Chronic renocardial syndrome in the elderly – a nephrologist’s perspective and practice notes
Authors:
Sulková Dusilová Sylvie 1; Jurašková Božena 2; Fialová Daniela 3,4; Kadlec Mirko 1; Šafránek Roman 1; Topinková Eva 4
Authors‘ workplace:
Nefrologická klinika, Lékařská fakulta v Hradci Králové, Univerzita Karlova, Fakultní nemocnice Hradec Králové
1; 3. interní gerontometabolická klinika, Lékařská fakulta v Hradci Králové, Univerzita Karlova, Fakultní nemocnice, Hradec Králové
2; Univerzitní centrum klinické farmacie, Katedra klinické a sociální farmacie, Farmaceutická fakulta v Hradci Králové, Univerzita Karlova
3; Geriatrická klinika 1. lékařské fakulty Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze
4
Published in:
Geriatrie a Gerontologie 2024, 13, č. 3: 136-143
Category:
Review Article
Overview
Patients with chronic kidney disease, especially the elderly, are at disproportionately high risk of cardiovascular complications and death. The pathophysiological and clinical links between the kidney and the cardiovascular system are aptly summarized in the terminology of cardiorenal syndromes.
Chronic renal syndrome (cardiorenal syndrome type 4) is a common consequence of known traditional but also so-called non-traditional risk factors resulting from renal tissue damage and renal function. Chronic kidney disease itself is an independent cardiovascular risk factor.
The article highlights the high mortality rate of patients with chronic kidney disease, starting from the early functional stages of chronic kidney disease, and recalls the basic pathogenesis and clinical significance of the most important renal-related nontraditional cardiovascular risks, including those that are particularly important for elderly patients.
Keywords:
chronic renal syndrome, chronic kidney disease (CKD), metabolic consequences of CKD, volume overload, vascular involvement in CKD, arterial hypertension, left ventricular hypertrophy, cardiovascular mortality
Sources
1. Barreto FC, Barreto DV, Liabeuf S, et al. European Uremic Toxin Work Group (EUTox). Serum indoxyl sulfate is associated with vascular disease and mortality in chronic kidney disease patients. Clin J Am Soc Nephrol 2009; 4(10): 1551–1558.
2. Ciceri P, Artioli L, Magagnoli L, et al. The role of uremic retention solutes in the MIA syndrome in hemodialysis subjects. Blood Purif 2023; 52(1): 41–53.
3. Cordero L, Ortiz A. Decreased life expectancy: a health outcome not corrected by kidney replacement therapy that emphasizes the need for primary prevention of CKD. Clin Kidney J 2024; 17(5): sfae053.
4. Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol 2011; 6(4): 913–921.
5. Currie G, Delles C. Proteinuria and its relation to cardiovascular disease. Int J Nephrol Renovasc Dis 2013; 7: 13–24.
6. Denic A, Glassock RJ, Rule AD. Structural and functional changes with the aging kidney. Adv Chronic Kidney Dis 2016; 23(1): 19–28.
7. Duque EJ, Elias RM, Moysés RMA. Parathyroid hormone: a uremic toxin. Toxins (Basel) 2020; 12(3): 189.
8. Dusilová Sulková S: Renální kostní nemoc – novinky v patogenezi. Postgrad Med 2015; 17(5): 526–535.
9. Edmonston D, Morris JD, Middleton JP. Working toward an improved understanding of chronic cardiorenal syndrome type 4. Adv Chronic Kidney Dis 2018; 25(5): 454–467.
10. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32(5 Suppl 3): S112–119.
11. Go AS, Chertow GM, Dingiie F, et al. Chronic kidney disease and the risk of death, cardiovascular events, and hospitalization. N Engl J Med 2004, 351: 1296–1305.
12. House AA. Management of heart failure in advancing CKD: Core Curriculum 2018. Am J Kidney Dis 2018; 72(2): 284–295.
13. Ito Y, Sun T, Tanaka H, et al. Tissue sodium accumulation induces organ inflammation and injury in chronic kidney disease. Int J Mol Sci 2023; 24(9): 8329.
14. Jankowski J, Floege J, Fliser D, et al. Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options. Circulation 2021; 143(11):1157–1172.
15. Leifheit-Nestler M, Vogt I, Haffner D, Richter B. Phosphate is a cardiovascular toxin. Adv Exp Med Biol 2022; 1362: 107–134.
16. Liu X, Xu X, Shang R, et al. Asymmetric dimethylarginine (ADMA) as an important risk factor for the increased cardiovascular diseases and heart failure in chronic kidney disease. Nitric Oxide 2018; 78: 113–120.
17. Levin A, Thompson CR, Ethier J, et al. Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin. Am J Kidney Dis 1999; 34: 125–134.
18. Locatelli F, Del Vecchio L. The search for the perfect agent for anemia management in chronic kidney disease. J Am Soc Nephrol 2022; 33(4): 662–664.
