Table 2.

Conclusions

1. In CVD:

Baseline CKD is up to 5 times more frequent than in the general population;

When CKD is present at baseline, the GFR decline is faster than in the general population, leading even to ESRD;

de novo CKD is frequently found;

CKD (GFR < 60 and/or albuminuria/proteinuria) is one of the most important factors independently predicting new CV events, rehospitalization, and mortality;

WRF/AKI occur in 50% of patients with AHF, slightly less frequently in CHF and ACS, and have a poor prognosis only if persistent and/or connected with residual congestion; transient WRF after decongestion may not result in a worse prognosis;

2. CVD may be considered one of the most important contributory causes of renal disease owing to the enormous diffusion of clinical and subclinical CVD and the high prevalence and incidence of renal abnormalities

3. Among the mechanisms of renal dysfunction in CVD, venous congestion is the most important; arterial renal hypoperfusion plays an important role particularly in acute severe reduction of cardiac output and/or of SBP

4. Therapeutic approaches for the treatment of HF with renal dysfunctions:

Treat fluid overload and congestion, and pay little attention to mild transient increases in serum creatinine after hemoconcentration;

Counteract hemodynamic and neurohormonal imbalance by RAAS inhibitors and/or β-blockers;

Infuse low dose dopamine in selected refractory AHF patients;

Counteract less traditional CV risk factors;

Avoid the underuse of CV drugs and interventions in CKD;

Early detect CRS for its effective management by a team involving cardiologists and nephrologists

CVD cardiovascular disease, CKD chronic kidney disease, GFR glomerular filtration rate, ESRD end stage renal disease, WRF worsening renal function, AKI acute kidney injury, AHF acute heart failure, CHF chronic heart failure, ACS acute coronary syndrome, SBP systolic blood pressure, HF heart failure, RAAS renin angiotensin aldosterone system, CV cardiovascular, CRS cardiorenal syndrome