CARDIORENAL SYNDROME: NOT AS STRAIGHT FORWARD AS WE USED TO THINK


Amir Kazory, M.D., University of Florida, Gainesville, FL, USA

Simultaneous dysfunction of the heart and the kidney represents a distinct spectrum of disease states composed of complex clinical scenarios with potentially adverse outcomes. Worsening renal function (WRF) in the setting of acute decompensated heart failure (ADHF) is one such clinical setup with not yet well-characterized underlying mechanisms. It is of paramount importance to characterize the pathways leading to WRF in ADHF in order to develop a mechanistically-relevant management strategy. There has been a shifting paradigm in our understanding of the cardiorenal interactions in patients with ADHF questioning some contemporary concepts such as the low forward flow theory or high backward pressure hypothesis. Besides, emerging data do not fully support our conventional thinking about other aspects of these interactions such as the independent adverse impact of WRF on the outcomes of patients with ADHF, pointing to congestion as a possibly overlooked factor. The findings of the recent studies also suggest that apparent improvement in renal function might be yet another risk factor for untoward outcomes in this patient population, further challenging our current understanding of the cardiorenal interactions. This talk will provide a brief overview of these emerging controversies in the field of cardiorenal syndrome with the goal of identifying the areas where clinical research can be most helpful to fill the gaps in our understanding.