Pharmacologic management of chronic reno-cardiac syndrome

Abstract

Chronic kidney disease (CKD) significantly increases cardiovascular morbidity and mortality. CKD remains an under-represented population in cardiovascular clinical trials, and cardiovascular disease is an under-treated entity in CKD. Traditional cardiovascular risk factors in conjunction with uremia-related complications often progress to myocardial dysfunction. Such uremic cardiomyopathy leads to over-activation of neurohormonal pathways with detrimental effects. Management of the reno-cardiac syndrome (RCS) requires the targeting of these multiple facets. In this article we discuss the relevant pathophysiology of RCS, and present the clinical data related to its management.

Figure 1

Kaplan-Meyer curves for cardiovascular death (left) and for all-cause hospital admission (right) during 24-month follow-up cumulative survival rate according to use of carvedilol. Solid lines = carvedilol group; dashed lines = placebo group. Reprinted from J Am Coll Cardiol., Volume 41, Issue 9, Gennaro C, et al. “Carvedilol increases two-year survival in dialysis patients with dilated cardiomyopathy: A prospective, placebo-controlled trial,” pages 1438-1444, ©2003, with permission from Elsevier.