The Acute Cardiorenal Syndrome Type I: Considerations on Physiology, Epidemiology, and Therapy

Current Heart Failure Reports

Volumn 11, Issue 4, 2014, Pages 382-392

  Valika, Ali A ^a,b   Costanzo, Maria Rosa ^a  

^a Lutheran General Hospital   (United States)

^b Midwest Heart Specialists   (United States)

Author keywords

Acute decompensated heart failure; Acute kidney injury; Cardiorenal syndrome; Cardiorenal syndrome type I; Diuretics; Ultrafiltration; Worsening renal function

Indexed keywords

BIOLOGICAL MARKER; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIURETIC AGENT; INOTROPIC AGENT; VASODILATOR AGENT;

CARDIORENAL SYNDROME; HEMOCONCENTRATION; HUMAN; KIDNEY FUNCTION; PATHOPHYSIOLOGY; PROGNOSIS; REVIEW; ULTRAFILTRATION; ACUTE DISEASE; CARDIO-RENAL SYNDROME; KIDNEY FUNCTION TEST;

ACUTE DISEASE; BIOLOGICAL MARKERS; CARDIO-RENAL SYNDROME; HUMANS; KIDNEY FUNCTION TESTS; PROGNOSIS;

EID: 84920792966     PISSN: 15469530     EISSN: 15469549     Source Type: Journal    
DOI: 10.1007/s11897-014-0224-6     Document Type: Review

References (72)

