Tuesday, March 12, 2019

In the NEWS: Cardio-renal syndrome scientific statement by AHA

A scientific statement was just issued on cardio-renal syndrome by the AHA. This is one of the first and comprehensive summary on cardio-nephrology. The mission of this scientific statement is to describe the epidemiology and pathogenesis of cardiorenal syndrome in the context of the continuously evolving nature of its clinicopathological description over the past decade. It also describes diagnostic and therapeutic strategies applicable to cardiorenal syndrome, summarizes cardiac-kidney interactions in special populations such as patients with diabetes mellitus and kidney transplant recipients, and emphasizes the role of palliative care in patients with cardiorenal syndrome. Some of the key summaries in the large statement are summarized in table 8 of the freely available statement. The important ones are: Distinguishing true AKI from functional causes of fluctuations in serum creatinine in the context of diuresis for acute decompensated heart failure is critical in ensuring delivery of goal-directed medical therapies; Identifying the factors contributing to diuretic resistance is a key step in optimizing decongestion in cardio-renal syndrome(CRS); Biomarkers of cardiac and kidney injury represent a new dimension in the diagnostic algorithm in evaluating HF with impaired kidney function and offer prognostic value in acute and chronic CRS; High-quality data for goal-directed medical therapy in chronic CRS with moderate to severe decline in kidney function are lacking. In addition, a multidisciplinary approach is required for cardiac device therapies to reduce arrhythmia burden in patients with CHF and CKD. Palliative care is an underused strategy in patients with the dual burden of CHF and advanced CKD. A cardio-nephrology multidisciplinary approach is essential in the joint management of patients with CRS with an emphasis on core outcome measures based on patient and physician priorities. Cross specialty educational programs are extremely important to promote the data on this important topic and also to increase awareness of newer technology. In addition, cross talk within two specialties could breed important decisions to improve patient related outcomes.

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