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When Cardiac Failure, Kidney Dysfunction, and Kidney Injury Intersect in Acute Conditions: The Case of Cardiorenal Syndrome

Legrand, Matthieu MD, PhD; Mebazaa, Alexandre MD, PhD; Ronco, Claudio MD; Januzzi, James L. Jr MD

doi: 10.1097/CCM.0000000000000404
Review Articles

Objective: To review and describe diagnostic and prognostic value of biomarkers of renal function and renal injury in the cardiorenal syndrome complicating acutely decompensated heart failure.

Data Sources: PubMed search and review of relevant medical literature.

Study Selection: Two reviewers screened and selected studies in English with diagnostic or prognostic assessment of biomarkers of renal injury.

Data Extraction: Narrative review of the medical literature.

Data Synthesis: Cardiorenal syndrome has a complex pathophysiology and has a generally poor prognosis in patients with acutely decompensated heart failure. Among the methods to recognize risk for cardiorenal syndrome may be the use of circulating or urinary biomarkers, which may allow for more accurate early diagnosis and risk stratification; use of biomarkers may provide important pathophysiologic understanding beyond risk prediction. However, different phenotypes of patients with acute renal dysfunction may be present, which has ramifications with respect to response to treatment strategies. Addition of biomarkers of renal injury may provide additional prognostic value to biomarkers of renal or cardiac function, but more data are needed.

Conclusions: Biomarkers reflecting renal function and injury are likely to better phenotype subgroups of patients with cardiorenal syndrome and to provide unique prognostic information. Future studies are needed relative to strategies using such biomarkers to guide care of affected patients.

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1AP-HP, Groupe Hospitalier St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Hôpitaux universitaires St-Louis-Lariboisière, Paris, France.

2Université Paris Diderot, Paris, France.

3Inserm UMR942, Paris, France.

4Department of Nephrology Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.

5Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

The work was performed in the Division of Cardiology, Massachusetts General Hospital, Boston, MA.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Dr. Legrand has received lecture fees from Alere, travel grants from Pfizer, and research funds from BRAHMS and Bioporto. Dr. Mebazaa served as board member for Critical Diagnostics, The Medicine Company, Cardiorentis, and Bayer and lectured for Alere, Bayer, Edwards Life Sciences, The Medicines Company, Novartis, Orion, Servier, Thermo-Fisher, and Vifor Pharma. He receives fees for lectures from Orion, Alere, Thermo-Fisher, and Edwards, consulting income from Bayer, Cardiorentis, Novartis, Vifor, and The Medicines Company, and grants from Critical Diagnostics. Dr. Ronco received support for development of educational presentations from GE; consulted for Alere, Astute, Abbvie, and General Electric; and lectured for FMC, Gambro, and B.Braun. His institution consulted for ASAHI and received support for travel from FMC and Gambro. Dr. Januzzi received support for participation in review activities from Radiometer. He received consulting fees from Roche Diagnostics, Critical Diagnostics, Novartis, Amgen, Zensun, Radiometer, and Boeringer Ingelheim. His institution received grant support from Roche Diagnostics, Siemens, Critical Diagnostics, BG Medicine, Singulex, and Thermo-Fisher. Drs. Legrand, Januzzi, and Mebazaa are members of the Global research onacute conditions team network.

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