1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–e292. doi:10.1161/01.cir.0000441139.02102.80.
2. Ronco C, Cicoira M, McCullough PA. Cardiorenal syndrome type 1: pathophysiological crosstalk leading to combined heart and kidney dysfunction in the setting of acutely decompensated heart failure. J Am Coll Cardiol. 2012;60(12):1031–42. doi:10.1016/j.jacc.2012.01.077.
3. Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J. High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail. 2007;13(6):422–30. doi:10.1016/j.cardfail.2007.03.011.
4. Costanzo MR, Chawla LS, Tumlin JA, Herzog CA, McCullough PA, Kellum JA, et al. The role of early and sufficient isolated venovenous ultrafiltration in heart failure patients with pulmonary and systemic congestion. Rev Cardiovasc Med. 2013;14(2–4):e123–33.
5. Gheorghiade M, Gattis WA, O’Connor CM, Adams Jr KF, Elkayam U, Barbagelata A, et al. Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA. 2004;291(16):1963–71. doi:10.1001/jama.291.16.1963.
6. Giglioli C, Landi D, Cecchi E, Chiostri M, Gensini GF, Valente S, et al. Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure: the ULTRADISCO study. Eur J Heart Fail. 2011;13(3):337–46.
7. Ronco C, McCullough P, Anker SD, Anand I, Aspromonte N, Bagshaw SM, et al. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J. 2010;31(6):703–11. doi:10.1093/eurheartj/ehp507.
8. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527–39. doi:10.1016/j.jacc.2008.07.051.
9. Damman K, Jaarsma T, Voors AA, Navis G, Hillege HL, van Veldhuisen DJ, et al. Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the coordinating study evaluating outcome of advising and counseling in heart failure (COACH). Eur J Heart Fail. 2009;11(9):847–54. doi:10.1093/eurjhf/hfp108.
10. Gottlieb SS, Abraham W, Butler J, Forman DE, Loh E, Massie BM, et al. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail. 2002;8(3):136–41.
11. Smith GL, Vaccarino V, Kosiborod M, Lichtman JH, Cheng S, Watnick SG, et al. Worsening renal function: what is a clinically meaningful change in creatinine during hospitalization with heart failure? J Card Fail. 2003;9(1):13–25. doi:10.1054/jcaf.2003.3.
12. Metra M, Nodari S, Parrinello G, Bordonali T, Bugatti S, Danesi R, et al. Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance. Eur J Heart Fail. 2008;10(2):188–95. doi:10.1016/j.ejheart.2008.01.011.
13. Chen S. Retooling the creatinine clearance equation to estimate kinetic GFR when the plasma creatinine is changing acutely. J Am Soc Nephrol JASN. 2013;24(6):877–88. doi:10.1681/ASN.2012070653.
14. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–12. doi:10.1186/cc2872.
15. Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73(5):538–46. doi:10.1038/sj.ki.5002743.
16. Roy AK, Mc Gorrian C, Treacy C, Kavanaugh E, Brennan A, Mahon NG, et al. A comparison of traditional and novel definitions (RIFLE, AKIN, and KDIGO) of acute kidney injury for the prediction of outcomes in acute decompensated heart failure. Cardioren Med. 2013;3(1):26–37. doi:10.1159/000347037.
17. Koyama S, Sato Y, Tanada Y, Fujiwara H, Takatsu Y. Early evolution and correlates of urine albumin excretion in patients presenting with acutely decompensated heart failure. Circ Heart Fail. 2013;6(2):227–32. doi:10.1161/CIRCHEARTFAILURE.112.000152.
18. Ferreira JP, Santos M, Almeida S, Marques I, Bettencourt P, Carvalho H. The role of albuminuria as a non-invasive marker for congestive acutely decompensated chronic heart failure and the spironolactone effect in elderly Portuguese: a non-randomized trial. Nephrology. 2014;19(3):149–56. doi:10.1111/nep.12188.
19. Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol JASN. 2003;14(10):2534–43.
20. Nickolas TL, O’Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, et al. Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med. 2008;148(11):810–9.
21. Aghel A, Shrestha K, Mullens W, Borowski A, Tang WH. Serum neutrophil gelatinase-associated lipocalin (NGAL) in predicting worsening renal function in acute decompensated heart failure. J Card Fail. 2010;16(1):49–54. doi:10.1016/j.cardfail.2009.07.003.
22. Maisel AS, Mueller C, Fitzgerald R, Brikhan R, Hiestand BC, Iqbal N, et al. Prognostic utility of plasma neutrophil gelatinase-associated lipocalin in patients with acute heart failure: the NGAL EvaLuation Along with B-type NaTriuretic Peptide in acutely decompensated heart failure (GALLANT) trial. Eur J Heart Fail. 2011;13(8):846–51. doi:10.1093/eurjhf/hfr087.
23. Macdonald J, Marcora S, Jibani M, Roberts G, Kumwenda M, Glover R, et al. GFR estimation using cystatin C is not independent of body composition. Am J Kidney Dis Off J National Kidney Found. 2006;48(5):712–9. doi:10.1053/j.ajkd.2006.07.001.
24. Harman G, Akbari A, Hiremath S, White CA, Ramsay T, Kokolo MB, et al. Accuracy of cystatin C-based estimates of glomerular filtration rate in kidney transplant recipients: a systematic review. Nephrol Dial Transplant Off Public Euro Dial Transplant Assoc Eur Renal Assoc. 2013;28(3):741–57. doi:10.1093/ndt/gfs498.
