactivity, renin-angiotensin-aldosterone system activation, adenosine release, and oxidative stress [14]. The universal term AKI may be more appropriate than CI-AKI in this clinical setting.…”

Acute Renal Injury Induced by Hypersensitivity to Tolvaptan in an Elderly Patient with Congestive Heart Failure

“…Many drugs used to treat HF may also influence the renal function in addition to diuretics (8). In the prospective randomized double-blind placebo-controlled Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial, approximately 3% of patients randomized to receive TLV developed renal failure (1).…”

The prevalence of renal dysfunction and its influence on the prognosis of patients with acute heart failure

“…Сердечная недостаточность является ФР для развития хронической болезни почек и наоборот, в то же время два этих состояния довольно часто сосуществуют [6]. Снижение скорости клубочковой фильтрации (СКФ) наблюдается у 30-40 % пациентов с ОКС, у 30-60 % пациентов с ХСН [7,8], достигая 70 % у пациентов с острой СН (ОСН) [9][10][11]. В свою очередь, у 27-40 % пациентов, госпитализированных по поводу ОСН, развивается острое почечное повреждение (ОПП), что сопряжено с более высоким уровнем смертно-сти и увеличением продолжительности госпитализа-ции, частотой повторных госпитализаций [12][13][14][15][16].…”