Renal dysfunction and heart failure – epidemiology and clinical significance

Abstract

The prevalence of heart failure (HF) and chronic kidney disease (CKD) tends to increase in the general population as a consequence of the increasing age and improvement of the management and the outcome of acute cardiac and renal syndromes. Both conditions co-exist very often in one and the same patient which is probably due to “sharing” common risk factors like arterial hypertension, diabetes mellitus and atherosclerotic disease. It is considered that cardiac dysfunction may lead to renal failure and vice versa. The prevalence of CKD among patients with HF is around 30-40%. In recent years, we speak about cardiorenal syndrome (CRS) which is a pathophysiological condition of the heart and kidneys where the acute or chronic dysfunction of one of these organs leads to acute or chronic dysfunction of the other. For a more precise chronological and pathophysiological definition CRS is classified in 5 types. New biomarkers for renal impairment such as NGAL, KIM-1, NAG, Cystatin С are already in clinical practice. More vigilance and more frequent laboratory monitoring of serum creatinine and electrolytes is required in patients with HF and CKD who are treated with ACE inhibitors/angiotensin-receptor blocking agents and aldosterone antagonists.