Cardiorenal Units as a Strategy to Improve Outcomes in Cardiorenal Syndrome

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Background: Cardiorenal Syndrome (CRS), is often a challenging condition with paucity of evidence-based therapy. The increasing burden of this entity has prompted the creation of cardiorenal units (CRU) as integrating programs intended to provide a combined multidisciplinary approach to maximize all chances for organ and patient recovery. Here we describe the early results of the creation of one CRU Methods: Observational study: all patients diagnosed with CRS, who have been seen in the cardiorenal day care unit, formed by specific trained nephrologist, cardiologist and nurses. Assessment of cardio-renal function and volume status was performed by conventional cardiac ultrasound plus V-Scan, GFR estimation by CKD EPI, NT-proBNP determination and bioelectrical impedance when indicated. Results: Cardiorenal Unit of Puerta de Hierro University Hospital was created in Jan 2021. 68 patients have been evaluated with a mean follow up of 4 months (SD 3.2). Most frequent cardiologic diagnoses were 63.9% heart fellow with reduced function (HFrF) and 37.1% Heart failure with preserved ejection fraction (HFpEF) and the presence on Pulmonary Hypertension or Tricuspid regurgitation was 29.4% and 50.9%. 51.6% patients showed diuretic resistance. Most frequent renal diagnosis were pure CRS 36.9%, and 27.7% and 24.6% CRS associated to diabetic kidney disease or nephroangioesclerosis, respectively. Mean FGe rate when patients were initially evaluated was 31.5 ml/min/1.73m2 (SD 11.0) with demonstration of albuminuria in 48.5% of patients. The integrated cardio-renal management of these patients included initiation or adjustment of specific cardio-nephro protective drugs (SGLT2 inhibitors (46.8%), ARNi (25.8%), aldosterone receptor antagonists (4,8%)) or diuretic regime adjustment including iv administration (54.8%). Peritoneal dialysis was indicated in 3 patients and hemodialysis inone. 13.2% patients suffer new episodes of heart failure that needed hospitalization or unexpected medical attention at the day-care clinic. One patient died during follow-up (1.5%). Conclusions: We conclude that this coordinated cardio-nephro approach of CRS was useful to optimize drug therapy aimed to mid-long term goals of cardio-nephro protection and to implement advanced therapies for fluid management in patients with diuretic resistance.

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