title: Focus on renal congestion in heart failure.
abstract: Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardiac output (forward failure), tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure. Regardless of the cause, renal congestion is associated with increased morbidity and mortality in heart failure. The impact on outcomes of renal decongestion strategies that do not compromise renal function should be explored in heart failure. These studies require novel diagnostic markers that identify early renal damage and renal congestion and allow monitoring of treatment responses in order to avoid severe worsening of renal function. In addition, there is an unmet need regarding evidence-based therapeutic management of renal congestion and worsening renal function. In the present review, we summarize the mechanisms, diagnosis, outcomes, prognostic markers and treatment options of renal congestion in heart failure.
authors.affiliation: Department of Medicine, Division of Nephrology , Konya Numune State Hospital , Konya , Turkey.
authors.forename: Baris
authors.initials: B
authors.lastname: Afsar
authors.affiliation: Nephrology and Hypertension Department , IIS-Fundacion Jimenez Diaz and School of Medicine , Madrid , Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: Nephrology Clinic, Dialysis and Renal Transplant Center , 'C.I. PARHON' University Hospital, and 'Grigore T. Popa' University of Medicine , Iasi , Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: Department of Nephrology , Sakarya Training and Research Hospital , Sakarya , Turkey.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Solak
authors.affiliation: Renal and Transplantation Department , Guy's and St Thomas' Hospitals , London , UK.
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.affiliation: Department of Medicine, Division of Nephrology , Koc University School of Medicine , Istanbul , Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kanbay
keywords: acute kidney injury; fluid management; heart failure; hypervolemia; renal congestion