A New Era in the Management of Cardiorenal Syndrome: The Importance of Cardiorenal Units

Abstract

Cardiorenal syndrome; Chronic kidney disease; Heart failure

Síndrome cardiorrenal; Enfermedad renal crónica; Insuficiencia cardíaca

Síndrome cardiorenal; Malaltia renal crònica; Insuficiència cardíaca

Introduction: Approximately 70% of patients with heart failure (HF) also have kidney disease. Mortality is increased both by cardiorenal syndrome (CRS) and by the exacerbation of other comorbidities. The purpose of this study is to evaluate the clinical performance of patients with CRS who are followed up by the Cardiorenal Unit (CRU). Methods: We conducted a retrospective observational study of patients referred to the CRU from April 1, 2022, to April 30, 2023. Demographics, laboratory and ultrasonographic tests, and outcomes were evaluated. Results: Fifty-four patients were seen in the CRU. A total of 45 (83%) and 16 (30%) patients completed follow-up in the CRU at 6 and 12 months, respectively. The mean age was 70 years ± 1.6, and 65% were men. Almost 50% of patients had ischemic heart disease-related HF. The mean cardiac ejection fraction (EF) was 40% ± 1.6, and 61% of patients had HF with reduced EF (HFrEF). NYHA functional classes II and III were the most frequent (60% and 35%, respectively). At 6 months after follow-up, treatment was optimized with sacubitril-valsartan in 33% vs. 49% (p = 0.02) and SGLT2 inhibitors in 48% vs. 72% (p = 0.008), without significant deterioration in renal function (creatinine: p = 0.61; eGFR: p = 0.19). There was also a reduction of more than 50% in the number of hospital admissions (p = 0.002). A total of 22% required peritoneal dialysis, and 20% required hemodialysis. Ten (19%) patients died, five of them due to cardiovascular (CV) events. Conclusions: The CRU is vital for the management of complex patients as it ensures the implementation of medications that reduce CV mortality and decrease the number of hospital admissions in HF.

This research was funded by ISCIIII-FEDER and ISCIII RETICS REDinREN, Grant No. PI21/01292, PI24/01510, ERA PerMed JTC2022 Grant No. AC22/00029, Río Hortega CM23/00213, Marató TV3 421/C/2020, Marató TV3 215/C/2021, and RICORS RD21/0005/0016. Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), enfermedades glomerulares complejas, PI23/01209 Proyectos de I+D+I en Salud AES2023.