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Renal function as a predictor of prognosis in chronic heart failure.
Heart Fail Monit. 2002; 2(3):78-84.HF

Abstract

The incidence of chronic heart failure (CHF) has been increasing, particularly because of the aging of the population and the improved survival of patients with coronary artery disease. Therefore, the current pathophysiological and clinical considerations in the diagnosis and treatment of CHF will need further improvement in terms of cardiovascular risk profiling, preventive measures, earlier intervention, and patient-tailored disease management. To date, the role of the kidney in CHF is mainly considered within the context of excessive salt and water retention, due to reduced renal blood flow. However, recent data indicate that the kidney may play a more decisive role in the progression and prognosis of the disease. It has been demonstrated that renal function is independently associated with an increased risk for all-cause mortality and cardiovascular morbidity. Furthermore, moderate renal insufficiency is a common phenomenon in this patient population and, for example, left ventricular ejection fraction, glomerular filtration rate, and New York Health Association class are not only prognostically important but are also acting independently, and support the hypothesis that cardiac function, clinical status, and renal function represent, in part, different prognostic entities of CHF. It could be questioned why an impaired renal function adds prognostic risk to develop CHF? A subclinically decreased renal function is unlikely to be the direct cause. Renal function is known to correlate with a variety of cardiovascular risk factors. Similar risk factors could contribute to the pathogenesis of intrarenal disease. Furthermore, a large number of metabolic abnormalities are related to impaired renal function and induce myocardial dysfunction and damage. Finally, neurohormonal activation is apparent in patients with chronic heart failure. Angiotensin II, the central product of the renin-angiotensin system, may play a central role in the pathophysiology and progression of cardiovascular and renal diseases. In conclusion, to prevent cardiovascular morbidity and mortality, new therapeutic strategies might be triggered by focussing on increasing our knowledge concerning adaptive and maladaptive mechanisms of the kidney involved in CHF.

Authors+Show Affiliations

Department of Cardiology/Thoraxcenter, University Hospital Groningen, Groningen, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12634888

Citation

Hillege, Hans, et al. "Renal Function as a Predictor of Prognosis in Chronic Heart Failure." Heart Failure Monitor, vol. 2, no. 3, 2002, pp. 78-84.
Hillege H, Van Gilst W, de Zeeuw D, et al. Renal function as a predictor of prognosis in chronic heart failure. Heart Fail Monit. 2002;2(3):78-84.
Hillege, H., Van Gilst, W., de Zeeuw, D., & van Veldhuisen, D. J. (2002). Renal function as a predictor of prognosis in chronic heart failure. Heart Failure Monitor, 2(3), 78-84.
Hillege H, et al. Renal Function as a Predictor of Prognosis in Chronic Heart Failure. Heart Fail Monit. 2002;2(3):78-84. PubMed PMID: 12634888.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal function as a predictor of prognosis in chronic heart failure. AU - Hillege,Hans, AU - Van Gilst,Wiek, AU - de Zeeuw,Dick, AU - van Veldhuisen,Dirk-Jan, PY - 2003/3/14/pubmed PY - 2003/4/11/medline PY - 2003/3/14/entrez SP - 78 EP - 84 JF - Heart failure monitor JO - Heart Fail Monit VL - 2 IS - 3 N2 - The incidence of chronic heart failure (CHF) has been increasing, particularly because of the aging of the population and the improved survival of patients with coronary artery disease. Therefore, the current pathophysiological and clinical considerations in the diagnosis and treatment of CHF will need further improvement in terms of cardiovascular risk profiling, preventive measures, earlier intervention, and patient-tailored disease management. To date, the role of the kidney in CHF is mainly considered within the context of excessive salt and water retention, due to reduced renal blood flow. However, recent data indicate that the kidney may play a more decisive role in the progression and prognosis of the disease. It has been demonstrated that renal function is independently associated with an increased risk for all-cause mortality and cardiovascular morbidity. Furthermore, moderate renal insufficiency is a common phenomenon in this patient population and, for example, left ventricular ejection fraction, glomerular filtration rate, and New York Health Association class are not only prognostically important but are also acting independently, and support the hypothesis that cardiac function, clinical status, and renal function represent, in part, different prognostic entities of CHF. It could be questioned why an impaired renal function adds prognostic risk to develop CHF? A subclinically decreased renal function is unlikely to be the direct cause. Renal function is known to correlate with a variety of cardiovascular risk factors. Similar risk factors could contribute to the pathogenesis of intrarenal disease. Furthermore, a large number of metabolic abnormalities are related to impaired renal function and induce myocardial dysfunction and damage. Finally, neurohormonal activation is apparent in patients with chronic heart failure. Angiotensin II, the central product of the renin-angiotensin system, may play a central role in the pathophysiology and progression of cardiovascular and renal diseases. In conclusion, to prevent cardiovascular morbidity and mortality, new therapeutic strategies might be triggered by focussing on increasing our knowledge concerning adaptive and maladaptive mechanisms of the kidney involved in CHF. SN - 1470-8590 UR - https://www.unboundmedicine.com/medline/citation/12634888/Renal_function_as_a_predictor_of_prognosis_in_chronic_heart_failure_ L2 - https://medlineplus.gov/heartfailure.html DB - PRIME DP - Unbound Medicine ER -