Renal dysfunction and heart failure: things are seldom what they seem

Abstract

This editorial refers to ‘Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis’[†][1], by K. Damman et al. on page 455 Heart failure (HF) is a risk factor for the development of chronic kidney disease (CKD) and vice versa, while the two conditions quite often co-exist. About one-third of HF patients suffer from at least mild to moderate CKD and about a quarter of them develop worsening renal function (WRF) during their hospitalization for HF.1–4 Renal dysfunction is an independent predictor of adverse prognosis in HF, but the significance of transient WRF during hospitalization for HF has not been fully investigated.1−4 The potential pathogenetic pathways linking HF with renal dysfunction are outlined in Figure 1 . Figure 1 Potential pathogenetic pathways linking heart failure with renal dysfunction. RAS, renin–angiotensin system. In their comprehensive meta-analysis of studies on the association between renal dysfunction and HF outcomes, Damman et al. provide updated evidence covering the wide spectrum of HF in its acute and chronic setting.4 Pooled data from > 1 million HF patients showed that CKD was present in 32% of cases and conferred a double risk of all-cause mortality.4 In an additional pooled analysis of nearly 50 000 HF patients, WRF occurred in 23% of cases during their hospitalization, and was also associated … [1]: #fn-2