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Cardiorenal Syndrome Type 1 in Patients with Heart Failure with Preserved Ejection Fraction

Lidija Savic1,2, Ratko Lasica1,2, Gordana Krljanac1,2

  • 1Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.

Journal of Clinical Medicine
|June 12, 2026
PubMed

Insights

Cardiorenal syndrome type 1 (CRS-1) in acute decompensated heart failure with preserved ejection fraction (ADHFpEF) involves kidney injury due to heart failure. Loop diuretics and SGLT-2 inhibitors are key treatments, impacting patient prognosis.

Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • Cardiorenal syndrome type 1 (CRS-1) links acute kidney injury (AKI) with acute decompensated heart failure (ADHF).
  • Heart failure with preserved ejection fraction (HFpEF) is a growing concern, with many patients experiencing CRS-1 during acute decompensation (ADHFpEF).

Purpose of the Study:

  • This review synthesizes current knowledge on CRS-1 epidemiology, pathophysiology, treatment, and prognosis specifically in ADHFpEF patients.
  • To provide a comprehensive overview for clinicians and researchers managing this complex cardiorenal interaction.

Main Methods:

  • Narrative review of existing literature.
  • Analysis of epidemiological data, pathophysiological mechanisms, therapeutic strategies, and prognostic factors.

Main Results:

  • Hemodynamic disturbances and inflammation are primary drivers of CRS-1 in ADHFpEF.
  • Loop diuretics are the standard for managing congestion; SGLT-2 inhibitors show promise for improving outcomes.
  • CRS-1 predicts poorer outcomes in ADHF, though its impact may be less pronounced in HFpEF compared to heart failure with reduced ejection fraction.

Conclusions:

  • Understanding CRS-1 in ADHFpEF is crucial for effective patient management.
  • Further research is essential to refine understanding of mechanisms and develop targeted therapies for improved cardiorenal outcomes.

Keywords:
acute heart failure with preserved ejection fractionacute kidney injurycardiorenal syndromeprognosistherapy

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