Article thumbnail

Pharmacological Management of Cardiorenal Syndromes

By Andrew A. House, Mikko Haapio, Johan Lassus, Rinaldo Bellomo and Claudio Ronco


Cardiorenal syndromes are disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The pharmacological management of Cardiorenal syndromes may be complicated by unanticipated or unintended effects of agents targeting one organ on the other. Hence, a thorough understanding of the pathophysiology of these disorders is paramount. The treatment of cardiovascular diseases and risk factors may affect renal function and modify the progression of renal injury. Likewise, management of renal disease and associated complications can influence heart function or influence cardiovascular risk. In this paper, an overview of pharmacological management of acute and chronic Cardiorenal Syndromes is presented, and the need for high-quality future studies in this field is highlighted

Topics: Review Article
Publisher: SAGE-Hindawi Access to Research
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (1995). a d k o u r ,M .G a d a l l a h ,B .R i v e l i n e ,G .E .P l a n t e ,a n dS .G . Massry, “Comparison between the effects of indapamide and hydrochlorothiazide on creatinine clearance in patients with impaired renal function and hypertension,”
  2. (2005). A high calciumphosphate product is associated with high C-reactive protein concentrations in hemodialysis patients,” Nephron. Clinical Practice,
  3. (2006). A modified goal-directed protocol improves clinical outcomes in intensive care unit patients with septic shock: a randomized controlled trial,” Shock,v o l .2 6 ,n o .6 ,p p .
  4. (2001). a n dF .K .P o r t ,“ A s s o c i a t i o no fe l e v a t e ds e r u mP
  5. (2009). a s u j a ,M .K .M o r ,K .C .H a rt w i g ,P .M .P a l e v s k y
  6. (2009). A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease,”
  7. (2006). A.K.Singh,L.Szczech,K.L.Tangetal.,“Correctionofanemia with epoetin alfa in chronic kidney disease,” New England
  8. (2006). Appropriateness of spironolactone prescribing in heart failure patients: a population-based study,”
  9. (2007). Assessing plasma total homocysteine in patients with end-stage renal disease,”
  10. (2006). Beta blockers in the management of chronic kidney disease,”
  11. (2006). C o c a ,H .M .K r u m h o l z ,A .X .G a r g ,a n dC .R . Parikh, “Underrepresentation of renal disease in randomized controlled trials of cardiovascular disease,”
  12. (2000). Calcineurin inhibitor attenuates left ventricular hypertrophy, leading to prevention of heart failure in hypertensive rats,”
  13. (2008). Cardiogenic shock secondary to combination of diltiazem and sotalol,”
  14. (2010). Cardiovascular disease and CKD: core curriculum
  15. (2010). Cattran et al., “Effect of Bvitamin therapy on progression of diabetic nephropathy: a randomized controlled trial,”
  16. (2005). Chapm a n ,a n dJ .C .C r a i g ,“ T a c r o l i m u sv e r s u sc y c l o s p o r i na s primary immunosuppression for kidney transplant recipients,” Cochrane Database of Systematic Reviews,n o .4 ,a r t i c l e CD003961,
  17. (2001). Clinical trials update: highlights of the scientific sessions of the
  18. (2010). Comparison of dopamine and norepinephrine in the treatment of shock,”
  19. (2006). Comparison of two fluid-management strategies in acute lung injury,”
  20. (2004). Continuous infusion versus bolus injection of loop diuretics in congestive heart failure,” Cochrane Database of Systematic Reviews,
  21. (2009). d e nU i l ,W .K .L a g r a n d ,S .D .A .V a l k ,P .E .S p r o n k ,a n d
  22. (2009). Defining contrast-induced nephropathy,”
  23. (2010). Definition and classification of Cardio-Renal Syndromes: workgroup statementsfromthe7thADQIConsensusConference,”Nephrology Dialysis Transplantation,
  24. (2007). Disease progression and the application of evidence-based treatment guidelines diagnose it early: a case for screening and appropriate management,”
  25. (2002). Diuretics, mortality, and nonrecovery of renal function in acute renal failure,”
  26. (2007). Effect of homocysteine lowering on mortality and vascular disease in advanced chronic kidney disease and end-stage renal disease: arandomizedcontrolledtrial,”JournaloftheAmericanMedical Association,
  27. (2008). Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials,”BritishMedicalJournal,
  28. (2003). Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction,”
  29. (2007). Erythropoietin protects cardiac myocytes against anthracycline-induced apoptosis,”
  30. (2008). Erythropoietin: ready for prime-time cardioprotection,”
  31. (2008). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure
  32. (2007). Evaluation of cinacalcet therapy to lower cardiovascular events (EVOLVE): rationale and design overview,”
