Heart failure and cardiorenal syndrome

Cardiorenal syndrome (CRS) is manifested as a clinical condition that involves the participation of both organs, its deleterious effects are enhanced so that the renal and myocardial damage progresses rapidly, complicating their treatment. Considering the results of different registers of heart failure (HF), we can infer that about 33% of patients admitted to coronary care units, with a diagnosis of decompensate HF have some degree of renal insufficiency (RI). The CRS may be an association by the coexistence of cardiovascular risk factors with chronic kidney disease (CKD) or by a direct effect of cardiac damage on kidney damage or vice versa. However, the most likely scenario is that there is a common pathophysiological link between them through the endothelial injury. Current treatment involves the use of inhibitors of angiotensin converting enzyme, antagonists angiotensin II, diuretics, beta blockers, inhibitors of arginine-vasopressin, aldosterone inhibitors, lipid lowering drugs, erythropoietin, recent ultrafiltration techniques and dialysis. The patients with a CRS should be referred early to make an initial risk stratification which will allow us to individualize treatment of renal failure and cardiovascular diseases through an essentially interdisciplinary approach. The identification of patients at risk, the development of common protocols and secondary prevention are the cornerstones that enable us to avoid further complications in this subgroup of patients. Finally, we must remember that the main objective of our strategies is to avoid iatrogenic, addressing systematically (without considering the cost-benefit of current pharmacological tools) a clinically increasingly complex as cardiorenal syndrome.