• Figure 1

    Intra-abdominal pressure (IAP) is increased in a significant number of patients with ADHF. The left half of the graph shows that elevated IAP is associated with worse renal function. Note a strong correlation between reduction in IAP and improved renal function in patients with baseline elevated IAP (Redrawn from Mullens et al. J Am Coll Cardiol 2008; 51:300–6).

  • Figure 2

    Renal function (creatinine clearance) improved substantially and rapidly in post-LVAD survivors (from Butler J, et al. Ann Thorac Surg; 81:1745–1751).

  • 1.

    K/DOQI clinical practice guidelines for chronic kidney disease : evaluation, classification, and stratification. Am J Kidney Dis 2002; 39:S1266.

  • 2.

    Gottlieb SS , Abraham W , Butler J , et al.. The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002; 8:136141.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Ronco C , McCullough P , Anker SD , et al.. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 2010; 31:703711.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Dries DL , Exner DV , Domanski MJ , et al.. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2000; 35:681689.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Shlipak MG , Smith GL , Rathore SS , et al.. Renal function, digoxin therapy, and heart failure outcomes: evidence from the digoxin intervention group trial. J Am Soc Nephrol 2004; 15:21952203.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Hillege HL , Nitsch D , Pfeffer MA , et al.. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 2006; 113:671678.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Khan NA , Ma I , Thompson CR , et al.. Kidney function and mortality among patients with left ventricular systolic dysfunction. J Am Soc Nephrol 2006; 17:244253.

  • 8.

    Ahmed A , Rich MW , Sanders PW , et al.. Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study. Am J Cardiol 2007; 99:393398.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Anand IS , Bishu K , Rector TS , et al.. Proteinuria, chronic kidney disease, and the effect of an angiotensin receptor blocker in addition to an angiotensin-converting enzyme inhibitor in patients with moderate to severe heart failure. Circulation 2009; 120:15771584.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    McAlister FA , Ezekowitz J , Tonelli M , Armstrong PW . Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study. Circulation 2004; 109:10041009.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Ezekowitz J , McAlister FA , Humphries KH , et al.. The association among renal insufficiency, pharmacotherapy, and outcomes in 6,427 patients with heart failure and coronary artery disease. J Am Coll Cardiol 2004; 44:15871592.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    McClellan WM , Flanders WD , Langston RD , et al.. Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. J Am Soc Nephrol 2002; 13:19281936.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Smith GL , Vaccarino V , Kosiborod M , et al.. Worsening renal function: what is a clinically meaningful change in creatinine during hospitalization with heart failure? J Card Fail 2003; 9:1325.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Forman DE , Butler J , Wang Y , et al.. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004; 43:6167.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Cowie MR , Komajda M , Murray-Thomas T , et al.. Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur Heart J 2006; 27:12161222.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    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; 13:422430.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Nohria A , Hasselblad V , Stebbins A , et al.. Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 2008; 51:12681274.

  • 18.

    Akhter MW , Aronson D , Bitar F , et al.. Effect of elevated admission serum creatinine and its worsening on outcome in hospitalized patients with decompensated heart failure. Am J Cardiol 2004; 94:957960.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Chittineni H , Miyawaki N , Gulipelli S , Fishbane S . Risk for acute renal failure in patients hospitalized for decompensated congestive heart failure. Am J Nephrol 2007; 27:5562.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Butler J , Forman DE , Abraham WT , et al.. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J 2004; 147:331338.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Anand IS , Ferrari R , Kalra GS , et al.. Edema of cardiac origin. Studies of body water and sodium, renal function, hemodynamic indexes, and plasma hormones in untreated congestive cardiac failure. Circulation 1989; 80:299305.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Firth JD , Raine AE , Ledingham JG . Raised venous pressure: a direct cause of renal sodium retention in oedema? Lancet 1988; 331:10331035.

  • 23.

    Weinfeld MS , Chertow GM , Stevenson LW . Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure. Am Heart J 1999; 138:285290.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Bradley SE , Bradley GP . The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest 1947; 26:10101022.

  • 25.

    Mullens W , Abrahams Z , Skouri HN , et al.. Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol 2008; 51:300306.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Mullens W , Abrahams Z , Francis GS , et al.. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 2009; 53:589596.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Butler J , Geisberg C , Howser R , et al.. Relationship between renal function and left ventricular assist device use. Ann Thorac Surg 2006; 81:17451751.

  • 28.

    Anand IS , Ferrari R , Kalra GS , et al.. Pathogenesis of edema in constrictive pericarditis. Studies of body water and sodium, renal function, hemodynamics, and plasma hormones before and after pericardiectomy. Circulation 1991; 83:18801887.

    • PubMed
    • Search Google Scholar
    • Export Citation

Cardiorenal Syndrome: The Cardiologist’s Viewpoint

By Inder S. Anand
Search for other papers by By Inder S. Anand in
Current site
Google Scholar
PubMed
Close
Restricted access
Save