Renal Mechanisms and Heart Failure
Chronic kidney disease is an established cardiovascular risk factor, and renal dysfunction is one of the most important independent risk factors for poor outcomes and all-cause mortality in patients with heart failure. The mechanisms by which the onset of
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Renal Mechanisms and Heart Failure Bojan Jelaković, Vedran Premužić, Ana Jelaković, and Davor Miličić
Chronic kidney disease (CKD) is a well-established cardiovascular (CV) risk factor, and as Dr. Dargie said, “The kidneys have always been at the heart of heart failure treatment.” Few years ago, the interrelationship between the heart and kidney was described as cardiorenal syndrome(s) by Ronco et al. [1]. However, recently this classification was criticized as being oversimplistic and biologically not completely plausible [2]. The pathophysiological relationships between heart failure (HF) and renal dysfunction are not fully understood, but it is obvious that dysfunction of one organ could cause deterioration of other organ function. Renal dysfunction is one of the most important independent risk factors for poor outcomes and all-cause mortality in patients with HF. Baseline glomerular filtration rate (GFR) appears to be a stronger predictor of mortality in patients with HF than left ventricular ejection fraction or NYHA functional class. In meta-analyses of studies on HF which included almost 19.000 subjects, 25% of patients exhibited an increase of serum creatinine more than 18 μmol/L or decrease of estimated GFR (eGFR) more than 5 mL/min/1.73 m2. This worsening renal function (WRF) was associated with a higher risk for mortality and hospitalization. Both elevated serum creatinine on admission and WRF during hospitalization predicted prolonged hospitalization, rehospitalization, and death [3]. In the Acute Decompensated Heart Failure National Registry (ADHERE) of >105.000 individuals admitted for acute decompensated HF (ADHF), 30% had a history of renal insufficiency, 21% had serum creatinine concentrations >176.2 μmol/L, and 9% had creatinine
B. Jelaković (*) · V. Premužić · A. Jelaković Department of Nephrology, Hypertension, Dialysis and Transplantation, School of Medicine University od Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia D. Miličić Cardiology Clinic, School of Medicine University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia e-mail: [email protected] © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_7
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concentrations >264.3 μmol/L [4]. McAlister et al. found that only 17% of patients with HF had creatinine clearances >90 mL/min [5]. In their cohort, 39% with New York Heart Association (NYHA) class IV symptoms and 31% with NYHA class III symptoms had creatinine clearance
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