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Acute Kidney Injury in Cardiogenic Shock: An Updated Narrative Review

Sohrab Singh1, Ardaas Kanwar2, Pranathi R Sundaragiri3

  • 1Department of Medicine, The Brooklyn Hospital, Brooklyn, NY 11201, USA.

Journal of Cardiovascular Development and Disease
|August 26, 2021
PubMed

Insights

Acute myocardial infarction with cardiogenic shock (AMI-CS) often leads to acute kidney injury (AKI), increasing mortality. Understanding the complex causes and management of AKI in AMI-CS is crucial for improving patient outcomes.

Area of Science:

  • Cardiology
  • Nephrology
  • Critical Care Medicine

Background:

  • Acute myocardial infarction with cardiogenic shock (AMI-CS) presents significant challenges, leading to high mortality and morbidity.
  • Multiorgan failure, particularly acute kidney injury (AKI), is a common complication in AMI-CS patients.
  • AKI in AMI-CS is linked to poorer prognosis and survival rates.

Purpose of the Study:

  • To comprehensively review the etiology and pathophysiology of AKI in the context of AMI-CS.
  • To discuss current and emerging management strategies for AKI complicating AMI-CS.
  • To analyze the impact of AKI on patient outcomes and mortality in AMI-CS.

Main Methods:

  • Literature review of studies on AMI-CS and AKI.
  • Analysis of pathophysiological mechanisms linking cardiac and renal dysfunction.
  • Synthesis of clinical data on management and outcomes.

Main Results:

  • The pathogenesis of AKI in AMI-CS is multifactorial, involving hemodynamic instability, inflammation, and direct cardiac effects.
  • Early intervention with renal replacement therapies, comorbidity management, and careful fluid balance are key therapeutic considerations.
  • AKI significantly worsens outcomes, increasing mortality and the length of hospital stay.

Conclusions:

  • AKI is a critical determinant of prognosis in patients with AMI-CS.
  • A multidisciplinary approach focusing on early recognition and tailored management of AKI is essential.
  • Further research into the complex interplay between cardiac and renal systems in AMI-CS is warranted.

Keywords:
acute kidney injuryacute myocardial infarctioncardiogenic shockcritical care cardiology

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