Cardiorenal syndrome caused by heart failure with preserved ejection fraction

Area of Science:

• Cardiology
• Nephrology
• Internal Medicine

Background:

• Cardiorenal syndrome (CRS) involves complex interactions between the heart and kidneys.
• Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a cause of cardiorenal dysfunction.
• Renal impairment in HFpEF (CRS types 2 and 4) is common, especially in older females with hypertension and/or diabetes.

Purpose of the Study:

• To explore the interrelationship between HFpEF and the development of cardiorenal syndrome.
• To highlight the growing incidence and underdiagnosis of renal impairment in HFpEF patients.
• To discuss the known pathophysiological mechanisms and the need for optimized therapeutic strategies.

Main Methods:

• Literature review and synthesis of current understanding on HFpEF and cardiorenal syndrome.
• Focus on pathophysiological mechanisms including increased intra-abdominal/central venous pressure and renin-angiotensin system activation.
• Analysis of clinical observations regarding patient demographics and co-morbidities.

Main Results:

• The association between HFpEF and renal impairment is common and potentially increasing.
• Key mechanisms include elevated venous pressures and activated renin-angiotensin system.
• Clinical trials specifically addressing this patient group are notably lacking.

Conclusions:

• Renal impairment in HFpEF is often underdiagnosed compared to CRS in heart failure with reduced ejection fraction.
• Optimal therapeutic strategies for cardiorenal syndrome in HFpEF are not yet fully established.
• Further research is crucial to define effective treatment regimens for patients with coexisting renal dysfunction and HFpEF.