The heart and the kidney are of utmost importance for the maintenance of
cardiovascular (CV) homeostasis. In healthy subjects, hemodynamic
changes in either organ may affect hemodynamics of the other organ. This
interaction is fine-tuned by neurohumoral activity, including atrial
natriuretic peptides, renin-angiotensin aldosterone system and
sympathetic activity. Dysfunction or disease of one organ may initiate,
accentuate, or precipitate dysfunction or disease state in the other
organ, often leading to a vicious cycle. Further, the interaction
between the heart and the kidney may occur in the setting of processes
and diseases that may affect both organs simultaneously, such as
advanced age, hypertension, diabetes mellitus, atherosclerosis, etc. In
this regard, a stiff aorta that occurs with aging due to mechanical
stress may independently initiate or precipitate dysfunction and disease
in the heart and the kidney. All of these factors contribute to a high
prevalence of coexistent CV and kidney disease, especially in the
elderly. In advanced kidney disease, hemodynamic and neurohumoral
homeostasis are lost, volume and pressure overload may coexist, and the
elimination of certain pharmacologic agents may be substantially
impaired. Thus, coexistence of CV and kidney disease complicates
diagnosis, propagates pathophysiology, adversely affects prognosis, and
hinders management. (C) 2016 Elsevier Inc. All rights reserved
