Textbook of Cardiorenal Medicine 9783030574598, 9783030574604

This textbook provides a practical and board-driven resource to describe and define the emerging field of cardiorenal me

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English Pages 397 [381] Year 2021

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Textbook of Cardiorenal Medicine
 9783030574598, 9783030574604

Table of contents :
1: Implications of Chronic Kidney Disease on the Epidemiology of Cardiovascular Disease
1.1 Introduction
1.2 Cardiovascular Risk in Chronic Kidney Disease
1.3 Coronary Heart Disease
1.4 Heart Failure
1.5 Valvular Calcific Deposits and Complications
1.6 Arrhythmias
1.7 Summary
2: Prevalence and Progression of Cardiovascular Calcification in the General Population and Patients with Chronic Kidney Disease
2.1 Coronary Artery Calcium as a Marker of Atherosclerotic Vascular Disease in the General Population
2.2 Cardiovascular Calcification in Chronic Kidney Disease
2.2.1 Pathogenesis
2.2.2 Epidemiology and Clinical Significance of Cardiovascular Calcification in CKD
2.2.3 Progression of Cardiovascular Calcification in CKD
2.3 Conclusions
3: Spectrum of Ventricular Dysfunction in Chronic Kidney Disease
4: The Myocardium in Renal Failure
5: Impact of Renal Failure on Valvular Heart Disease
5.1 Introduction
5.2 Pathology
5.3 Prevention
5.4 Diagnosis and Follow Up
5.5 Treatment
5.5.1 Aortic Valve Stenosis
5.5.2 Aortic Regurgitation
5.5.3 Mitral Valve Stenosis
5.5.4 Mitral Regurgitation
5.6 Choice of Valve Type
5.7 Management Post-Surgery: Anticoagulation
5.8 Conclusions
6: Arrythmias in Chronic Kidney Disease: Working Towards a Clinical Approach in Atrial Fibrillation
6.1 Introduction
6.2 CKD, Atrial Fibrillation, and Stroke
6.3 Anticoagulation in Atrial Fibrillation and CKD: Shifting Paradigms to Novel Anticoagulants
6.3.1 NOACs Versus Warfarin
6.3.2 Individual NOACs and Post-Hoc Analyses
6.3.3 Network Meta-Analyses
6.3.4 Post-Marketing Observational Surveillance Studies
6.4 Working Towards a Clinical Approach to Stroke Prevention CKD and Atrial Fibrillation
6.5 Conclusion
7: Type 1 Cardio-Renal Syndrome
7.1 Introduction
7.2 Definition of Acute (Type 1) Cardio-Renal Syndrome
7.3 Factors Contributing to the Development of Acute CRS
7.4 Preventing Type 1 CRS: Identifying Sub-Clinical Cardio-Renal Injury
7.5 Managing Type 1 CRS
7.6 Conclusions
8: Type 2 Cardiorenal Syndrome
8.1 Introduction
8.2 Description of CRS2
8.3 Pathophysiology
8.4 Chronic Inflammatory State: Fibrosis as the Unifying Pathogenesis
8.5 Cardiorenal Type 2 in Heart Failure with Preserved Ejection Fraction
8.6 Diagnosis
8.6.1 Biomarkers and CRS2 Cardiac Biomarkers Renal Biomarkers
GFR and Albuminuria
8.6.2 Cystatin C
8.6.3 Potential Therapies Angiotensin-Converting Enzyme (ACE) Inhibitor and an Angiotensin Receptor Blocker Mineralocorticoid Receptor Antagonists Angiotensin Receptor Neprilysin Inhibitor
8.7 Newer Options for Diabetics: Sodium–Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Agonist
8.7.1 Cardiac Devices CRT LVAD
8.8 Conclusion
9: Type 3 Cardiorenal Syndrome
9.1 Introduction
9.2 Epidemiology of AKI
9.3 Epidemiology of Renocardiac Syndrome
9.4 Diagnosis of AKI
9.5 Pathophysiology of Renocardiac Syndrome
9.5.1 Hemodynamic Factors
9.5.2 Non-hemodynamic Factors
9.6 Endothelial Dysfunction
9.7 Management: Cardiac Related
9.7.1 Diuretics
9.7.2 Vasodilators
9.7.3 Natriuretic Peptides
9.7.4 Mechanical Ultrafiltration and Dialysis
9.8 Prevention of CRS-3
10: Type-5 Cardiorenal Syndrome
10.1 Introduction
10.2 Pathogenesis of CRS 5
