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(Circulation. 2004;110:1514-1517.)
© 2004 American Heart Association, Inc.

Editorial

The Clinical Challenge of Cardiorenal Syndrome

Michael G. Shlipak, MD, MPH; Barry M. Massie, MD

From the General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, Calif, and Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco (M.G.S.), and the Department of Medicine and Cardiovascular Research Institute of the University of California, San Francisco, and the Cardiology Division of the San Francisco VAMC (B.M.M.).

Correspondence to Barry M. Massie, MD, Cardiology Division (111C), San Francisco VAMC, 4150 Clement St, San Francisco, CA 94121. E-mail barry.massie@med.va.gov

Key Words: Editorials • heart failure • kidney • natriuretic peptides • vasodilation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Renal dysfunction is a common and progressive complication of chronic heart failure, with a clinical course that typically fluctuates with the patient’s clinical status and treatment. Despite growing recognition of the frequent presentation of combined cardiac and renal dysfunction, or "cardiorenal syndrome," its underlying pathophysiology is not well understood, and no consensus as to its appropriate management has been achieved. Because patients with heart failure are surviving longer and dying less frequently from primary arrhythmia, we expect that the cardiorenal syndrome will become more common. Against this background, the article by Wang and colleagues¹ in the present issue of Circulation is particularly significant because it is the first prospective, controlled therapeutic trial in patients with this condition. To place the findings and implications of this study in context, we first briefly review what is currently known about the cardiorenal syndrome and its treatment options.

See p 1620

Characteristics and Outcomes of Patients With Cardiorenal Dysfunction

In ambulatory heart failure patients, the presence of concomitant renal dysfunction consistently has been one of the strongest risk factors for mortality.^2–4 This risk becomes evident even at serum creatinine clearance levels >1.3 mg/dL and estimated creatinine clearance values 60 to 70 mL/min. Furthermore, renal function is at least as powerful an adverse prognostic factor as most clinical variables, including ejection fraction and New York Heart Association function class. Although renal dysfunction predicts all-cause mortality, it is most predictive of death from progressive heart failure, which suggests that it is a manifestation of and/or exacerbating factor for left ventricular dysfunction.²

In the setting . . . [Full Text of this Article]

Related Article:

Nesiritide Does Not Improve Renal Function in Patients With Chronic Heart Failure and Worsening Serum Creatinine

David J. Wang, Thomas C. Dowling, Dean Meadows, Tomas Ayala, Joanne Marshall, Stacey Minshall, Nancy Greenberg, Emil Thattassery, Michael L. Fisher, Krishnamurti Rao, and Stephen S. Gottlieb
Circulation 2004 110: 1620-1625. [Abstract] [Full Text]

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