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CARDIORENAL SYNDROME CARDIORENAL SYNDROME AND MANAGEMENT OF THE CARDIOVASCULAR COMPLICATIONS

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Page 1: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

CARDIORENAL SYNDROMECARDIORENAL SYNDROME

AND MANAGEMENT OF THE CARDIOVASCULAR COMPLICATIONS

Page 2: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

DEFININITIONDEFININITION

• CARDIORENAL SYNDROME (CRS) IS ACARDIORENAL SYNDROME (CRS)  IS A PATHOPHYSIOLOGIC  SYNDROME OF THE HEART AND KIDNEYS WHEREBY ACUTE ORHEART AND KIDNEYS  WHEREBY ACUTE OR CHRONIC DYSFUNCTION OF ONE ORGAN CAUSES ACUTE OR CHRONIC DYSFUNCTION INCAUSES ACUTE OR CHRONIC DYSFUNCTION IN THE OTHER.

Page 3: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

CRS Type 1

Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.

Ronco, C. et al. J Am Coll Cardiol 2008;52:1527-1539

Page 4: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

CRS Type 2

Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.

Ronco, C. et al. J Am Coll Cardiol 2008;52:1527-1539

Page 5: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

CRS Type 3

Ronco C et al J Am Coll Cardiol 2008;52:1527-1539

Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.

Ronco, C. et al. J Am Coll Cardiol 2008;52:1527-1539

Page 6: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

CRS Type 4

Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.

Ronco, C. et al. J Am Coll Cardiol 2008;52:1527-1539

Page 7: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

CRS Type 5

Copyright ©2008 American College of Cardiology Foundation. Restrictions may apply.

Ronco, C. et al. J Am Coll Cardiol 2008;52:1527-1539

Page 8: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

CARDIORENAL CLINICCARDIORENAL CLINIC

A NEW INITIATIVE – PRIMARILY TYPE 4 CRS

Page 9: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

PURPOSE

• MAXIMIZE CARDIAC STATUS FOR

PURPOSE

MAXIMIZE CARDIAC STATUS FOR

• ‐ PRE TRANSPLANT PATIENTS

C O S S• ‐ CKD   NON ESRD AND ESRD

Page 10: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

CARDIAC RISK ASSESSMENT

• ISCHEMIA ‐ SILENT VS SYMPTOMATIC

CARDIAC RISK ASSESSMENT

ISCHEMIA    SILENT VS SYMPTOMATIC

C O O• CARDIOMYOPATHY

• ‐ INFARCTION VS HIBERNATION

• EXTENT VASCULAR DISEASEEXTENT VASCULAR DISEASE

Page 11: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

BENEFITS

• FOR PATIENT 

BENEFITS

• COORDINATION OF CARE• IDENTIFICATION OF RISK• FACILITATE TREATMENT IF INDICATED

• ADVANTAGE FOR MEDICINE• TEMPORAL DATA ON CARDIAC EVOLUTION IN CKDIN CKD

• PROFILE RISK AND OUTCOME RATHER THAN JUST “HIGH” – DO INTERVENTIONS HELP?

Page 12: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

C di R l R f lCardio Renal ReferralFax Referral to Heart Function Clinic416 431 8193

Patient ________________________________________________ Unique  ________________________________________________AddressAddress  ________________________________________________Phone  ________________________________________________HCN ________________________________________________Current Patient Treatment:  CKD PD HD Referral Type: Routine Cardiac           Pre Transplant  Include the following:g1. CKD Medication Sheet 2. Lab Flow Sheet  3. History   4. Signed Release Consent  5 R t ECHO/ECG 5. Recent ECHO/ECG  Referring Physician  ______________________Signature ______________________  

Page 13: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

MANAGEMENTMANAGEMENT

• HYPERTENSION ACE/ARB DRI CCBHYPERTENSION  ACE/ARB   DRI  CCB

• STATIN ?OTHER LIPID RX

G OS S G G ? G O S S• DIAGNOSIS – IMAGING  ?ANGIO INVASIVE VS CARDIAC CT OR MR

• INTERVENTION – ANY VALUE IN TERMS OF PROGNOSIS

Page 14: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

HYPERTENSIONHYPERTENSION

• FACTORS INFLUENCING THERAPYFACTORS INFLUENCING THERAPY

24 HR AMBP RECORDING

G C O S C OUNDERLYING FACTORS – LV FUNCTION, PROTEINURIA, RENAL AND CARDIAC DIAGNOSIS DIABETESDIAGNOSIS, DIABETES

RAAS BLOCKADE – ACE‐i, ARB, DRI

CCB

POTENTIAL B‐BLOCKER‐ CAD COMPONENTPOTENTIAL B BLOCKER CAD COMPONENT

Page 15: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

ISCHEMIA?ISCHEMIA?

