Diagnosis, treatment, and renal replacement therapy of cardio-renal syndrome_West China Medical Journal

Authors：

 DING Xiaoqiang , XIE Yeqing

Department of Nephrology, Zhongshan Hospital, Fudan University; Shanghai Medical Center of Kidney Diseases; Shanghai Institute of Kidney and Dialysis; Shanghai 200032, P. R. China;

Corresponding author：

DING Xiaoqiang, Email: ding.xiaoqiang@zs-hospital.sh.cn

Keywords：

Cardio-renal syndrome; Epidemiology; Biomarkers; Renal replacement therapy

DOI：

10.7507/1002-0179.201807004

Video：

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Abstract Full text Figures/Tables Video References Cited by

Heart and kidney interact with each other. Cardio-renal syndrome (CRS) refers to conditions where acute or chronic dysfunction of either the heart or the kidney leads to dysfunction of the other. Conventional classification of CRS outlined five subgroups according to the clinical presentation. This review focused on the epidemiology, new bio- markers, drug management, and renal replacement therapy of type Ⅰ and type Ⅱ CRS, which emphasized the multi-discipline collaboration and individualized evaluation, in order to achieve goal-directed approach to renal replacement therapy.

Citation： DING Xiaoqiang, XIE Yeqing. Diagnosis, treatment, and renal replacement therapy of cardio-renal syndrome. West China Medical Journal, 2018, 33(7): 892-895. doi: 10.7507/1002-0179.201807004 Copy

1.	Ronco C, Di Lullo L. Cardiorenal syndrome. Heart Fail Clin, 2014, 10(2): 251-280.
2.	Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol, 2008, 52(19): 1527-1539.
3.	Hatamizadeh P, Fonarow GC, Budoff MJ, et al. Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol, 2013, 9(2): 99-111.
4.	Pimienta González R, Couto Comba P, Rodríguez Esteban M, et al. Incidence, mortality and positive predictive value of type 1 cardiorenal syndrome in acute coronary syndrome. PLoS One, 2016, 11(12): e0167166.
5.	Ronco C, Di Lullo L. Cardiorenal syndrome in western countries: epidemiology, diagnosis and management approaches. Kidney Dis (Basel), 2017, 2(4): 151-163.
6.	Xu J, Jiang W, Fang Y, et al. Management of cardiac surgery-associated acute kidney injury. Contrib Nephrol, 2016, 187: 131-142.
7.	Hou FF, Yang X. Advances in the management of acute cardiorenal syndrome in China: biomarkers for predicting development and outcomes. Kidney Dis (Basel), 2017, 2(4): 145-150.
8.	Cheng H, Chen YP. Clinical prediction scores for type 1 cardiorenal syndrome derived and validated in Chinese cohorts. Cardiorenal Med, 2015, 5(1): 12-19.
9.	Hillege HL, Nitsch D, Pfeffer MA, et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation, 2006, 113(5): 671-678.
10.	Braam B, Joles JA, Danishwar AH, et al. Cardiorenal syndrome-current understanding and future perspectives. Nat Rev Nephrol, 2014, 10(1): 48-55.
11.	Parikh CR, Mansour SG. Perspective on clinical application of biomarkers in AKI. J Am Soc Nephrol, 2017, 28(6): 1677-1685.
12.	Wang Y, Zou Z, Jin J, et al. Urinary TIMP-2 and IGFBP7 for the prediction of acute kidney injury following cardiac surgery. BMC Nephrol, 2017, 18(1): 177.
13.	Jiang W, Teng J, Xu J, et al. Dynamic predictive scores for cardiac surgery-associated acute kidney injury. J Am Heart Assoc, 2016, 5(8): e003754.
14.	Ronco C, Kaushik M, Valle R, et al. Diagnosis and management of fluid overload in heart failure and cardio-renal syndrome: the " 5B” approach. Semin Nephrol, 2012, 32(1): 129-141.
15.	Kim DH, Chien FJ, Eisen HJ. Pharmacologic management for heart failure and emerging therapies. Curr Cardiol Rep, 2017, 19(10): 94.
16.	Bart BA, Boyle A, Bank AJ, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial. J Am Coll Cardiol, 2005, 46(11): 2043-2046.
17.	Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol, 2007, 49(6): 675-683.
18.	Bart BA, Goldsmith SR, Lee KL, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med, 2012, 367(24): 2296-2304.
19.	Kazory A. Cardiorenal syndrome: ultrafiltration therapy for heart failure--trials and tribulations. Clin J Am Soc Nephrol, 2013, 8(10): 1816-1828.
20.	Writing Committee Members, Yancy CW, Jessup M, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation, 2016, 134(13): e282-e293.
21.	Cho YJ, Lee EH, Lee K, et al. Long-term clinical outcomes of Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial in patients undergoing cardiac surgery. Int J Cardiol, 2017, 231: 84-89.
22.	Premuzic V, Basic-Jukic N, Jelakovic B, et al. Continuous veno-venous hemofiltration improves survival of patients with congestive heart failure and cardiorenal syndrome compared to slow continuous ultrafiltration. Ther Apher Dial, 2017, 21(3): 279-286.
23.	Xu J, Ding X, Fang Y, et al. New, goal-directed approach to renal replacement therapy improves acute kidney injury treatment after cardiac surgery. J Cardiothorac Surg, 2014, 9: 103.
24.	Wu B, Yan W, Li X, et al. Initiation and cessation timing of renal replacement therapy in patients with type 1 cardiorenal syndrome: an observational study. Cardiorenal Med, 2017, 7(2): 118-127.
25.	Xu J, Shen B, Fang Y, et al. Postoperative fluid overload is a useful predictor of the short-term outcome of renal replacement therapy for acute kidney injury after cardiac surgery. Medicine (Baltimore), 2015, 94(33): e1360.
26.	Ezekowitz JA, O’meara E, Mcdonald MA, et al. 2017 comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure. Can J Cardiol, 2017, 33(11): 1342-1433.

