Table 1.
Example of proposed topics for the cardionephrology curriculum
| Topic | Details |
|---|---|
| Inpatients | |
| Volume status assessment | Use of bioimpedance analysis, lung and IVC ultrasound |
| Fluid overload therapy | Use of SCUF, urgent-start PD, optimization of PD modalities and regimens for sodium and water removal if ESRD, and evidence-based use of diuretics in landmark studies (e.g., DOSE and CARRESS-HF) |
| AKI (ADHF and postcardiac surgery) | Use of biomarkers for early diagnosis and prognostication, and impact of changes in renal function (WRF/IRF) on outcomes |
| Mechanical circulatory support | Impact of renal function on eligibility of patients for LVAD implantation, trajectory of post-LVAD renal function, impact of changes in renal function (WRF/IRF) on outcomes, and Impella and the kidney |
| Renal replacement therapy (ADHF) | Choice of RRT (HD, SCUF, or CRRT), customization of UFR, BFR, and DFR in HD, in-line continuous monitoring of hematocrit and oxygen saturation change, and urgent-start PD |
| Dysnatremia (ADHF) | Evidence-based use of vasopressin-2 receptor antagonists, management of hypernatremia in fluid overloaded patients, and management of AKI complicated by hyponatremia |
| Cardiac pressures and hemodynamics | Familiarity with TTE and TEE, interpretation of various right and left cardiac pressures and their relation to volume and hemodynamics, kidney in pulmonary hypertension, and the role of inotropes and their distinctive impact on various hemodynamic and renal parameters |
| Outpatients | |
| HF co-management | Use of neprilysin inhibitors, novel agents for chronic hyperkalemia associated with HF therapy, PD for refractory HF and fluid overload, optimal blood pressure goals and management, and patients with LVAD as destination therapy |
| ESRD | Focused diagnosis and classification of HF in the ESRD population, hemodialysis access placement in severe HF (indications and management), optimization of PD modalities and regimens for sodium and water removal (e.g., the use of icodextrin solution), familiarity with the RRT care of patients with continuous-flow LVADs, and sudden cardiac death |
| Heart transplantation | Antirejection medications and renal function, mTOR inhibitors and proteinuria, dual heart-kidney transplantation, and CKD care of heart transplant patients |
| Pulmonary hypertension | Familiarity with PHTN groups as related to the kidney, recognizing distinct effects of PHTN on kidney function, and impact of PHTN therapies on renal function and outcomes |
| Valvular heart disease | Renal function in various valvular disease (e.g., aortic stenosis and tricuspid insufficiency) and impact of TAVR and SAVR on the kidney |
| Arrhythmias | Impact on the kidney, renal function and the choice of antiarrhythmic agents, anticoagulation in patients with renal dysfunction, and ICD and PM placement in ESRD population |
| End-of-life decisions and discussions | Patients with cardiorenal syndrome of various etiologies, severity, and outcomes (e.g., LVAD as destination therapy in irreversible severe kidney dysfunction or ESRD) |
VC, inferior vena cava; SCUF, slow continuous ultrafiltration; PD, peritoneal dialysis; DOSE, diuretic optimization strategies evaluation; CARRESS-HF, Cardiorenal Rescue Study in Acute Decompensated Heart Failure; WRF, worsening renal function; IRF, improvement in renal function; LVAD, left-ventricular assist device; ADHF, acute decompensated heart failure; RRT, renal replacement therapy; AKI, acute kidney injury; PHTN, pulmonary hypertension; HF, heart failure; mTOR, mechanistic target of rapamycin; CKD, chronic kidney disease; TAVR, transcatheter aortic valve replacement; SAVR, surgical aortic valve replacement; ESRD, end-stage renal disease; ICD, implantable cardioverter defibrillator; PM, pacemaker; CRRT, continuous renal replacement therapy; UFR, ultrafiltration rate; BFR, blood flow rate; DFR, dialysate flow rate.