10.2.1 CRS-5 and Sepsis
10.2.2 CRS-5 and Amyloidosis
10.2.3 CRS-5 and Systemic Lupus Erythematosus (SLE)
10.2.4 CRS-5 and Fabry’s Disease Pathology of Renal Involvement Clinical Renal Involvement Pathology of Cardiac Involvement Clinical Cardiac Involvement
10.3 Diagnosis of CRS-5
10.4 Management of CRS-5
11: Post Contrast Acute Kidney Injury
11.1 Introduction
11.2 Name
11.3 Definition
11.4 Pathophysiology
11.4.1 In Vitro
11.4.2 In Vivo
11.4.3 Man
11.5 Epidemiology and Risk
11.6 Complications
11.7 Prevention
11.7.1 More Fluid Rather than Less Is Beneficial [43–46]
11.7.2 Oral Fluid Intake May Be Very Important
11.7.3 Increasing Urine Output May Be the Key to a Successful Prophylactic Strategy
11.8 Controversies
11.9 Conclusion
12: Distinct Cardiorenal Syndromes: Cardiac Surgery Associated Acute Kidney Injury
12.1 Introduction and Epidemiology
12.2 Risk Factors for CSA-AKI
12.2.1 Patient Specific Factors
12.2.2 Surgical Factors
12.2.3 Risk Scores
12.3 The Role of Novel Biomarkers in the Diagnosis of CSA-AKI
12.3.1 Neutrophil Gelatinase-Associated Lipocalin
12.3.2 Cystatin C
12.3.3 IL-18
12.3.4 Kidney Injury Molecule-1
12.4 Pathophysiology of CSA-AKI
12.4.1 Inflammatory Response
12.4.2 Renal Ischemia
12.4.3 Nephrotoxic Medications
12.4.4 Factors Unique to Cardiopulmonary Bypass Hemolysis Embolism Temperature Control
12.5 Treatment and Prevention
12.5.1 Risk Factor Modification
12.5.2 Pharmacologic Interventions Natriuretic Peptides Fenoldepam Dexmetodomidine Levosimendan N-Acetylcysteine Sodium Bicarbonate Statins
12.5.3 Remote Ischemic Preconditioning
12.5.4 Renal Replacement Therapy
12.6 Pediatrics
12.7 Summary and Future Directions
13: Pediatric Cardiorenal Syndromes
13.1 Introduction
13.2 CRS Type 1: Acute Cardiorenal Syndrome
13.3 CRS Type 2: Chronic Cardiorenal Syndrome
14: Key Concepts of Organ-Crosstalk
14.1 Background
14.2 Gene Expression
14.3 Epigenetic and Epigenome
14.4 Small Non-coding RNAs
14.5 Extracellular Vesicles
14.6 Proteomics and Metabolomics
14.7 Inflammation
14.8 Immune Cell Signaling and Immunomodulation: The Role of Innate and Adaptive Immunity
14.9 Neurohormonal Systems in Cardiorenal Syndromes
14.10 Endocrine Dysregulation in Cardiorenal Syndromes
15: Methods to Assess Intra- and Extravascular Volume Status in Heart Failure Patients
15.1 Introduction
15.2 Pathophysiology of Fluid Overload in Heart Failure
15.3 Blood Volume Measurement and the Indicator Dilution Principle
15.4 Bio-electrical Impedance Analysis Methods
15.4.1 Bio-electrical Impedance Vector Analysis
15.4.2 Impedance Cardiography
15.4.3 Bioimpedance Spectroscopy
15.4.4 Bioreactance
15.5 Other Methods for Non-invasive Hemodynamic Monitoring
15.6 Less Invasive Hemodynamic Monitoring Methods
15.6.1 Cardiac Output Monitoring by Pulse Contour Analysis
15.6.2 Peripheral Intravenous Volume Analysis
15.7 Hemodynamic Data from Implanted Monitors
15.7.1 Pulmonary Artery Pressure Sensors
15.7.2 Left Atrial Pressure Sensors
15.8 Data from Cardiac Implanted Electronic Devices
15.9 Ultrasound Methods
15.9.1 Lung Ultrasound
15.9.2 Inferior Vena Cava Ultrasound
15.10 Biomarkers
15.11 Prospective and Conclusions
16: Novel Biomarkers of Acute Cardiorenal Disease
16.1 Brief Terminology of Acute Cardiorenal Disease
16.2 Major Pathomechanisms of Cardiorenal Syndromes (CRS) Types 1 and 3
16.3 Biomarkers of Acute Cardiorenal Disease
16.3.1 Biomarkers for Early AKI Detection After Cardiac Impairment (CRS Type 1) Biomarkers of Glomerular Filtration
Serum Cystatin C
