Cardio-Renal Syndrome Type 4: Epidemiology, Pathophysiology and Treatment
Section snippets
Epidemiology
The association between CKD and increased risk for cardiac disease and events has long been recognized. In the current era, cardiovascular causes represent close to 50% of deaths in all age groups of CKD patients.3 Many patients progress through CKD and ultimately initiate dialysis with significant underlying cardiovascular disease, in part owing to the aging population and high prevalence of diabetes and other traditional risk factors such as hypertension and dyslipidemia. Illustrating this
Pathophysiology
Having identified the scope and significance of this burden of CRS type 4, it is important to examine the potential mechanisms that could be responsible for the increase in cardiovascular disease, congestive heart failure, and arrhythmia. In terms of ischemic heart disease and congestive heart failure, as mentioned before, the relationship between advancing kidney disease and heart disease may be one of shared or common risk factors, a reflection of widespread vascular disease and endothelial
Treatment
The management of CRS type 4 requires a multidisciplinary, multifaceted approach. Because of the presence of so-called traditional cardiovascular risk factors, these represent an obvious target for therapy, as they would in the general population. These typically are divided into fixed factors that are inherent to the individual, such as genetic factors, sex, age, and family history, and those that are acquired and therefore may be potentially modifiable, such as lipids, lifestyle factors, and
Conclusions
Type 4 CRS or chronic renocardiac syndrome represents a burden of cardiovascular diseases under which CKD and ESRD patients suffer that is disproportionate to the risk expected based on comorbid illnesses and Framingham risk profile. Higher than expected rates of ischemic cardiac events, congestive heart failure, left ventricular hypertrophy, cardiac arrhythmias, and sudden death plague all levels of CKD, increasing steeply as kidney function declines. The pathophysiology of CRS type 4 is
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Cited by (27)
Developing the subspecialty of cardio-nephrology: The time has come. A position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology
2021, NefrologiaCitation Excerpt :Either ischemic or non-ischemic cardiac diseases in CKD patients are characterized by progression to chronic congestive HF.26 Combined chronic dysfunction of kidney and heart is referred to as type 4 cardiorenal (or renocardiac) syndrome.27 Interestingly, the prevalence of HF in CKD patients has been reported close to 26%, compared to 6% among patients without CKD.17
Chronic Kidney Disease and Heart Failure—A Nephrologic Approach
2019, Chronic Renal DiseaseEffect of dialysis dependence and duration on post-coronary artery bypass grafting outcomes in patients with chronic kidney disease: A nationwide cohort study in Asia
2016, International Journal of CardiologyCitation Excerpt :The association between chronic kidney disease (CKD) and increased risk of cardiovascular diseases has been widely reported [1–3].
Chronic Kidney Disease and Heart Failure - A Nephrologic Approach
2015, Chronic Renal DiseasePrognostic value of worsening renal function in outpatients with chronic heart failure
2014, European Journal of Internal MedicineCitation Excerpt :A variety of mechanisms can contribute to a reduction in glomerular filtration rate in patients with HF, including neurohumoral adaptations, reduced renal perfusion, increased renal venous pressure and right ventricular dysfunction [1,2]. Likewise, both acute kidney injury and chronic kidney disease may result in cardiac injury or dysfunction [3,4]. Also, comorbidities such as diabetes mellitus and drugs used in HF affect renal function [5,6].
Proposal for a functional classification system of heart failure in patients with end-stage renal disease: Proceedings of the Acute Dialysis Quality Initiative (ADQI) XI workgroup
2014, Journal of the American College of Cardiology
Financial support for this work: none.
Financial disclosure and conflict of interest statements: none.