Introduction to Nephrocardiology

From cardiorenal syndrome to nephrocardiology: The journey of exploring the interconnection between nephrology and cardiovascular medicine

The knowledge about the pathophysiology of cardiorenal syndrome has evolved remarkably over the past two decades. However, cardiorenal syndrome is only one subject within a much broader field of nephrocardiology, which encompasses the interconnection between nephrology and cardiovascular medicine from nine different standpoints of pathophysiology, epidemiology, prevention, prognosis, diagnosis, therapy, monitoring, risk factors and systemic diseases. The complexities of these nine elements of the interaction between nephrology and cardiovascular medicine are not adequately addressed in either of those two fields of medicine. Nephrocardiology is an emerging field in medicine aiming at addressing those subtleties to improve prognosis and quality of life of a large and vulnerable patient population with combined cardiovascular and nephrology related conditions.

Implantable Cardioverter Defibrillator and Resynchronization Therapy in Patients With Overt Chronic Kidney Disease: JACC State-of-the-Art Review

Heart failure and chronic kidney disease are common and clinically important conditions that regularly coexist. Electrophysiologic changes of advanced heart failure often result in abnormal conduction, causing dyssynchronous contraction, and development of ventricular arrhythmias, which can lead to sudden cardiac arrest. In the last 2 decades, implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been developed to address these complications. However, when the coexisting chronic kidney disease is advanced, the associated pathophysiologic cardiovascular changes can alter the efficacy and safety of those interventions and complicate the management. This review explores the impact of comorbid advanced heart failure and advanced chronic kidney disease on the efficacy and safety of implantable cardioverter-defibrillator and cardiac resynchronization therapy, the currently available evidence, and potential future directions.

From cardiorenal syndromes to cardionephrology: a reflection by nephrologists on renocardiac syndromes

Cardiorenal syndromes (CRS) are broadly defined as disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. CRS are currently classified into five categories, mostly based on disease-initiating events and their acuity or chronicity. CRS types 3 and 4 (also called renocardiac syndromes) refer to acute and chronic kidney dysfunction resulting in acute and chronic heart dysfunction, respectively. The notion of renocardiac syndromes has broadened interest in kidney-heart interactions but uncertainty remains in the nephrological community's understanding of the clinical diversity, pathophysiological mechanisms and optimal management approaches of these syndromes. This triple challenge that renocardiac syndromes (and likely other cardiorenal syndromes) pose to the nephrologist can only be faced through a specific and demanding training plan to enhance his/her cardiological scientific knowledge and through an appropriate clinical environment to develop his/her cardiological clinical skills. The first must be the objective of the subspecialty of cardionephrology (or nephrocardiology) and the second must be the result of collaboration with cardiologists (and other specialists) in cardiorenal care units. This review will first consider various aspects of the challenges that renocardiac syndromes pose to nephrologists and, then, will discuss those aspects of cardionephrology and cardiorenal units that can facilitate an effective response to the challenges.