Coexistent renal and heart failure: the importance of recognizing ‘congestive cardio-renal failure’

The coexistence of heart disease and renal failure is common in clinical practice (Packer et al, 1986). The pathophysiology of both conditions results in sodium and water retention. In accordance with Starling's law, cardiac function decreases once an optimum left ventricular end diastolic volume is exceeded, such that the dysfunctional heart will perform even less well when challenged by salt and water retention secondary to intrinsic renal disease. The differentiation between end stage heart disease and the failing heart that is exposed to salt and water overload in renal failure is important, both for determining clinical management and prognosis (Braunwald, 1991).