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Cardiorenal syndrome 

Cardiorenal syndrome
Cardiorenal syndrome

Darren Green

and Philip A Kalra

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date: 19 September 2021

Concurrent renal and cardiovascular disease is common. Renal disease is a potent cardiovascular risk factor and consequently cardiovascular disease is the most important cause of mortality in patients with endstage renal disease. This increased risk is mediated by vascular disease (coronary calcification, endothelial dysfunction, dyslipidaemia, etc.), left ventricular hypertrophy, risk of arrhythmias and left ventricular systolic and diastolic dysfunction. These interactions are further complicated by the presence of anaemia in advanced renal disease. The coexistence of renal disease and heart failure presents a major therapeutic challenge and requires careful attention to fluid status and renal function. Diuretic resistance is common and the important prognostic benefit of angiotensin converting enzyme (ACE) inhibition in this high-risk group is often neglected. Cardiovascular drugs, in particular antiarrhythmic agents such as digoxin, sotalol, and flecainide, should be used with caution in patients with renal disease. Patients with severe cardiac and renal disease require a multidisciplinary approach to their management.

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