Renal dysfunction in cardiovascular diseases – from molecular to clinical level

7th International Congress of Cardionephrology KARNEF (2025) [pp. 13-18]

AUTHOR(S) / АУТОР(И): Vladimir Petrović 

Download Full Pdf   

DOI: 10.46793/KARNEF25.013P

ABSTRACT / САЖЕТАК:

The heart and kidneys are vital for maintaining cardiovascular (CV) homeostasis, with the heart supplying blood and oxygen to organs, and the kidneys maintain fluid, electrolyte, and acid-base balance, erythropoetin production, and waste removal. In healthy individuals, renal hemodynamics affect cardiac hemodynamics and vice versa. When cardiovascular and kidney diseases coexist, it may lead to cardiorenal syndromes (CRS), where dysfunction in one organ triggers the dysfunction in the other [4]. Studies have shown that majority of patients affected by cardiovascular disease usually display some kind of kidney damage of different extent. Renal dysfunction in CV diseases often results from hemodynamic changes and neurohormonal activity. Shared risk factors, including hypertension, diabetes, obesity, dyslipidemia, smoking, inflammation, anemia, and malnutrition, further complicate these interactions. In this paper we discuss the pathophysiological mechanisms lying behind the acute renal injury and chronic kidney disease in cardiovascular diseases.

KEYWORDS / КЉУЧНЕ РЕЧИ:

heart, kidney, cardiovascular disease, acute renal injury, chronic kidney disase, molecular – clinical level

REFERENCES / ЛИТЕРАТУРА:

  • Al-Naher A, Wright D, Devonald MAJ et al. Renal function monitoring in heart failure – what is the optimal frequency? A narrative review. Br J Clin Pharmacol. 2018 ;84(1):5-17.
  • Alpert JS. The effect of right ventricular dysfunction on left ventricular form and function. Chest 2001; 119: 1632–1633.
  • Aronson D, Burger AJ. The relationship between transient and persistent worsening renal function and mortality in patients with acute decompensated heart failure. J Card Fail. 2010;16:541–547. 
  • Boorsma EM, Ter Maaten JM, Voors AA et al. Renal Compression in Heart Failure: The Renal Tamponade Hypothesis. JACC Heart Fail. 2022;10:175–183.
  • Buliga-Finis ON, Ouatu A, Tanase DM et al. Managing Anemia: Point of Convergence for Heart Failure and Chronic Kidney Disease? Life. 2023;13:1311.
  • Chen X, Wang X, Honore PM et al. Renal failure in critically ill patients, beware of applying (central venous) pressure on the kidney. Ann Intensive Care. 2018;8:91.
  • Clark H, Krum H, Hopper I. Worsening renal function during renin–angiotensin–aldosterone system inhibitor initiation and long-term outcomes in patients with left ventricular systolic dysfunction. Eur J Heart Fail 2014;16:41–48.
  • Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, Van Veldhuisen DJ, Hillege HL. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail 2007;13:599–608.
  • Damman K, Valente MA, Voors AA, O’Connor CM, Van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J 2014;35:455–469.
  • Damman K, Testani JM. The kidney in heart failure: an update. Eur Heart J. 2015;36(23):1437-44.
  • De Nicola L, Zoccali C. Chronic kidney disease prevalence in the general population: heterogeneity and concerns. Nephrol Dial Transplant. 2016;31:331–335.
  • de Silva R, Nikitin NP, Witte KK et al. Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis. Eur Heart J. 2006;27:569–581.
  • Deferrari G, Cipriani A, La Porta E. Renal dysfunction in cardiovascular diseases and its consequences. J Nephrol. 2021;34(1):137-153. 
  • Gill RM, Jones BD, Corbly AK et al. Exhaustion of the frank‐Starling mechanism in conscious dogs with heart failure induced by chronic coronary microembolization. Life Sci 2006; 79: 536–544.
  • Gnanaraj JF, von Haehling S, Anker SD et al. The relevance of congestion in the cardio-renal syndrome. Kidney Int. 2013;83:384–391. 
  • Goldberg A, Hammerman H, Petcherski S et al. Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction. Am Heart J. 2005;150:330–337. 
  • Hatamizadeh P, Fonarow GC, Budoff MJ et al. Cardiorenal syndrome: pathophysiology and potential targets for clinical management. Nat Rev Nephrol. 2013;9:99–111.
  • Heywood JT, Fonarow GC, Costanzo MR et al. High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail. 2007;13:422–430.
  • Hillege HL, Girbes AR, de Kam PJ et al. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation. 2000;102:203–210.
  • Jankowski J, Floege J, Fliser D et al. Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options. Circulation. 2021;143:1157–1172.
  • Metra M, Davison B, Bettari L et al. Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function. Circ Heart Fail. 2012;5:54–62. 
  • Rockey DC, Bell PD, Hill JA. Fibrosis—A common pathway to organ injury and failure. N. Engl. J. Med. 2015;372:1138–1149. 
  • Schefold JC, Filippatos G, Hasenfuss G et al. Heart failure and kidney dysfunction: epidemiology, mechanisms and management. Nat Rev Nephrol. 2016;12:610–623.
  • Schuett K, Marx N, Lehrke M. The Cardio-Kidney Patient: Epidemiology, Clinical Characteristics and Therapy. Circ Res. 2023 Apr 14;132(8):902-914. 
  • Smith DH, Thorp ML, Gurwitz JH et al. Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study. Circ Cardiovasc Qual Outcomes. 2013;6:333–342.
  • Smith GL, Lichtman JH, Bracken MB, Shlipak MG, Phillips CO, DiCapua P, Krumholz HM. Renal impairment and outcomes in heart failure: systematic review and meta-analysis. J Am Coll Cardiol 2006;47:1987–1996.
  • Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006;17:2034–2047.
  • Travers JG, Kamal FA, Robbins J et al. Cardiac Fibrosis: The Fibroblast Awakens. Circ. Res. 2016;118:1021–1040.
  • Wencker D. Acute cardio‐renal syndrome: progression from congestive heart failure to congestive kidney failure. Curr Heart Fail Rep 2007; 4: 134–138.
  • Xanthopoulos A, Papamichail A, Briasoulis A et al. Heart failure in patients with chronic kidney disease. J Clin Med. 2023;12(18):6105.
  • Zoccali C. Cardiorenal risk as a new frontier of nephrology: research needs and areas for intervention. Nephrol Dial Transplant. 2002;17(S11):50–54.