Cardiorenal Syndrome

What is cardiorenal syndrome?

Cardiorenal syndrome is a disorder of your heart and kidneys where an issue with how well one organ works affects how well the other functions. These issues can be acute (happening now) or chronic (long-term).

Your kidneys and heart both handle your blood. Your heart keeps blood moving through your body and your kidneys clean waste from your blood. But your kidneys also control how much salt and water leave your body through urine (pee). This affects your blood pressure and how much fluid your body holds on to.

What happens in cardiorenal syndrome?

Cardiorenal syndrome involves a complex process with many different factors affecting your kidneys and heart. Some factors involved may include:

• Lower cardiac output or heart failure.
• Higher blood pressure in your vena cava (large veins that bring blood to your heart).
• Reduced blood flow to your kidneys, causing injury to them.

How common is cardiorenal syndrome?

It’s very common for people to have issues with their heart and kidneys at the same time. About 64 million people in the world have heart failure. Healthcare providers have seen kidney disease in 45% to 63% of people with chronic heart failure. Sometimes, it’s difficult for providers to know which organ had issues first.

What are the symptoms of cardiorenal syndrome?

Cardiorenal syndrome symptoms include:

• Fatigue.
• Shortness of breath.
• Low urine (pee) output.
• Depression.
• Swelling of your legs and abdomen.
• Confusion.
• Sensation of your heart skipping a beat.

What is the cause of cardiorenal syndrome?

Cardiorenal syndrome causes may include:

• Cardiogenic shock.
• Heart failure.
• Acute coronary syndrome.
• Heart surgery complications.
• Heart valve disease.
• Vasculitis.
• Atherosclerosis.
• Pulmonary embolism (PE).
• Kidney disease or injury.
• Sepsis.
• Lupus.
• Sarcoidosis.
• Diabetes.
• Electrolyte disorders.

What are the risk factors for cardiorenal syndrome?

Cardiorenal syndrome risk factors include:

• Diabetes.
• High blood pressure.
• A body mass index (BMI) greater than 30.
• Vascular (blood vessel) disorders.
• Kidney disease.
• Heart failure.

What are the complications of cardiorenal syndrome?

Cardiorenal syndrome can lead to:

• Cardiogenic shock.
• Worsening kidney disease.
• Atherosclerosis.
• Inflammation.

How is cardiorenal syndrome diagnosed?

Cardiorenal syndrome doesn’t have one “gold standard” test a healthcare provider can use to diagnose it. A provider may get information by examining the amount of fluid in your body by assessing your heart, lungs, abdomen, legs and blood vessels. Also, they may order imaging studies or blood tests.

What tests will be done to diagnose cardiorenal syndrome?

Healthcare providers can diagnose cardiorenal syndrome with:

• Blood tests.
• Urinalysis.
• Echocardiogram (Echo).
• Ultrasound of your kidneys and/or chest.
• Right heart catheterization.
• Chest X-ray.

Types of cardiorenal syndrome

When healthcare providers talk about cardiorenal syndrome, they assign it a type based on which organ started it and how long ago it began.

Cardiorenal syndrome types are:

• Type 1: Your heart suddenly isn’t working well, which leads to injury to your kidneys. This makes your kidneys unable to work well. This is an acute problem for all organs involved.
• Type 2: Chronic issues with how well your heart works harm your kidneys over time.
• Type 3: Acute kidney injury causes acute heart failure.
• Type 4: Chronic kidney disease causes chronic issues with your heart, like abnormal heart rhythms, heart failure or coronary artery disease (CAD).
• Type 5: A disorder that affects your whole body makes your heart and kidneys unable to work well.

How is cardiorenal syndrome treated?

The goal of cardiorenal syndrome treatment is to have a normal amount of blood and fluids in your body.

When you have heart failure, your heart can’t pump as well as it should. This allows fluid to collect in parts of your body. Your kidneys play a role in moving fluid out of your body to maintain the right fluid level. It can be challenging to achieve this when you have issues with your heart and kidneys at the same time.

Cardiorenal syndrome treatments

Cardiorenal syndrome treatments range from medicines to devices to transplants, including:

• Diuretics.
• Beta-blockers.
• ACE inhibitors.
• ARBs.
• ARNI (angiotensin receptor/neprilysin inhibitors).
• Renin angiotensin system blockers.
• Mineralocorticoid receptor antagonists.
• Inotropes.
• Ultrafiltration or dialysis.
• Implantable cardioverter defibrillator (ICD).
• Left ventricular assist device (LVAD).
• Cardiac resynchronization therapy (CRT).
• Heart transplant.
• Kidney transplant.

Complications/side effects of the treatment

Treatments for cardiorenal syndrome can cause:

• Headache.
• Dizziness.
• Fatigue.
• Frequent urination.
• Slow heart rate.
• High potassium.
• Kidney injury.
• Device malfunction.
• Infection or bleeding after receiving a device or organ.
• Kidney disease.
• Organ rejection.

How can I lower my risk of cardiorenal syndrome?

You may be able to lower your risk of cardiorenal syndrome by treating conditions like:

• Diabetes.
• Coronary artery disease.
• High blood pressure.
• Having a body mass index (BMI) greater than 30.

Taking the right medications for these conditions at the right dose is important, as they can otherwise make your kidney function worse.

What can I expect if I have cardiorenal syndrome?

Getting an early diagnosis for cardiorenal syndrome is important. Having the right treatment when you need it can improve your quality of life.

The prognosis (outlook) for cardiorenal syndrome is poor. Palliative care can help you if you have advanced cardiorenal syndrome. It can help you avoid trips to the hospital.

How do I take care of myself with cardiorenal syndrome?

To care for yourself with cardiorenal syndrome:

• Follow your healthcare provider’s treatment plan.
• Tell your provider about any symptoms you have that are new or get worse.
• Go to your scheduled appointments with your provider.

When should I go to the ER?

Get immediate help if you’re not producing urine (pee) or you can’t catch your breath.

What questions should I ask my healthcare provider?

Questions to ask your provider include:

• What’s the best treatment for me?
• Can you treat me with medications?
• Is there a support group for people with cardiorenal syndrome?
• How advanced is my condition?

A note from Cleveland Clinic

Having cardiorenal syndrome is difficult because it means that three important organs — your heart and two kidneys — aren’t working right. Do your best to follow your provider’s instructions for the best results. Informing your loved ones about your wishes can give you peace of mind. If your condition worsens quickly and you have a living will, it can guide your family in deciding what care you want.