Cardiorenal Syndrome and the Role of the Bone-Mineral Axis and Anemia.
The association between chronic kidney disease (CKD) and cardiovascular disease (CVD) is well established, and there is mounting evidence of interorgan cross talk that may accelerate pathologic processes and the progression of organ dysfunction in both systems. This process, termed cardiorenal syndrome (CRS) by the Acute Dialysis Quality Initiative, is considered a major health problem: patients with CKD and CVD are at much higher risk of mortality than patients with either condition alone. To date, the majority of CRS research has focused on neurohormonal mechanisms and hemodynamic alterations. However, mounting evidence suggests that abnormalities in the normal pathophysiology of the bone-mineral axis, iron, and erythropoietin play a role in accelerating CKD and CVD. The goal of this article is to review the role and interrelated effects of the bone-mineral axis and anemia in the pathogenesis of chronic CRS.
Renal Division, Brigham and Women's Hospital, Boston, MA. Electronic address: dcharytan@partners.org.
David M
DM
Charytan
Division of Kidney Diseases and Hypertension, North Shore University Hospital and Long Island Jewish Medical Center, Great Neck, NY.
Steven
S
Fishbane
2nd Department of Nephrology, Medical University, Bialystok, Poland.
Jolanta
J
Malyszko
Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas; The Heart Hospital, Plano, TX.
Peter A
PA
McCullough
Department of Nephrology, King's Health Partners Academic Health Sciences Centre, London, United Kingdom.
David
D
Goldsmith
D000740:Anemia / Q000150:complications / Q000378:metabolism*; D001842:Bone and Bones / Q000378:metabolism*; D002112:Calcifediol / Q000378:metabolism; D002117:Calcitriol / Q000378:metabolism; D002118:Calcium / Q000378:metabolism*; D059347:Cardio-Renal Syndrome / Q000150:complications / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000150:complications / Q000378:metabolism; D004921:Erythropoietin / Q000378:metabolism*; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism*; D010281:Parathyroid Hormone / Q000378:metabolism; D010710:Phosphates / Q000378:metabolism*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism
C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D004921:Erythropoietin; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D007501:Iron; D002117:Calcitriol; D002112:Calcifediol; D002118:Calcium
Cardiorenal syndrome (CRS); anemia; bone-mineral axis; cardiovascular disease (CVD); chronic kidney disease (CKD); end-stage renal disease (ESRD); erythropoietin (EPO); fibroblast growth factor 23 (FGF-23); heart failure (HF); iron; phosphate; renal dysfunction; review; vitamin D