The kidney in heart failure:  friend or foe?
Heart failure constitutes a significant source of morbidity and mortality in the United States and its incidence and prevalence continue to grow, increasing its burden on the health care system. Renal dysfunction in patients with heart failure is common and has been associated with adverse clinical outcomes. This complex interaction is characterized by a pathophysiological disequilibrium between the heart and the kidney, in which cardiac malfunction promotes renal impairment, which in turn feeds back for further deterioration of cardiovascular function. Multiple neurohumoral and hemodynamic mechanisms are involved in this cardiorenal dyshomeostasis, including the deficiency of and/or resistance to compensatory natriuretic peptides, leading to sodium retention, volume overload and organ remodeling. Management of patients with cardiorenal dysfunction can be challenging and should be individualized. Emerging therapies must address the impairment of both organs to secure better clinical outcomes. To this end, a multidisciplinary approach is warranted to achieve optimal results.
Department of Internal Medicine and Division of Cardiology, SUNY Upstate Medical University, Syracuse, New York 13210, USA.
Shilpa
S
Kshatriya
Hani
H
Kozman
Danish
D
Siddiqui
Luna
L
Bhatta
Kan
K
Liu
Ali
A
Salah
Timothy
T
Ford
Robert
R
Michiel
Robert
R
Carhart
Daniel
D
Villarreal
D002317:Cardiovascular Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D006706:Homeostasis; D006801:Humans; D045283:Natriuretic Agents / Q000627:therapeutic use; D012076:Renal Agents / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D014462:Ultrafiltration
D002317:Cardiovascular Agents; D045283:Natriuretic Agents; D012076:Renal Agents