title: Heart failure and kidney dysfunction: epidemiology, mechanisms and management.
abstract: Heart failure (HF) is a major health-care problem and the prognosis of affected patients is poor. HF often coexists with a number of comorbidities of which declining renal function is of particular importance. A loss of glomerular filtration rate, as in acute kidney injury (AKI) or chronic kidney disease (CKD), independently predicts mortality and accelerates the overall progression of cardiovascular disease and HF. Importantly, cardiac and renal diseases interact in a complex bidirectional and interdependent manner in both acute and chronic settings. From a pathophysiological perspective, cardiac and renal diseases share a number of common pathways, including inflammatory and direct, cellular immune-mediated mechanisms; stress-mediated and (neuro)hormonal responses; metabolic and nutritional changes including bone and mineral disorder, altered haemodynamic and acid-base or fluid status; and the development of anaemia. In an effort to better understand the important crosstalk between the two organs, classifications such as the cardio-renal syndromes were developed. This classification might lead to a more precise understanding of the complex interdependent pathophysiology of cardiac and renal diseases. In light of exceptionally high mortality associated with coexisting HF and kidney disease, this Review describes important crosstalk between the heart and kidney, with a focus on HF and kidney disease in the acute and chronic settings. Underlying molecular and cellular pathomechanisms in HF, AKI and CKD are discussed in addition to current and future therapeutic approaches.
authors: Department of Intensive Care Medicine, Inselspital, Bern University Hospital, Freiburgstrasse 18, 3010 Bern, Switzerland.
authors: Joerg C
authors: JC
authors: Schefold
authors: Department of Clinical Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece.
authors: Gerasimos
authors: G
authors: Filippatos
authors: Department of Cardiology and Pneumology, University of Göttingen Medical School, Robert-Koch-Strasse 40, Göttingen 37075, Germany.
authors: Gerd
authors: G
authors: Hasenfuss
authors: Department of Cardiology and Pneumology, Innovative Clinical Trials, University of Göttingen Medical School, Robert-Koch-Strasse 40, Göttingen 37075, Germany.
authors: Stefan D
authors: SD
authors: Anker
authors: Department of Cardiology and Pneumology, Innovative Clinical Trials, University of Göttingen Medical School, Robert-Koch-Strasse 40, Göttingen 37075, Germany.
authors: Stephan
authors: S
authors: von Haehling
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D000818:Animals; D059347:Cardio-Renal Syndrome / Q000145:classification / Q000209:etiology; D006321:Heart / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D018377:Neurotransmitter Agents / Q000502:physiology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy
chemical_list: D018377:Neurotransmitter Agents