Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement.
OBJECTIVE
There is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term "cardiorenal syndrome" (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with "cardiovascular-renal disorders" (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised.


METHODS
Following a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species.


RESULTS
Of the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD.


CONCLUSIONS
The resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine.
Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie d'Alfort, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Maisons-Alfort 94704, France.
J L
JL
Pouchelon
Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA.
C E
CE
Atkins
Clinica Veterinaria Gran Sasso, Milano 20131, Italy.
C
C
Bussadori
Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
M A
MA
Oyama
Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA.
S L
SL
Vaden
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA.
J D
JD
Bonagura
Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie d'Alfort, Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Maisons-Alfort 94704, France.
V
V
Chetboul
Department of Medicine and Epidemiology, University of California-Davis, Davis, CA 95616, USA.
L D
LD
Cowgill
Comparative Biomedical Sciences, The Royal Veterinary College, University of London, London NW1 0TU.
J
J
Elliot
Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern 3012, Switzerland.
T
T
Francey
Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506, USA.
G F
GF
Grauer
Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield AL9 7TA, UK.
V Luis
VL
Fuentes
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
N Sydney
NS
Moise
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA.
D J
DJ
Polzin
Department of Clinical Sciences of Companion Animals, University of Utrecht College of Veterinary Medicine, Utrecht 3584, The Netherlands.
A M
AM
Van Dongen
ACAPULCO Animal Cardiopulmonary Consultancy, Masta, Stavelot 4970, Belgium.
N
N
Van Israël
D000818:Animals; D059347:Cardio-Renal Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy / Q000662:veterinary*; D002371:Cat Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002415:Cats; D032921:Consensus; D003697:Delphi Technique; D004283:Dog Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D004285:Dogs; D017410:Practice Guidelines as Topic; D014730:Veterinary Medicine