Determination of Renal Function and Injury Using Near-Infrared Fluorimetry in CRS Biomarkers of Acute Renal Tubular Damage/Stress Biomarkers of Acute Renal Tubular Damage/Stress After ADHF/ACS
NGAL: Biological Characteristics
NGAL: Clinical Trials
Biomarker Combinations
Interpretation of Test Results of Markers of Acute Tubular Damage/Stress
16.3.2 Markers to Predict or Indicate Cardiac Impairment After AKI (CRS type 3) Novel Kidney Biomarkers for Early Diagnosis of Diuretic Resistance Novel Kidney Biomarkers for Early Diagnosis of Cardiac Impairment Novel Cardiac Biomarkers of Plaque Destabilization Before Troponin Rise Novel Biomarkers of Cardiac Dysfunction
16.4 Summary
17: Novel Biomarkers of Chronic Cardiorenal Disease
17.1 Conclusions
18: Mechanisms of Kidney and Heart Cross-talk in Acute Kidney Injury
18.1 Introduction
18.2 Acute Renocardiac Syndrome
18.3 Mechanisms of Cardiac Injury Triggered by AKI
18.4 Possible Interventions Against Cardiac Injury in AKI
18.5 Long Term Prognosis of Acute Renocardiac Syndrome
18.6 Conclusion
19: Kidney and the Heart in Multiorgan System Failure
19.1 Introduction
19.2 Fluid Balance and Kidney and Heart Interaction
19.3 Hemodynamics
19.4 Hemodynamic Targets
19.5 Afterload Therapy: Afterload Reduction and Treatment of Vasoplegia
19.6 Contractility
19.7 Position on the Ventricular Function Curve: Volume Responsiveness
19.8 Ventricular Compliance
19.9 Ventricular Imaging
19.10 Oxygen Delivery and Balance
19.11 Whole Body Perfusion Monitoring
19.12 Specific Organ Perfusion
19.13 Kidney Perfusion: Acute Kidney Injury and Acute Kidney Stress
19.14 Summary
20: Cardiac Consequences of Renal Artery Stenosis
20.1 Introduction
20.2 Prevalence
20.3 Pathophysiology
20.4 RAS and Cardiovascular Disease
20.5 Clinical Manifestations
20.6 Diagnosis
20.7 Medical Treatment
20.8 Renal Revascularization
20.9 Important Clinical Trials
20.10 Guidelines Summary
20.11 Conclusion
21: Obesity
21.1 Introduction
21.2 Obesity Related Dysfunction of Cardio-Renal Axis and Cardiac Adaptation
21.3 Renal Adaptations to Obesity
21.4 Role of Cytokines, Inflammatory Pathways, and Adipokines in Obesity
21.5 Role of Aldosterone and Resistin
21.6 Obesity, Metabolic Status and Chronic Kidney Disease
21.7 Therapeutic Interventions
21.7.1 Dietary Modification
21.7.2 Physical Activity
21.7.3 Behavioral Modification
21.7.4 Antiobesity Agents
21.8 Obstructive Sleep Apnea (OSA)
21.9 Hypertension Pharmacotherapy
21.10 Bariatric Surgery
21.11 Conclusion
22: Class Effects of SGLT2 Inhibitors on Cardiorenal Outcomes
22.2 The CANVAS Program
22.3 The DECLARE-TIMI 58 Trial
22.4 The CREDENCE Trial
22.5 Cardiovascular and Renal Outcomes
22.6 Outcome Definitions
22.7 Other Notable Trial Results
22.8 RAASi Use
22.9 Safety
22.10 Future Potential Benefits of SGLT2i
22.11 Class Effects
22.12 Conclusions
23: Management of Diabetes Mellitus in Acute and Chronic Cardiorenal Syndromes
23.1 Introduction
23.2 Screening for Diabetes
23.3 Screening for CKD
23.4 Medications in Diabetic Nephropathy
23.4.1 Insulin Long-Acting Insulins Intermediate-Acting Insulin Short-Acting Insulin Rapid-Acting Insulins Premixed Insulins Varying Insulin Concentrations Inhaled Insulin
23.4.2 Oral Medications Metformin (Biguanides) Sulfonylureas Glinides Thiazolidinediones Alpha-Glucosidase Inhibitors Dipeptidyl Peptidase-4 Inhibitors Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitors Other Oral Medications
23.4.3 Other Subcutaneous Medications GLP-1 Receptor Agonists Amylin Analog
23.5 Glycemic Control
23.5.1 Glycemic Goal Targeting an A1c ~7.0%
23.5.2 A1c and Glucose Targets
23.5.3 Accuracy of A1c
