Pathogenesis of Cardiorenal Syndrome Type 1 in Acute Decompensated Heart Failure: Workgroup Statements from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

摘要

Pathophysiological mechanisms of cardiorenal syndromes (CRS) types 1 -5 are still sparsely characterized. In an attempt to address this issue, a consensus conference on CRS was held in Venice,italy, in November 2012 under the auspices of the Acute Dialysis Quality Initiative (ADQI). Working group 1 discussed monodirectional mechanisms of CRS type 1 which is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Pre-conference we performed a systematic search and review of the available literature using a modified Delphi analysis. Hereby identified and in this review discussed questions were: (i) What are the predominant pathophysiologic mechanisms of CRS type 1 in acute decompensated heartfailure? (ii) Could biomarker profiling identify pathomech-anisms or hemodynamic phenotype of patients with CRS type 1? Could predictive bio-markers improve renal safety of therapy in CRS type 1? (iii) How do the timing, severity and duration relate to the mechanisms and outcomes of CRS type 1 ? In summary, after discussion and appraisal of the best available evidence, working group 1 makes consensus recommendations for future research on pathologic mechanisms of CRS type 1 and recommendations for clinical practice where treatment is in either proof or disproof of a mechanism.