  33. (2009). Filippatos et al., “Ferric carboxymaltoseinpatientswithheartfailureandirondeficiency,”New
  34. (2009). focused update incorporated into the ACC/AHA
  35. Function and effect of bone morphogenetic protein-7 in kidney bone and the bone-vascular links in chronic kidney disease,”
  36. (2007). h e o r g h i a d e ,M .A .K o n s t a m ,J .C .B u r n e t tJ r .e ta l . , “Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST clinical status trials,”
  37. (2009). Highlights of the 2009 scientific sessions of the European society of cardiology,”
  38. (2003). iG i a n t o m a s s o ,C .N .M a y ,a n dR .B e l l o m o ,“ V i t a lo r g a n bloodflowduringhyperdynamicsepsis,”Chest,vol.124,no.3,
  39. (2007). Iovine et al., “Effects of β-erythropoietin treatment on left ventricular remodeling, systolic function, and B-type natriuretic peptide levels in patients with the cardiorenal anemia syndrome,”
  40. (1979). Kinetics of elimination of thiocyanate in 7 healthy subjects and in 8 subjects with renal failure,”
  41. (2006). L a r s o n ,P .G .D e a n ,M .D .S t e g a l le ta l . ,“ C o m p l e t e avoidance of calcineurin inhibitors in renal transplantation: a randomized trial comparing sirolimus and tacrolimus,”
  42. (2007). Levosimendan improvesrenalfunctioninpatientswithacutedecompensated heart failure: comparison with dobutamine,”
  43. (2007). Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE randomized trial,”
  44. (2007). M c C u l l o u g h ,C .T .J u r k o v i t z ,P .E .P e r g o l ae ta l . , “Independent components of chronic kidney disease as a cardiovascular risk state: results from the kidney early evaluation program
  45. M¨ arz et al., “Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis,”
  46. (2009). Managing acute renal failure in patients with acute decompensated heart failure: the cardiorenal syndrome,” Current Heart Failure Reports,
  47. (2008). Molecular and physiological effects of nesiritide,”
  48. (2008). Normal Hematocrit Cardiac Trial Authors: the normal hematocrit study—follow-up,”
  49. (2006). Normalization of hemoglobin level in patients with chronic kidney disease and anemia,”NewEnglandJournalofMedicine,vol.355,no.20,pp.
  50. (2008). Randomized double-blind trial of darbepoetin alfa in patients with symptomatic heart failure and anemia,”
  51. (2004). Rates of hyperkalemia after publication of the Randomized
  52. (2009). Rationale and design of the Acute Study of Clinical
  53. (2005). Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure,”
  54. (2009). Rosuvastatin and cardiovascular events in patients undergoing hemodialysis,”
  55. (2007). S u k i ,R .Z a b a n e h ,J .L .C a n g i a n oe ta l . ,“ E ffects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients,”
  56. (2009). Scheuerle et al., “Comparison of cardiac, hepatic, and renal effects of arginine vasopressin and noradrenaline during porcine fecal peritonitis: a randomized controlled trial,”
  57. Sepsisinduced cardiomyopathy: a review of pathophysiologic mechanisms,”
  58. (2007). Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes,”
  59. (2002). Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial,”
  60. (2008). Skouri et al., “Elevated intraabdominal pressure in acute decompensated heart failure. A potential contributor to worsening renal function?”
  61. (2008). Sodium nitroprusside for advanced low-output heart failure,”
  62. (2007). Systematic review of theclinicalefficacyandsafetyofsevelamerindialysispatients,”
  63. (2010). T e s t a n i ,J .C h e n ,B .D .M c C a u l e y ,S .E .K i m m e l ,a n d
  64. (2005). The cardiorenal syndrome: lessons from the ADHERE database and treatment options,”
  65. (2009). The cardiorenal syndrome.
  66. (1999). The effect of spironolactone on morbidity and mortality in patients with severe heart failure,”
  67. (2007). The effectiveness and cost-effectiveness of cinacalcet for secondary hyperparathyroidism in end-stage renal disease patients on dialysis: a systematic review and economic evaluation.,”
  68. (2008). The endothelin system as a therapeutic target in cardiovascular disease: great expectations or bleak house?”
  69. (2010). The Results of the Study of Heart and Renal Protection
  70. (2007). Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure,”
  71. (2007). venous congestion and the association with renal impairment in patients with cardiac dysfunction,”
  72. (2006). Vitamin D in chronic kidney disease: a systemic role for selective vitamin D receptor activation,”
  73. (2004). W r o n e ,J .M .H o r n b e r g e r ,J .L .Z e h n d e r ,L .M .M c C a n n
  74. (2006). Wollman,andD.Schwartz,“Anemia,chronicrenaldiseaseand congestive heart failure—The cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists,”