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Cardiorenal risk: an important clinical intersection
1Section of Cardiology, Departments of Basic Science and Internal Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center, Kansas City, MO, USA.
Insights
Millions of Americans face combined chronic cardiovascular and kidney disease. Renin-angiotensin system antagonism shows promise in protecting both heart and kidney health, reducing disease progression and major endpoints.
Area of Science:
- Cardiorenal Medicine
- Nephrology
- Cardiology
Background:
- Cardiovascular and kidney diseases frequently coexist, affecting millions and presenting complex clinical challenges.
- Patients with chronic kidney disease (CKD) face significantly elevated risks for cardiovascular events, including atherosclerosis, myocardial infarction, heart failure, arrhythmias, and cardiac death.
- CKD complicates the use of standard cardioprotective treatments, necessitating specialized therapeutic approaches.
Purpose of the Study:
- To explore the intricate relationship between cardiovascular and kidney diseases.
- To highlight novel diagnostic and therapeutic strategies for patients with cardiorenal conditions.
- To emphasize the benefits of targeting the cardiorenal intersection.
Main Methods:
- Review of observational studies quantifying acute renal failure risk in interventional procedures.
- Analysis of evidence supporting therapeutic interventions for cardiorenal disease.
- Focus on renin-angiotensin system antagonism as a dual-acting therapy.
Main Results:
- While procedural risks are low for the general cardiovascular population, CKD significantly elevates cardiovascular event risk.
- Renin-angiotensin system antagonism demonstrates potential in slowing disease progression and preventing adverse cardiac and renal outcomes.
- Innovative diagnostic and therapeutic strategies are emerging for this high-risk group.
Conclusions:
- The cardiorenal intersection poses significant risks and challenges, requiring focused clinical attention.
- Therapies targeting both the heart and kidneys, such as renin-angiotensin system antagonism, offer a promising approach to improve patient outcomes.
- Continued research into innovative strategies is crucial for managing combined cardiovascular and kidney disease.
Abstract:
Approximately 6 million Americans have combined chronic cardiovascular and kidney disease. This clinical intersection presents unique risks to the patient and unique challenges to the clinician. Observational studies have provided quantitative methods for estimating the risk of acute renal failure in patients undergoing percutaneous intervention and bypass surgery procedures. Fortunately, for the general cardiovascular population these risks are small. On the other hand, patients with chronic kidney disease have increased risks of accelerated atherosclerosis, nonfatal myocardial infarction, congestive heart failure, atrial and ventricular arrhythmias, and cardiac death. Chronic kidney disease presents difficult scenarios in using conventional cardioprotective therapy. However, there are increasing bodies of evidence to suggest the kidney and the heart can be targeted with lines of therapy, specifically with renin-angiotensin system antagonism, that benefit both systems with respect to reduction in the progression of disease, and the prevention of hard kidney and cardiac endpoints. This article will focus on the cardiorenal intersection and highlight innovative diagnostic and therapeutic strategies concerning this high-risk patient group.