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The kidney in heart failure: les liaisons dangereuses

Heart Failure (HF)

Pathophysiology of renal failure (IS Anand, US)
Renal failure is a very important prognostic factor, frequent in heart failure patients. It may be due to comorbidities, but is strongly related to hemodynamics, and more specifically to decreased renal perfusion. This is the result of a decrease in CI and increase in right atrial pressure, which appears as an important factor. The same renal perfusion deficit is responsible for renal failure in COPD or anemia or AVE fistula. The same hormonal activation is present. In acute heart failure, hypertension is a risk factor, whereas low blood pressure is associated with renal failure in chronic heart failure.

Prevalence and outcomes of chronic kidney disease (M Cowie, UK)
Dr. Cowie stressed the frequency of renal failure in the general population, stressing that it is usually underdiagnosed. Similarly, microalbuminuria occurs in 16% of diabetics, and 11% of hypertensives. In a survey of new HF patients, 38% had more than 125 microM/l, and renal failure is associated with hypertension and diabetes. Renal failure is associated with longer hospital stay, and higher mortality. The interaction between renal failure and heart failure is also illustrated by the high rate of cardiovascular complications occurring in patients with renal disease, much higher than the rate of replacement therapy. The prognostic importance of its baseline value as well as its variation was underlined again.

Assessment of renal function,(A Voors, Netherlands)
The recommendation has clearly been to use formulas (preferably MDRC) to evaluate renal function, although they are less reliable when creatinine is at the upper limit of normal (the tendency is to overestimate renal function). The reference technique, isotopic measurement, is clearly only necessary in very selected cases or for research purposes. Cystatin C is emerging as a very powerful tool, interestingly even in patients in whom creatinine plasma levels are normal. Studies of tubular function are ongoing, suggesting that it is also altered early in heart failure.

Treatment of renal dysfunction (F Follath, Switzerland)
Altered renal function has been associated with blockade of RAS and diuretic use, but not beta-blockade. In the stable patient, the recommendation from Prof. Follath was to evaluate whether dosage could be decreased safely (diuretic first, then ACEI or ARB after) under close follow-up. In the acute setting, after verification that the patient is not hypovolemic, positive inotropic therapy may be considered.


This session, very practical and lively, must have been useful for attendees. Very clear and precise presentations allowed practical conclusions to be drawn today but led us to expect improvements for tomorrow.




The kidney in heart failure: les liaisons dangereuses

Notes to editor

This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.