Pathophysiology of Cardiorenal Syndrome and Use of Diuretics and Ultrafiltration as Volume Control

Acute or chronic dysfunction of the heart or kidneys can cause dysfunction of other organs. This interaction between the heart and kidneys is characterized as cardiorenal syndrome (CRS). Recently, a preponderance of data indicated that venous congestion plays an important role in the combination of renal and cardiac diseases. This review aims to focus on the pathophysiology of venous congestion that leads to renal impairment in heart failure and the use of diuretics or ultrafiltration as decongestive therapy in CRS. We found that although clinical studies have confirmed that decongestive therapy has a definite role in decreasing volume overload and the consequent symptom improvement in patients with CRS, the impact of diuretics or ultrafiltration on the improvement of kidney function or mortality remains uncertain. A precise assessment of volume status is required to determine the adequacy of decongestion. Objective measures of renal venous congestion may be a future metric to assess the adequacy of the diuretic response in patients and guide therapeutic decision making.

Automated summary

Heart and kidney dysfunction can affect other organs, with venous congestion playing a key role in renal and cardiac diseases. Decongestive therapy can alleviate symptoms in CRS patients, but its impact on kidney function and mortality is still uncertain, highlighting the need for accurate assessment of volume status. Future objective measures of renal venous congestion may help guide therapeutic decisions.