• WALL MOTION ABNORMALITYWALL MOTION ABNORMALITY

• INDUCIBLE ISCHEMIA

OC• VIABLE MYOCARDIUM

• ‐‐‐‐‐‐ UNKNOWN IMPROVEMENT IN OUTCOME BY REVSCULARIZATION

Page 16: Cardiorenal Syndrome-Dr Jim Cherry - Institute of Kidney ... · defininition • cardiorenal syndrome (crs) is a pathophysiologic syndrome of the heart and kidneys whereby acute or

QUESTIONSQUESTIONS


Pathophysiologic targets for acute heart failure therapy: The ... · Pathophysiologic targets for acute heart failure therapy: The Cardiorenal Syndrome Professor and Co-Head, Dept

UF vs diuretics in treatment of ADHF, Cardiorenal syndrome

Cardiorenal Syndrome - Nephroblog · PDF fileSTATE-OF-THE-ART PAPER Cardiorenal Syndrome Claudio Ronco, MD,* Mikko Haapio, MD,† Andrew A. House, MSC, MD,‡ Nagesh Anavekar, MD,§

Cardiorenal Syndrome · Cardiorenal Syndrome November 4, 2008:1527–39. protective treatments have yet emerged for this condition. Despite some initial promising results, the use

Cardiorenal Syndrome Type 3: Pathophysiologic and … · ing, summarizing and disseminating knowledge from a group of experts focused on a specific problem or task. A detailed description

Cardiorenal Syndrome Type 1 (2).pdf

CARDIORENAL SYNDROME

ACUTE DECOMPENSATD HEART FAILURE AND CARDIORENAL SYNDROME · ACUTE DECOMPENSATD HEART FAILURE AND CARDIORENAL SYNDROME Author: Sindhu Pingili Created Date: 9/26/2014 11:04:46 AM

Cardiorenal and “Renocardiac” Syndrome · Cardiorenal and “Renocardiac” Syndrome. 2 A sick heart makes a sick kidney and a sick kidney makes a sicker heart and so on. Ascites

Cardiorenal Syndrome · Cardiorenal Syndrome November 4, 2008:1527–39

Origins of Cardiorenal Syndrome and the Cardiorenal Connectioncdn.intechopen.com/pdfs/32307/InTech-Origins_of... · 2018-09-25 · Origins of Cardiorenal Syndrome and the Cardiorenal

Cardiorenal Syndrome: What the Clinician Needs to Know · Orlando, Florida – October 7-9, 2011 Cardiorenal Syndrome: What the Clinician Needs to Know William T. Abraham, MD Director,

Cardiorenal syndrome DR Osama EL-Shahat

CardioRenal Syndrome 2017 (1)Impact of Renal Function on Survival in HF Ibopamine Trial n=1906 Hillege et al. Circ. 2000; 102:203-210 Definitions • Cardiorenal Syndrome (CRS) –

“CARDIORENAL SYNDROME-ANEMIA” COMPLEX IN SMALL …€¦ · Cardiorenal syndrome (CRS) can be defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic

Acute decompensated heart failure and the cardiorenal syndrome

The Cardiorenal Syndrome - American Heart Association

Diabetic Kidney Disease and the Cardiorenal Syndrome

Origins of Cardiorenal Syndrome and the Cardiorenal Connection€¦ · 7 Origins of Cardiorenal Syndrome and the Cardiorenal Connection L. G. Bongartz 1,2, M. J. Cramer 1 and J. A

Overview Cardiorenal Syndrome - 台灣災難醫學會 · Cardiorenal syndrome (CRS) Definitions.. Recently, A new definition has been proposed which focuses on the complexity of the

Wednesday, November 11, 2015 Diabetes and the Cardiorenal ... · • What is cardiorenal syndrome? • Pathophysiology of how diabetes can impact cardiorenal syndrome The Stats •

The Cardiorenal Syndrome in Heart Failure 2… · The Cardiorenal Syndrome in Heart Failure Van N Selby, MD Assistant Professor of Medicine Advanced Heart Failure Program, UCSF October

The Cardiorenal Syndrome A Cardiologist’s Perspective

Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome

syndrome · Acute cardiorenal syndrome (CRS-1) is a morbid complication of acute cardiovascular disease. Heart-to-kidney signals transmitted by “cardiorenal connectors” have been

Cardiorenal Syndrome Nat Rev Nephrol 2013

Preeclampsia as a Form of Type 5 Cardiorenal Syndrome: An ... · Cardiorenal Med 2018;8:160–172 Preeclampsia as a Form of Type 5 Cardiorenal Syndrome: An Underrecognized Entity

Replacement Therapy in Cardiorenal Syndromemsic.org.my/sfnag402ndfbqzxn33084mn90a78aas0s9g/... · Replacement Therapy in Cardiorenal Syndrome Manish Kaushik Singapore General Hospital

Cardiorenal biomarkers in acute heart failure · characterized as cardiorenal syndrome.[10,11] Ronco et al.,[11] proposed the definition for cardiorenal syndrome as, “disorders

Type 1 cardiorenal syndrome in a patient with an acute infection … · Cardiorenal syndrome (CRS) is a pathophysiological disorder in which an acute or chronic dysfunction of one

Acute decompensated heart failure and the cardiorenal syndrome decompensated heart failure and the... · Acute decompensated heart failure and the cardiorenal syndrome Kelly V. Liang,

Cardiorenal Syndrome in Hypertensive Rats ... · and renal function is known as the cardiorenal syndrome (CRS), where the dysfunction of one leads to the alteration of the second

Clinical profile and outcomes of acute cardiorenal syndrome type … · in secondary injury/dysfunction to the other organ. Cardiorenal syndrome is sub-typed based on the chronicity

The Cardiorenal Syndrome in Heart Failure - UCSF … 2_Hawaii... · The Cardiorenal Syndrome in Heart Failure Van N Selby, MD Assistant Professor of Medicine Advanced Heart Failure

Diabetic Kidney Disease and the Cardiorenal Syndrome · 2019-04-19 · Diabetic Kidney Disease and the Cardiorenal Syndrome Old Disease, New Perspectives Ankur Jindal, MDa,b, Mariana