19. London GM. Arterial stiffness in chronic kidney disease and end-stage renal disease. Blood Purif 2018; 45(1–3): 154–158.
20. Magagnoli L, Cozzolino M, Caskey FJ, et al. Association between CKD-MBD and mortality in older patients with advanced CKD-results from the EQUAL study. Nephrol Dial Transplant 2023; 38(11): 2562–2575.
21. McCullough PA, Kellum JA, Haase M, et al. Pathophysiolgy of the cardiorenal syndromes: executive summary from the eleventh consensus konference of the Acute Dialysis Quality initiative (ADQI). Contrib Nephrol 2013; 182: 82–98.
22. McCullough PA, Amin A, Pantalone KM, et al. Cardiorenal Nexus: A review with focus on combined chronic heart and kidney failure, and insights from recent clinical trials. J Am Heart Assoc 2022; 11(11): e024139.
23. Mistrik E, Bláha V, Dusilová Sulková S, et al. MIAC (malnutrice, zánět, ateroskleróza, kalcifikace syndrom). Vnitř Lék 2007; 53(10): 1092–1099.
24. Odden MC, Shlipak MG, Whitson HE, et al. Risk factors for cardiovascular disease across the spectrum of older age: the Cardiovascular Health Study. Atherosclerosis 2014; 237(1): 336–342.
25. Pinheiro da Silva AL, Vaz da Silva MJ. Type 4 cardiorenal syndrome. Rev Port Cardiol 2016; 35(11): 601–616.
26. Roehm B, Weiner DE. Blood pressure targets and kidney and cardiovascular disease: same data but discordant guidelines. Curr Opin Nephrol Hypertens 2019; 28(3): 245–250.
27. Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52(19): 1527–1539.
28. Ronco C, McCullough P, Anker SD, et al. Cardio-renal syndromes: report from the Consensus Conference of the Acute Dialysis Quality Initiative. Eur Heart J 2010; 31: 703–711.
29. Ritter CS, Slatopolsky E. Phosphate toxicity in CKD: the killer among us. Clin J Am Soc Nephrol 2016; 11(6): 1088–1100.
30. Ryšavá R. Novinky v léčbě renální anémie – erythropoietin vs inhibitory propylhydroxylázy? Vnitř Lék 2022; 68(7): 438–443.
31. Santoro A. Heart failure and cardiorenal syndrome in the elderly. J Nephrol 2012; 25(Suppl 19): S67–72.
32. Scialla JJ, Wolf M. Roles of phosphate and fibroblast growth factor 23 in cardiovascular disease. Nat Rev Nephrol 2014; 10(5): 268–278.
33. Shang W, Li L, Huang S, et al. Chronic kidney disease and the risk of new-onset atrial fibrillation: a meta-analysis of prospective cohort studies. PLoS One 2016; 11(5): e0155581.
34. Schuett K, Marx N, Lehrke M. The cardio-kidney patient: epidemiology, clinical characteristics and therapy. Circ Res 2023; 132(8): 902–914.
35. Tonelli M, Wiebe N, Culleton B, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006; 17: 2034–2047.
36. Torra R. Kidney health matters: a global imperative for public health. Nephrol Dial Transplant 2024: gfae083.
37. Tunnicliffe DJ, Palmer SC, Cashmore BA, et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis. Cochrane Database Syst Rev 2023; 29; 11(11): CD007784.
38. Turakhia MP, Blankestijn PJ, Carrero JJ, et al. Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Eur Heart J 2018; 39: 2314–2325.
39. Valdivieso JM, Rodriguez-Pujo lD, Pascual J, et al. Atherosclerosis in chronic kidney disease: more, less, or just different? Arterioscler Thromb Vasc Biol 2019; 39: 1938–1966.
40. Vervloet MG, de Jong HJ, Pander J, et al. Prevalence of chronic kidney disease in the Netherlands and its cardiovascular and renal complications. BMC Nephrol 2023; 24(1): 337.
41. Zoccali C, Mallamaci F, Adamczak M, et al. Cardiovascular complications in chronic kidney disease: a review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association. Cardiovasc Res 2023; 119(11): 2017–2032.
42. Sembajwe LF, Ssekandi AM, Namaganda A, et al. Glycocalyx-sodium interaction in vascular endothelium. Nutrients 2023; 15(13): 2873
Labels
Geriatrics General practitioner for adults Orthopaedic prostheticsArticle was published in
Geriatrics and Gerontology
2024 Issue 3
Most read in this issue
- Swallowing disorders in old age
- Muscle dynamopenia and sarcopenia in old age
- Chronic renocardial syndrome in the elderly – a nephrologist’s perspective and practice notes
- The association of BDNF, irisin, muscle mass and strength with cognitive function in older women: how strongly these parameters predict scores on selected cognitive domain tests