ABSTRACT
Heart and kidney disease frequently co-exist and the course of one condition often interferes with course, prognosis, and management of the other. Several bidirectional interactions between heart failure (HF) and kidney disease exist, as acute or chronic failure of the heart or kidneys can induce acute or chronic dysfunction in the other organ. Patients with HF suffer from multiple comorbidities that further increase their morbidity and mortality. Among these co-morbidities, a large proportion of patients have varying degrees of renal dysfunction varying from mild chronic kidney disease (CKD) to ESRD requiring dialysis. These interactions between cardiac and kidney disease are described by the term “cardiorenal” syndrome (CRS). Kidney dysfunction in HF patients is multifactorial and among others right atrial pressure is a key factor inversely correlating with renal function. There are no medical therapies that have been shown to directly increase glomerular filtration rate (GFR) in patients with HF. However, strategies targeting decongestion and improvement of cardiac output can produce increases in GFR, indicating that types 1 and 2 CRS have substantial reversible components. This chapter discusses concepts, mechanisms, and approaches to treatment of cardiorenal syndrome across the spectrum of HF patients.