23.5.4 Strategy for Glycemic Control in Type 1 and type 2 Diabetes Type 1 DM Type 2 DM Patients on Dialysis
23.6 Cardiovascular Disease and Risk Factors
23.6.1 Blood Pressure Control
23.6.2 Dyslipidemia
23.6.3 Nutrition and Dietary Protein
23.7 Referral to Specialized Care
23.8 Conclusion
24: Pharmacoepidemiology in Cardiorenal Medicine
24.1 Introduction
24.2 Therapies and Adaptations
24.2.1 Angiotensin Converting Enzyme Inhibitors
24.2.2 Angiotensin Receptor Blockers
24.2.3 Beta Adrenergic Receptor Blockers
24.2.4 Mineralocorticoid Receptor Antagonists
24.2.5 Diuretics
24.2.6 Statins
24.2.7 Digoxin
24.2.8 Sodium-Glucose Transport Protein 2 Inhibitors
24.3 Medication Usage Limitations
24.3.1 Pill Burden
24.3.2 Poor Communication and Affordability
24.3.3 Side Effects
24.3.4 Contextual Issues
24.4 Conclusion
25: Anticoagulation for Atrial Fibrillation in Advanced Chronic Kidney Disease
25.1 Vitamin K Antagonists in Patients with Advanced Chronic Kidney Disease and End Stage Renal Disease
25.2 DOACs in Patients with Advanced CKD and ESRD
25.3 Percutaneous Left Atrial Appendage Occlusion
26: Cardiac Consultative Approach to Hemodialysis Patients and Cardiovascular Evaluation and Management of Potential Kidney Transplant Recipients
26.1 Evaluation and Management of Dialysis-Dependent Chronic Kidney Disease Prior to Renal Transplant and Non-cardiac Surgery
26.2 Challenges in the Evaluation of Patients with Advanced Chronic Kidney Disease and End-Stage Renal Disease for Renal Transplant
26.3 Preoperative Factors
26.3.1 Chronic Conditions
26.3.2 Acute and Recent Events
26.3.3 Intraoperative and Postoperative Events
26.4 Assessment and Management of Potential Renal Transplant Recipients
26.5 Risk Stratification and Detection of Cardiovascular Disease in Patients Undergoing Pre-renal-Transplant Evaluation
26.5.1 Very High Risk
26.5.2 High Risk
26.5.3 Moderate Risk
26.5.4 Low Risk
26.6 Risk Assessment Methods
26.6.1 Risk Estimation Indices
26.6.2 Noninvasive Imaging Studies
26.6.3 Cardiopulmonary Stress Testing
26.6.4 Biomarkers
26.6.5 Invasive Coronary Angiogram
26.6.6 Approach to Screening Potential Renal Transplant Candidates
26.7 Surveillance and Perioperative Management
26.8 Revascularization in Dialysis-Dependent ESRD Patients
26.9 Revascularization in Acute Coronary Syndrome
26.10 Revascularization in Stable Coronary Artery Disease
26.11 Cardiac Surgery in Dialysis-Dependent CKD
27: Nephrology Inpatient Consultative Approach in Patients with Cardiovascular Disease
27.1 Introduction
27.2 Consultative Approach to the Patient with Acute Heart Failure and Diuretic Resistance
27.2.1 Pathophysiological Considerations in Acute Heart Failure
27.2.2 Determinants of Renal Perfusion in Acute Heart Failure
27.2.3 Diuretic Resistance: Mechanisms and Clinical Approach in Worsening Renal Function with Acute Heart failure
27.2.4 Ultrafiltration for Decongestion in Acute Heart Failure: Is There a Role in Contemporary Cardio-Renal Medicine?
27.2.5 Optimization Prior to Cardiac Catheterization and Cardiac Surgery: Role of the Nephrologist
27.2.6 Reduction of Contrast Induced Acute Kidney Injury
27.2.7 Reduction of Acute Kidney Injury After Cardiovascular Interventions: Procedural Aspects
27.2.8 Reduction of Acute Kidney Injury After Cardiovascular Interventions: Targeting Renal Blood Flow and Filtration Fraction
27.2.9 Pre-procedural Medical Optimization of Patients with Advanced Chronic Kidney Disease
27.3 Continuous Renal Replacement Therapy for Severe Acute Kidney Injury
27.4 Conclusions and Future Directions

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