1. Ronco C, Di Lullo L. Cardiorenal syndrome. Heart Fail Clin, 2014, 10(2): 251-280.
2. Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol, 2008, 52(19): 1527-1539.
3. Hatamizadeh P, Fonarow GC, Budoff MJ, et al. Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol, 2013, 9(2): 99-111.
4. Pimienta González R, Couto Comba P, Rodríguez Esteban M, et al. Incidence, mortality and positive predictive value of type 1 cardiorenal syndrome in acute coronary syndrome. PLoS One, 2016, 11(12): e0167166.
5. Ronco C, Di Lullo L. Cardiorenal syndrome in western countries: epidemiology, diagnosis and management approaches. Kidney Dis (Basel), 2017, 2(4): 151-163.
6. Xu J, Jiang W, Fang Y, et al. Management of cardiac surgery-associated acute kidney injury. Contrib Nephrol, 2016, 187: 131-142.
7. Hou FF, Yang X. Advances in the management of acute cardiorenal syndrome in China: biomarkers for predicting development and outcomes. Kidney Dis (Basel), 2017, 2(4): 145-150.
8. Cheng H, Chen YP. Clinical prediction scores for type 1 cardiorenal syndrome derived and validated in Chinese cohorts. Cardiorenal Med, 2015, 5(1): 12-19.
9. Hillege HL, Nitsch D, Pfeffer MA, et al. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation, 2006, 113(5): 671-678.
10. Braam B, Joles JA, Danishwar AH, et al. Cardiorenal syndrome-current understanding and future perspectives. Nat Rev Nephrol, 2014, 10(1): 48-55.
11. Parikh CR, Mansour SG. Perspective on clinical application of biomarkers in AKI. J Am Soc Nephrol, 2017, 28(6): 1677-1685.
12. Wang Y, Zou Z, Jin J, et al. Urinary TIMP-2 and IGFBP7 for the prediction of acute kidney injury following cardiac surgery. BMC Nephrol, 2017, 18(1): 177.
13. Jiang W, Teng J, Xu J, et al. Dynamic predictive scores for cardiac surgery-associated acute kidney injury. J Am Heart Assoc, 2016, 5(8): e003754.
14. Ronco C, Kaushik M, Valle R, et al. Diagnosis and management of fluid overload in heart failure and cardio-renal syndrome: the " 5B” approach. Semin Nephrol, 2012, 32(1): 129-141.
15. Kim DH, Chien FJ, Eisen HJ. Pharmacologic management for heart failure and emerging therapies. Curr Cardiol Rep, 2017, 19(10): 94.
16. Bart BA, Boyle A, Bank AJ, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial. J Am Coll Cardiol, 2005, 46(11): 2043-2046.
17. Costanzo MR, Guglin ME, Saltzberg MT, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol, 2007, 49(6): 675-683.
18. Bart BA, Goldsmith SR, Lee KL, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med, 2012, 367(24): 2296-2304.
19. Kazory A. Cardiorenal syndrome: ultrafiltration therapy for heart failure--trials and tribulations. Clin J Am Soc Nephrol, 2013, 8(10): 1816-1828.
20. Writing Committee Members, Yancy CW, Jessup M, et al. 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation, 2016, 134(13): e282-e293.
21. Cho YJ, Lee EH, Lee K, et al. Long-term clinical outcomes of Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial in patients undergoing cardiac surgery. Int J Cardiol, 2017, 231: 84-89.
22. Premuzic V, Basic-Jukic N, Jelakovic B, et al. Continuous veno-venous hemofiltration improves survival of patients with congestive heart failure and cardiorenal syndrome compared to slow continuous ultrafiltration. Ther Apher Dial, 2017, 21(3): 279-286.
23. Xu J, Ding X, Fang Y, et al. New, goal-directed approach to renal replacement therapy improves acute kidney injury treatment after cardiac surgery. J Cardiothorac Surg, 2014, 9: 103.
24. Wu B, Yan W, Li X, et al. Initiation and cessation timing of renal replacement therapy in patients with type 1 cardiorenal syndrome: an observational study. Cardiorenal Med, 2017, 7(2): 118-127.
25. Xu J, Shen B, Fang Y, et al. Postoperative fluid overload is a useful predictor of the short-term outcome of renal replacement therapy for acute kidney injury after cardiac surgery. Medicine (Baltimore), 2015, 94(33): e1360.
26. Ezekowitz JA, O’meara E, Mcdonald MA, et al. 2017 comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure. Can J Cardiol, 2017, 33(11): 1342-1433.

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