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Cardiogenic shock and acute kidney injury: the rule rather than the exception
N Ghionzoli1, C Sciaccaluga2, G E Mandoli2
1Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico Le Scotte, Viale Bracci 16, Siena, Italy. nicologhionzoli@gmail.com.
Insights
Cardiogenic shock (CS) with acute kidney injury (AKI) is a severe condition with poor outcomes. This review synthesizes current evidence on CS and AKI, identifying knowledge gaps and potential strategies for improved patient management and outcomes.
Area of Science:
- Cardiology and Nephrology
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) is a critical condition characterized by diminished cardiac output and end-organ hypoperfusion.
- Acute kidney injury (AKI) frequently complicates CS, leading to cardiorenal syndrome and a poorer prognosis.
- Current CS management often relies on empirical decisions rather than evidence-based strategies.
Purpose of the Study:
- To review and consolidate current evidence on the epidemiology, pathophysiology, diagnosis, and management of CS with AKI.
- To identify significant gaps in the existing body of evidence.
- To propose potential strategies for improving clinical outcomes in patients with CS and AKI.
Main Methods:
- Comprehensive literature review of evidence-based acknowledgments.
- Analysis of factors contributing to renal impairment in CS.
- Identification of knowledge gaps and future research directions.
Main Results:
- CS with AKI presents a complex clinical scenario with significantly worse prognosis.
- Multiple intrinsic and iatrogenic factors contribute to AKI development in CS.
- There is a notable lack of evidence-based strategies for managing this combined condition.
Conclusions:
- Effective management of CS with AKI requires a better understanding of its multifaceted nature.
- Addressing identified evidence gaps is crucial for developing targeted therapeutic interventions.
- Improved strategies are needed to enhance patient survival and recovery from cardiorenal syndrome.
Abstract:
Cardiogenic shock (CS) is a life-threatening condition of poor end-organ perfusion, caused by any cardiovascular disease resulting in a severe depression of cardiac output. Despite recent advances in replacement therapies, the outcome of CS is still poor, and its management depends more on empirical decisions rather than on evidence-based strategies. By its side, acute kidney injury (AKI) is a frequent complication of CS, resulting in the onset of a cardiorenal syndrome. The combination of CS with AKI depicts a worse clinical scenario and holds a worse prognosis. Many factors can lead to acute renal impairment in the setting of CS, either for natural disease progression or for iatrogenic causes. This review aims at collecting the current evidence-based acknowledgments in epidemiology, pathophysiology, clinical features, diagnosis, and management of CS with AKI. We also attempted to highlight the major gaps in evidence as well as to point out possible strategies to improve the outcome.
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