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World J Methodol. Jul 20, 2021; 11(4): 187-198
Published online Jul 20, 2021. doi: 10.5662/wjm.v11.i4.187
Evidence based review of management of cardiorenal syndrome type 1
Leong Tung Ong
Leong Tung Ong, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia
Author contributions: Ong LT designed and performed the literature search, analyzed the data, wrote the paper, and approved the final manuscript.
Conflict-of-interest statement: The author declares no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Leong Tung Ong, Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, Kuala Lumpur 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia. leotungong@gmail.com
Received: December 25, 2020
Peer-review started: December 25, 2020
First decision: May 6, 2021
Revised: May 9, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: July 20, 2021
Abstract

Cardiorenal syndrome (CRS) type 1 is the development of acute kidney injury in patients with acute decompensated heart failure. CRS often results in prolonged hospitalization, a higher rate of rehospitalization, high morbidity, and high mortality. The pathophysiology of CRS is complex and involves hemodynamic changes, neurohormonal activation, hypothalamic-pituitary stress reaction, inflammation, and infection. However, there is limited evidence or guideline in managing CRS type 1, and the established therapeutic strategies mainly target the symptomatic relief of heart failure. This review will discuss the strategies in the management of CRS type 1. Six clinical studies have been included in this review that include different treatment strategies such as nesiritide, dopamine, levosimendan, tolvaptan, dobutamine, and ultrafiltration. Treatment strategies for CRS type 1 are derived based on the current literature. Early recognition and treatment of CRS can improve the outcomes of the patients significantly.

Keywords: Cardiorenal syndrome, Heart failure, Acute kidney injury, Renal insufficiency, Management

Core Tip: Cardiorenal syndrome (CRS) type 1 is defined as the development of acute kidney injury or worsening renal function in patients with acute decompensated heart failure. Impaired renal function in acute decompensated heart failure is often associated with prolonged hospitalization, a higher rate of rehospitalization, high morbidity, and high mortality. The aim of this paper is to discuss the different treatment strategies and provide a guideline for the management of CRS type 1. Early recognition and treatment of CRS can improve the outcomes of the patients significantly.