Cardio-Renal Syndromes: Report from the Consensus Conference of the Acute Dialysis Quality Initiative
Eur Heart J 2010;316:703–711
“A consensus conference on CRS was held in Venice Italy, in September 2008 under the auspices of the ADQI. The following topics were matter of discussion after a systematic literature review and the appraisal of the best available evidence: definition/classification system; epidemiology; diagnostic criteria and biomarkers; prevention/protection strategies; management and therapy. The umbrella term CRS was used to identify a disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. Different syndromes were identified and classified into five subtypes. Acute CRS (type 1): acute worsening of heart function leading to kidney injury and/or dysfunction. Chronic CRS (type 2): chronic abnormalities in heart function leading to kidney injury and/or dysfunction. Acute reno-cardiac syndrome (type 3): acute worsening of kidney function leading to heart injury and/or dysfunction. Chronic reno-cardiac syndrome (type 4): chronic kidney disease leading to heart injury, disease, and/or dysfunction. Secondary CRS (type 5): systemic conditions leading to simultaneous injury and/or dysfunction of heart and kidney. Consensus statements concerning epidemiology, diagnosis, prevention, and management strategies are discussed in the paper for each of the syndromes.”
Cardiac and renal diseases are common and frequently coexist to significantly increase mortality, morbidity, and the complexity and cost of care. Syndromes describing the interaction between heart and kidney have been defined and classified but never as a result of a consensus process. Thus, there is limited appreciation of epidemiology and standardized diagnostic criteria. Moreover, prevention and treatment is fragmented, single organ centred, and not multidisciplinary in approach. As a result, timing and quality of care may suffer. A consensus conference was organized under the auspices of the ADQI in Venice, Italy, in September 2008. It involved opinion leaders and experts in nephrology, critical care, cardiac surgery, and cardiology. In this manuscript, we present the findings of this consensus conference.