Management of the cardiorenal syndrome in acute heart failure.


Journal Article

OPINION STATEMENT: Interactions between the heart and kidney in the setting of acute heart failure are complex and have a substantial impact on patient care and outcomes. Further research is needed to better distinguish the different causes of kidney injury, allow its early and accurate prediction and detection, and identify therapeutic targets. Novel renal biomarkers could potentially provide a useful tool for this purpose. Restoration of optimal fluid status and resolution of renal venous congestion are important goals of therapy. Changes in serum creatinine, although an important marker of renal function, may not be associated with adverse outcomes, especially if they are transient and a consequence of more aggressive decongestion, or the appropriate titration of drugs affecting the renin-angiotensin-aldosterone axis. In addition to loop diuretics, a variety of drugs and strategies have been investigated in acute heart failure. Use of mineralocorticoid receptor antagonists and vasopressin antagonists may have potential benefits and should be further investigated. Inotropic agents should be limited in those clinical settings suggesting hypoperfusion. Ultrafiltration seems to provide a safe and effective tool to overcome diuretic resistance and optimize fluid status avoiding detrimental effects of diuretic therapy.

Full Text

Duke Authors

Cited Authors

  • Lazzarini, V; Felker, GM

Published Date

  • August 2012

Published In

Volume / Issue

  • 14 / 4

Start / End Page

  • 342 - 355

PubMed ID

  • 22644350

Pubmed Central ID

  • 22644350

Electronic International Standard Serial Number (EISSN)

  • 1534-3189

Digital Object Identifier (DOI)

  • 10.1007/s11936-012-0186-5


  • eng

Conference Location

  • United States