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Studies continue to identify biomarkers of cardiorenal syndrome

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LOS ANGELES – Cardiology professionals have struggled to adequately treat patients with cardiorenal syndrome over the past 25 years, according to Tom Heywood, MD, director of the congestive heart failure program and clinic at Scripps Clinic, La Jolla, Calif., who presented at the American Association of Heart Failure Nurses Annual Conference.

“How do we approach the individual patient?” Heywood asked here. “We all read [studies] with large groups of patients in which 37% of patients have this and 65% of patients have that. That’s great to know, but we typically have to treat one patient at a time, and you have to know what’s going on with that individual patient in order to help take care of them.”

Cardiorenal syndrome has several nuances that make the condition difficult to understand, including a decrease in renal function among patients with acutely compensated HF; fluid overload that is difficult to diurese; ACE inhibitor intolerance from hypotension, hyperkalemia or worsening renal failure; and, in approximately half of patients, kidney disease.

Heywood cited results from several studies indicating that elevated blood urea nitrogen levels above 40 mg/dL, a poor cardiac index of 1.5 L or lower and elevated creatinine levels of 1.5 mg/dL or higher are clear signs of cardiorenal syndrome.

Above all, Heywood said, answering the following five questions is key to diagnosing and treating cardiorenal syndrome:

• What is the fluid status?
• Is the BP adequate for renal perfusion?
• What is the cardiac output/SVR?
• Is there evidence of high central venous pressure?
• Is there intrinsic renal disease?

For more information:

Heywood JT. Cardiorenal syndrome: A cardiologist’s perspective. Presented at: the American Association of Heart Failure Nurses Annual Conference; June 26-28, 2014; Los Angeles.

Disclosure: Heywood is a member of speaker’s bureaus for Actelion, Medtronic, St. Jude and Thoratec. He also reports receiving research support from Gambro and Medtronic, and ​fellowship support from St. Jude.