Cardiorenal syndrome: A vicious cycle of diseases

PHILADELPHIA — Heart failure is a common complication of diabetes and runs hand in hand with renal dysfunction, leading to cardiorenal syndrome, according to a speaker here.

“Studies have shown that the rate of heart failure is increased in people with diabetes,” Jeffrey M. Testani, MD, MTR, director of heart failure research, section of cardiovascular medicine at Yale University, said at the Heart in Diabetes Clinical Education Conference. “Once you have heart failure, the presence of diabetes is a significant risk factor for death, inflammation, fibrosis, hypertrophy, advanced glycation end-products and more.”

Testani added that renal dysfunction is also very common in HF.

“When you look at it, greater than 50% of patients admitted to the hospital for [HF] actually have stage 3 or greater chronic kidney disease,” he said. “It’s actually pretty uncommon to find an HF patient with normal estimated glomerular filtration rate.”

Renal dysfunction is also one of the most powerful predictors of adverse outcomes in patients with HF, Testani said.

“We know that kidney disease can probably cause HF and HF can at least exacerbate, if not cause, diabetes, so we end up with this vicious cycle,” he said.

In the setting of diabetes, there is a broad spectrum of plausible mechanisms that can lead to the synergistic decline of all kidney and heart function, and much of the same biology is hypothesized to affect each disease state bidirectionally, according to Testani.

“Unfortunately, we don’t currently have any proven therapies that are specifically indicated to treat this triad of disease,” he said. “Currently, it is not clear if there is any specific therapy for this syndrome beyond the treatment of the individual disease.”

However, recent studies have shown that SGLT-2 inhibitors may be effective in correcting several of the underlying issues in the cardiorenal syndrome by improving distal tubular salt delivery, volume status and neurohormonal activation and reducing hyperfiltration pressure and proteinuria.

Testani said that although he only considers SGLT-2 inhibitor therapy as experimental for HF, it “may correct some of the fundamental defects of cardiorenal syndrome.” – by Amber Cox

Reference:

Testani JM. The Impact of Kidney Disease on CHF in Diabetes. Presented at: Heart in Diabetes Medical Conference; July 14-16, 2017; Philadelphia.

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