Renal Dysfunction Across the Spectrum of Cardiogenic Shock: Mechanisms, Clinical Implications, and Therapeutic Strategies

Abstract

Purpose of review: This review aims to elucidate the complex interplay between cardiogenic shock (CS) and renal function, detailing the mechanisms of kidney injury, identifying risk factors, and providing a framework for the diagnosis and management of acute kidney injury (AKI) in CS. We evaluate evidence supporting medical interventions, including vasopressors, inotropes, and mechanical circulatory support (MCS), in relation to renal outcomes.

Recent findings: AKI affects up to 80% of patients with CS and is associated with higher mortality, especially when Renal Replacement Therapy (RRT) is required. Mechanisms include impaired perfusion, venous congestion, and systemic inflammation. Invasive hemodynamic assessment improves diagnostic accuracy. Continuous RRT is preferred in unstable patients, although early initiation has not been shown to provide a survival benefit. Emerging tools such as novel biomarkers and machine learning may aid in early detection and risk stratification. AKI in CS is common and multifactorial, with significant prognostic impact. Early recognition, hemodynamic optimization, and a multidisciplinary strategy remain essential. Future work should focus on individualized management approaches to improve outcomes.

Keywords: Acute kidney injury; Cardiogenic shock; Cardiorenal syndrome; Renal replacement therapy.