The complexity of the cardio-renal link: taxonomy, syndromes, and diseases

Abstract

Bidirectional mechanisms exist that link diseases affecting the heart and kidney. This link is complex and remains poorly understood; therefore, charting the shared territory of cardiovascular (CV) and renal medicine poses major problems. Until now, no convincing rationale for delineating new syndromes existed. The multiple connections of the arterial system and the heart and kidney with other systems, from energy and protein balance to the musculoskeletal, clearly require special focus and rigorous framing. Nephrologists have yet to fully understand why the application of dialysis has had only limited success in halting the parallel burdens of CV and non-CV death in patients with end-stage renal disease. Cardiologists, intensivists, and nephrologists alike should settle whether and when extracorporeal ultrafiltration benefits patients with decompensated heart failure. These sparse but interconnected themes spanning from the basic science-clinical transition phase to clinical science, epidemiology, and medical technology already form the basis for the young discipline of 'CV and renal medicine'.

Keywords: CKD; ESRD; cardio-renal; cardiovascular risk; death; progression of CKD.

Figure 1

Relationship between glomerular filtration rate (GFR) and the risk for cardiovascular events. Data are adjusted for age, sex, and other Framingham risk factors. HR, hazard rate; eGFR, estimated GFR.