Cardiogenic shock and acute kidney injury: the rule rather than the exception
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Cardiogenic shock and acute kidney injury: the rule rather than the exception N Ghionzoli 1 & C Sciaccaluga 1 & GE Mandoli 1 & G Vergaro 2,3 & F Gentile 3 & F D’Ascenzi 1 & S Mondillo 1 & M Emdin 2,3 & S Valente 1 & M Cameli 1 Accepted: 23 September 2020 # The Author(s) 2020
Abstract Cardiogenic shock (CS) is a life-threatening condition of poor end-organ perfusion, caused by any cardiovascular disease resulting in a severe depression of cardiac output. Despite recent advances in replacement therapies, the outcome of CS is still poor, and its management depends more on empirical decisions rather than on evidence-based strategies. By its side, acute kidney injury (AKI) is a frequent complication of CS, resulting in the onset of a cardiorenal syndrome. The combination of CS with AKI depicts a worse clinical scenario and holds a worse prognosis. Many factors can lead to acute renal impairment in the setting of CS, either for natural disease progression or for iatrogenic causes. This review aims at collecting the current evidence-based acknowledgments in epidemiology, pathophysiology, clinical features, diagnosis, and management of CS with AKI. We also attempted to highlight the major gaps in evidence as well as to point out possible strategies to improve the outcome. Keywords Cardiogenic shock . Acute kidney injury . Heart failure . Replacement therapy . Outcome
Abbreviations AKI Acute kidney injury AMI Acute myocardial infarction CRS Cardiorenal syndrome CS Cardiogenic shock CVP Central venous pressure CVVH Continuous veno-venous hemofiltration ECMO Extracorporeal membrane oxygenation IABP Intra-aortic balloon pump LV Left ventricular MCS Mechanical support devices RV Right ventricular PCWP Pulmonary capillary wedge pressure PEEP Positive end-expiration pressure RRT Renal replacement therapy
* N Ghionzoli [email protected] 1
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy
2
Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy
3
Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
Introduction Cardiogenic shock (CS) is a critical condition of end-organ hypoperfusion, consequent to a severe decrease in cardiac output, in spite of adequate intravascular volume. Therefore, hypotension requiring volume resuscitation and signs of endorgan hypoperfusion represent the clinical landmarks of CS, urgently demanding for pharmacological and/or mechanical intervention [1–3]. Acute kidney injury (AKI) represents a sudden insult to renal function that encompasses several clinical scenarios, ranging from a mild increase in serum creatinine to endstage renal disease, as stated by Risk-Injury-Failure-LossEnd-stage (RIFLE) criteria. In order to make a diagnosis of AKI, at least one of the following criteria has to be met: increase in serum creatinine ≥ 0.3 mg/dL within 48 h; increase in basal serum creatinine by ≥ 1.5 times within the previous 7 days; urine volume < 0
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