25. McCullough PA, Kellum JA, Haase M, Muller C, Damman K, Murray PT. Pathophysiology of the cardiorenal syndromes: executive summary from the eleventh consensus conference of the Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol. 2013;182:82–98. doi:10.1159/000349966. This paper highlights an up to date review of cardiorenal pathophysiology.
26. Adams Jr KF, Uddin N, Patterson JH. Clinical predictors of in-hospital mortality in acutely decompensated heart failure-piecing together the outcome puzzle. Congest Heart Fail. 2008;14(3):127–34.
27. Jao GT, Chiong JR. Hyponatremia in acute decompensated heart failure: mechanisms, prognosis, and treatment options. Clin Cardiol. 2010;33(11):666–71. doi:10.1002/clc.20822.
28. Navar LG. Renal autoregulation: perspectives from whole kidney and single nephron studies. Am J Physiol. 1978;234(5):F357–70.
29. Damman K, Navis G, Smilde TD, Voors AA, van der Bij W, van Veldhuisen DJ, et al. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail. 2007;9(9):872–8. doi:10.1016/j.ejheart.2007.05.010.
30. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53(7):589–96. doi:10.1016/j.jacc.2008.05.068.
31. Nohria A, Hasselblad V, Stebbins A, Pauly DF, Fonarow GC, Shah M, et al. Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol. 2008;51(13):1268–74. doi:10.1016/j.jacc.2007.08.072.
32. Mullens W, Abrahams Z, Skouri HN, Francis GS, Taylor DO, Starling RC, et al. Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol. 2008;51(3):300–6. doi:10.1016/j.jacc.2007.09.043.
33. Mullens W, Abrahams Z, Francis GS, Taylor DO, Starling RC, Tang WH. Prompt reduction in intra-abdominal pressure following large-volume mechanical fluid removal improves renal insufficiency in refractory decompensated heart failure. J Card Fail. 2008;14(6):508–14. doi:10.1016/j.cardfail.2008.02.010.
34. Guazzi M, Gatto P, Giusti G, Pizzamiglio F, Previtali I, Vignati C, et al. Pathophysiology of cardiorenal syndrome in decompensated heart failure: role of lung-right heart-kidney interaction. Int J Cardiol. 2013;169(6):379–84. doi:10.1016/j.ijcard.2013.09.014.
35. Milo O, Cotter G, Kaluski E, Brill A, Blatt A, Krakover R, et al. Comparison of inflammatory and neurohormonal activation in cardiogenic pulmonary edema secondary to ischemic versus nonischemic causes. Am J Cardiol. 2003;92(2):222–6.
36. Virzi GM, Torregrossa R, Cruz DN, Chionh CY, de Cal M, Soni SS. Cardiorenal syndrome type 1 may be immunologically mediated: a pilot evaluation of monocyte apoptosis. Cardio Med. 2012;2(1):33–42.
37. Forman DE, Butler J, Wang Y, Abraham WT, O’Connor CM, Gottlieb SS, et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol. 2004;43(1):61–7.
38. Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, et al. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail. 2007;13(8):599–608. doi:10.1016/j.cardfail.2007.04.008.
39. Krumholz HM, Chen Y-T, Vaccarino V, Wang Y, Radford MJ, Bradford WD. Correlates and impact on outcomes of worsening renal function in patients ≥65 years of age with heart failure. Am J Cardiol. 2000;85(9):1110–3. doi:10.1016/S0002-9149(00)00705-0.
40. Butler J, Forman DE, Abraham WT, Gottlieb SS, Loh E, Massie BM. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J. 2004;147(2):331–8. doi:10.1016/j.ahj.2003.08.012.
41. Testani JM, McCauley BD, Chen J, Coca SG, Cappola TP, Kimmel SE. Clinical characteristics and outcomes of patients with improvement in renal function during the treatment of decompensated heart failure. J Card Fail. 2011;17(12):993–1000. doi:10.1016/j.cardfail.2011.08.009. This paper highlights the important notion that improvement in renal function also does not necessarily portend a favorable prognosis.
42. Testani JM, Chen J, McCauley BD, Kimmel SE, Shannon RP. Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation. 2010;122(3):265–72. doi:10.1161/CIRCULATIONAHA.109.933275.
43. Greene SJ, Gheorghiade M, Vaduganathan M, Ambrosy AP, Mentz RJ, Subacius H, et al. Haemoconcentration, renal function, and post-discharge outcomes among patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial. Eur J Heart Fail. 2013;15(12):1401–11. doi:10.1093/eurjhf/hft110.
44. Testani JM, Brisco MA, Chen J, McCauley BD, Parikh CR, Tang WH. Timing of hemoconcentration during treatment of acute decompensated heart failure and subsequent survival: importance of sustained decongestion. J Am Coll Cardiol. 2013;62(6):516–24. doi:10.1016/j.jacc.2013.05.027.
45. Lorenz JN, Weihprecht H, Schnermann J, Skott O, Briggs JP. Renin release from isolated juxtaglomerular apparatus depends on macula densa chloride transport. Am J Physiol. 1991;260(4 Pt 2):F486–93.
46. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364(9):797–805. doi:10.1056/NEJMoa1005419.
47. Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med. 2012;367(24):2296–304. doi:10.1056/NEJMoa1210357.
48. Testani JM, Brisco MA, Turner JM, Spatz ES, Bellumkonda L, Parikh CR, et al. Loop diuretic efficiency: a metric of diuretic responsiveness with prognostic importance in acute decompensated heart failure. Circ Heart Fail. 2014;7(2):261–70. doi:10.1161/CIRCHEARTFAILURE.113.000895.
49. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239. doi:10.1016/j.jacc.2013.05.019.
50. Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC. Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) database. J Am Coll Cardiol. 2006;47(1):76–84. doi:10.1016/j.jacc.2005.09.022.
51. Wynne J, Narveson SY, Littmann L. Cardiorenal syndrome. Heart & lung. J Acute Crit Care. 2012;41(2):157–60. doi:10.1016/j.hrtlng.2011.06.001.
52. Cuffe MS, Califf RM, Adams Jr KF, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002;287(12):1541–7. doi:10.1001/jama.287.12.1541.
53. Armando I, Villar VA, Jose PA. Dopamine and renal function and blood pressure regulation. Compre Physiol. 2011;1(3):1075–117. doi:10.1002/cphy.c100032.
54. Giamouzis G, Butler J, Starling RC, Karayannis G, Nastas J, Parisis C, et al. Impact of dopamine infusion on renal function in hospitalized heart failure patients: results of the Dopamine in Acute Decompensated Heart Failure (DAD-HF) trial. J Card Fail. 2010;16(12):922–30. doi:10.1016/j.cardfail.2010.07.246.
55. Chen HH, Anstrom KJ, Givertz MM, et al. Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the rose acute heart failure randomized trial. JAMA. 2013;310(23):2533–43. doi:10.1001/jama.2013.282190.
56. Triposkiadis FK, Butler J, Karayannis G, Starling RC, Filippatos G, Wolski K. Efficacy and safety of high dose versus low dose furosemide with or without dopamine infusion: the Dopamine in Acute Decompensated Heart Failure II (DAD-HF II) trial. Int J Cardiol. 2014;172(1):115–21. doi:10.1016/j.ijcard.2013.12.276.
57. O’Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365(1):32–43. doi:10.1056/NEJMoa1100171.
58. Costanzo MR, Ronco C. Isolated ultrafiltration in heart failure patients. Curr Cardiol Rep. 2012;14(3):254–64. doi:10.1007/s11886-012-0257-y.
59. Ronco C, Ricci Z, Bellomo R, Bedogni F. Extracorporeal ultrafiltration for the treatment of overhydration and congestive heart failure. Cardiology. 2001;96(3–4):155–68.
60. Costanzo MR, Guglin ME, Saltzberg MT, Jessup ML, Bart BA, Teerlink JR, et al. Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol. 2007;49(6):675–83. doi:10.1016/j.jacc.2006.07.073.
61. Marenzi G, Muratori M, Cosentino ER, Rinaldi ER, Donghi V, Milazzo V. Continuous ultrafiltration for congestive heart failure: the CUORE trial. J Card Fail. 2014;20(1):9–17. doi:10.1016/j.cardfail.2013.11.004.
62. Costanzo MR, Fonarow GC, Filippatos GS. Ultrafiltration in heart failure with cardiorenal syndrome. N Engl J Med. 2013;368(12):1158–9. doi:10.1056/NEJMc1300456#SA4.
63. Voors AA, Dittrich HC, Massie BM, DeLucca P, Mansoor GA, Metra M, et al. Effects of the adenosine A1 receptor antagonist rolofylline on renal function in patients with acute heart failure and renal dysfunction: results from PROTECT (Placebo-Controlled Randomized Study of the Selective Adenosine A1 Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function). J Am Coll Cardiol. 2011;57(19):1899–907. doi:10.1016/j.jacc.2010.11.057.
64. Yilmaz MB, Grossini E, Silva Cardoso JC, Edes I, Fedele F, Pollesello P, et al. Renal effects of levosimendan: a consensus report. Cardio Drugs Therapy Spon Int Soc Cardio Pharmaco. 2013;27(6):581–90. doi:10.1007/s10557-013-6485-6.
65. Konstam MA, Gheorghiade M, Burnett Jr JC, Grinfeld L, Maggioni AP, Swedberg K, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297(12):1319–31. doi:10.1001/jama.297.12.1319.
66. Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet. 2013;381(9860):29–39. doi:10.1016/s0140-6736(12)61855-8.
67. Metra M, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, et al. Effect of serelaxin on cardiac, renal, and hepatic biomarkers in the Relaxin in Acute Heart Failure (RELAX-AHF) development program: correlation with outcomes. J Am Coll Cardiol. 2013;61(2):196–206. doi:10.1016/j.jacc.2012.11.005.
68. Diez J. Serelaxin: a novel therapy for acute heart failure with a range of hemodynamic and non-hemodynamic actions. Am J Cardio Drugs Drugs Dev Interven. 2014. doi:10.1007/s40256-014-0069-0.
69. AVOID Clinical Study Protocol, version 4.0, Appendix IV: Treatment Guidelines for the Loop Diuretic Arm and the Aquapheresis Arm
70. Negoianu D. Using ultrafiltration in patients with heart failure: who, how, and when? Presentation at 2013 HFSA satellite symposium
71. Bart BA, et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. The New England Journal of Medicine. 2012;367(24):2296–304. doi:10.1056/NEJMoa1210357
72. Ronco C. Cardiorenal syndrome. J Am Coll Cardiol. 2008 Nov 4; 52(19):1527–39