title: The complexity of the cardio-renal link: taxonomy, syndromes, and diseases.
abstract: Bidirectional mechanisms exist that link diseases affecting the heart and kidney. This link is complex and remains poorly understood; therefore, charting the shared territory of cardiovascular (CV) and renal medicine poses major problems. Until now, no convincing rationale for delineating new syndromes existed. The multiple connections of the arterial system and the heart and kidney with other systems, from energy and protein balance to the musculoskeletal, clearly require special focus and rigorous framing. Nephrologists have yet to fully understand why the application of dialysis has had only limited success in halting the parallel burdens of CV and non-CV death in patients with end-stage renal disease. Cardiologists, intensivists, and nephrologists alike should settle whether and when extracorporeal ultrafiltration benefits patients with decompensated heart failure. These sparse but interconnected themes spanning from the basic science-clinical transition phase to clinical science, epidemiology, and medical technology already form the basis for the young discipline of 'CV and renal medicine'.
authors.affiliation: Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension , Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.affiliation: Renal Unit, Guy's and St Thomas' NHS Foundation Hospital, King's Health Partners , London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.affiliation: Indiana University and VAMC , Indianapolis, Indiana, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Department of Nephrology, University Medical Center , Utrecht, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.affiliation: Department of Internal Medicine IV, Saarland University Medical Centre , Homburg/Saar, Germany.
authors.forename: Danilo
authors.initials: D
authors.lastname: Fliser
authors.affiliation: Division of Internal Medicine and Nephrology, Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia , Katowice, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wiecek
authors.affiliation: Nephrology Division, Department of Medicine, Akdeniz University Medical School , Antalya, Turkey.
authors.forename: Gultekin
authors.initials: G
authors.lastname: Suleymanlar
authors.affiliation: Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo , Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: INSERM ERI-12 (EA 4292) , Amiens, France ; Amiens University Hospital and the Jules Verne University of Picardie , Amiens, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Massy
authors.affiliation: Clinic of Nephrology, C.I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy , Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat , Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez-Castelao
authors.affiliation: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, The Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: INSERM U970, Hôpital Européen Georges Pompidou , Paris, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: London
keywords: CKD; ESRD; cardio-renal; cardiovascular risk; death; progression of CKD