Renal congestion in heart failure

Abstract

Chronic Kidney Disease (CKD) is a frequent comorbid condition and a major determinant of outcomes in patients with heart failure (HF). In acute and chronic HF, deterioration of kidney function usually occurs. The cause of this deterioration is much more complex than first thought and represents a combination of various pathophysiological pathways. Apart from low cardiac output (forward failure), tubuloglomerular feedback and increased intraabdominal pressure; increased venous congestion including renal vessels plays a major role. Regardless of the cause, the sustained deterioration of kidney function and increased systemic and renal congestion is related with increased morbidity and mortality in HF. Thus the therapeutic aim must be the relief of decongestion without compromising renal function. To target this issue we need novel diagnostic markers which shown the damage earlier and evidence based therapeutic options. To accomplish these issues active research is necessary. Based on these data in the present discussion, the mechanisms, outcomes, prognostic markers and the treatment options especially related with renal congestion in HF is summarised.