Type 4 Cardiorenal Syndrome

Rev Port Cardiol. 2016 Nov;35(11):601-616. doi: 10.1016/j.repc.2016.06.007. Epub 2016 Oct 4.
[Article in English, Portuguese]


The Acute Dialysis Quality Initiative consensus conference proposed a classification of cardiorenal syndrome (CRS), aiming for a better delineation of each subtype. Although the exact pathophysiology of type 4 CRS is not completely understood, the mechanisms involved are probably multifactorial. There is growing evidence that oxidative stress is a major connector in the development and progression of type 4 CRS. Giving its complexity, poor prognosis and increasing incidence, type 4 CRS is becoming a significant public health problem. Patients with chronic kidney disease are particularly predisposed to cardiac dysfunction, due to the high prevalence of traditional cardiovascular risk factors in this population, but the contribution of risk factors specific to chronic kidney disease should also be taken into account. Much remains to be elucidated about type 4 CRS: despite progress over the last decade, there are still significant questions regarding its pathophysiology and there is as yet no specific therapy. A better understanding of the mechanisms involved may provide potential targets for intervention. The present review will provide a brief description of the definition, epidemiology, diagnosis, prognosis, biomarkers and management strategies of type 4 CRS, and the pathophysiological mechanisms and risk factors presumably involved in its development will be particularly highlighted.

Keywords: Ativação neuro-hormonal; Cardiovascular risk factors; Chronic kidney disease; Doença renal crónica; Doença renal crónica terminal; End-stage renal disease; Fatores de risco cardiovascular; Heart failure; Insuficiência cardíaca; Neurohormonal activation; Oxidative stress; Stresse oxidativo; Síndrome cardiorrenal tipo 4; Type 4 cardiorenal syndrome.

Publication types

  • Review

MeSH terms

  • Cardio-Renal Syndrome / classification*
  • Cardio-Renal Syndrome / etiology
  • Cardiovascular Diseases / etiology
  • Humans
  • Risk Factors