title: Cardio-renal insufficiency: the search for management strategies.
abstract: OBJECTIVE
  This review focuses on the pathophysiology and treatment of an increasingly common entity, cardio-renal insufficiency. Cardio-renal insufficiency is more than a simultaneous cardiac and renal disease. Patients with this condition live within a fragile equilibrium challenged by the interaction of profibrogenic, atherosclerotic, neurohumoral, and other less known factors. Regarding therapy, the avoidance of oscillations between overfilled-decompensated and emptied-overtreated states becomes of critical importance. Particular focus should be paid to personalized treatment, adjusted according to heart and kidney reserve, the predictable complications of therapy, prevention of decompensations, simple measures-based follow-up and alternative procedures.
  
  
  RESULTS
  Recent studies have established the important repercussions of unbalanced renal function on cardiovascular prognosis. In the heart failure setting, trials involving extensive cohorts of ageing or comorbidity-affected patients are presently under way. Special attention should be paid to recognize the presence of renal failure coexisting with heart failure, especially in patients with deceivingly near-normal plasma creatinine. Formulae to predict creatinine clearance are being increasingly incorporated into daily clinical practice. Disturbed renal function is an underappreciated prognostic factor in heart failure, and renal failure is frequently viewed as a relative contraindication to some proven efficacious therapies.
  
  
  CONCLUSIONS
  Cardio-renal insufficiency is an emerging entity, with affected individuals surviving with extreme degrees of simultaneous heart failure and renal failure. Management of the condition is an intellectually demanding process. Crucial to this management is extensive medical expertise and an in-depth understanding of the particular renal, haemodynamic and internal milieu equilibrium of the patients.
authors.affiliation: Nephrology and Medicine Departments, Jiménez Díaz Foundation, University Autónoma, Queen Sofia Institue of Nephrology Research, Reyes Católicos 2, 28040 Madrid, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Gil
authors.forename: Soledad
authors.initials: S
authors.lastname: Justo
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Castilla
authors.forename: Carolina
authors.initials: C
authors.lastname: Criado
authors.forename: Carlos
authors.initials: C
authors.lastname: Caramelo
mesh_terms: D000740:Anemia / Q000209:etiology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006947:Hyperkalemia / Q000209:etiology; D007668:Kidney / Q000503:physiopathology; D011379:Prognosis; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D017582:Renal Replacement Therapy
chemical_list: D002317:Cardiovascular Agents