title: Chronic kidney disease and worsening renal function in acute heart failure: different phenotypes with similar prognostic impact?
abstract: Nearly a third of patients with acute heart failure experience concomitant renal dysfunction. This condition is often associated with increased costs of care, length of hospitalisation and high mortality. Although the clinical impact of chronic kidney disease (CKD) has been well established, the exact clinical significance of worsening renal function (WRF) during the acute and post-hospitalisation phases is not completely understood. Therefore, it is still unclear which of the common laboratory markers are able to identify WRF at an early stage. Recent studies comparing CKD with WRF showed contradictory results; this could depend on a different WRF definition, clinical characteristics, haemodynamic disorders and the presence of prior renal dysfunction in the population enrolled. The current definition of acute cardiorenal syndrome focuses on both the heart and kidney but it lacks precise laboratory marker cut-offs and a specific diagnostic approach. WRF and CKD could represent different pathophysiological mechanisms in the setting of acute heart failure; the traditional view includes reduced cardiac output with systemic and renal vasoconstriction. Nevertheless, it has become a mixed model that encompasses both forward and backward haemodynamic dysfunction. Increased central venous pressure, renal congestion with tubular obliteration, tubulo-glomerular feedback and increased abdominal pressure are all potential additional contributors. The impact of WRF on patients who experience preserved renal function and individuals affected with CKD is currently unknown. Therefore it is extremely important to understand the origins, the clinical significance and the prognostic impact of WRF on CKD.
authors.affiliation: Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy palazzuoli2@unisi.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.affiliation: Department of Experimental and Applied Medicine, University and Civil Hospital of Brescia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ruocco
authors.affiliation: Department of Cardiology, Le Scotte Hospital, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Padeletti
authors.affiliation: Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
authors.affiliation: Department of Experimental and Applied Medicine, University and Civil Hospital of Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Nephrology Dialysis and Transplantation International Renal Research Institute (IRRIV), St Bortolo Hospital, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D000208:Acute Disease; D042241:Early Diagnosis; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis*
keywords: Worsening renal function; acute heart failure; chronic kidney disease; outcome