The Cardiorenal Syndrome in Heart Failure

Heart Fail Clin. 2020 Jan;16(1):81-97. doi: 10.1016/j.hfc.2019.08.010.


Abnormal fluid handling leads to physiologic abnormalities in multiple organ systems. Deranged hemodynamics, neurohormonal activation, excessive tubular sodium reabsorption, inflammation, oxidative stress, and nephrotoxic medications are important drivers of harmful cardiorenal interactions in patients with heart failure. Accurate quantitative measurement of fluid volume is vital to individualizing therapy for such patients. Blood volume analysis and pulmonary artery pressure monitoring seem the most reliable methods for assessing fluid volume and guiding decongestive therapies. Still the cornerstone of decongestive therapy, diuretics' effectiveness decreases with progression of heart failure. Extracorporeal ultrafiltration, an alternative to diuretics, has been shown to reduce heart-failure events.

Keywords: Acute kidney injury; Cardiorenal syndrome; Creatinine; Diuretics; Fluid overload; Heart failure; Ultrafiltration; Worsening renal function.

Publication types

  • Review

MeSH terms

  • Cardio-Renal Syndrome / etiology*
  • Cardio-Renal Syndrome / therapy
  • Disease Progression
  • Diuretics / therapeutic use*
  • Heart Failure / complications*
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Hemodynamics / physiology*
  • Humans
  • Ultrafiltration / methods*


  • Diuretics