Key result
This review highlights that while diuretics and RAAS inhibitors are mainstay therapies for cardiorenal syndromes, their use requires careful management of risks like hyperkalemia and worsening renal function.
This review highlights the pharmacological management of cardiorenal syndromes, emphasizing the role of diuretics in acute settings and RAAS inhibition in chronic settings, while cautioning against hyperkalemia and renal dysfunction with combined RAAS blockade.
Supports careful titration of diuretics and RAAS inhibitors in cardiorenal syndromes; leaves open evidence-based protocols for combined use.
In the setting of cardiorenal syndrome(s) (CRS), the main pathophysiological triggers of renal disease progression include increases in renal venous pressure, maladaptive activation of the renin-angiotensin-aldosterone (RAAS) and the sympathetic nervous systems, and a chronic inflammatory state. In acute decompensated heart failure (HF)/type 1 CRS, diuretics remain the mainstay of first-line therapy in order to prevent congestion and renal venous hypertension. In chronic HF/type 2 CRS, RAAS multiple inhibition has been recommended in addition to diuretics. However, cotreatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and mineralocorticoid receptor antagonists is likely to lead to more frequent occurrences of hyperkalemia and worsening renal function. In this review, the main pharmacological therapies of acute and chronic CRS are discussed regarding their indication as well as intended and side effects. Future therapies are suggested, underlining that a multidisciplinary approach to a deeper understanding of the pathophysiology of CRS is still required to improve specific treatment and clinical outcome.
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Roubille et al. (2014) conducted a review in Cardiorenal Syndromes (acute and chronic heart failure). Pharmacological therapies (diuretics, RAAS inhibitors) was evaluated. This review highlights that while diuretics and RAAS inhibitors are mainstay therapies for cardiorenal syndromes, their use requires careful management of risks like hyperkalemia and worsening renal function.
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