CHAPTER 105: THE KIDNEY IN HEART DISEASE

Summary

This chapter discusses the relationship between kidney injury and heart disease. Cardiac and renal physiology are closely related, and impaired cardiac function can lead to kidney injury and vice versa (see accompanying Hurst’s Central Illustration). Impaired renal function has traditionally been classified into acute kidney injury (AKI) and chronic kidney disease (CKD); the latter syndrome is defined as persistent (>3 months) functional or structural kidney abnormalities. AKI can occur when renal hemodynamics become deranged secondary to acutely impaired cardiac function. Management of cardiovascular disease (CVD) can also cause AKI. For example, contrast-induced AKI can occur in patients undergoing percutaneous interventions, which require imaging, often repeatedly, of the vasculature, and AKI is common after transcatheter aortic valve replacement and after cardiac surgery. Additionally, chronic heart failure can lead to CKD; the pathophysiological mechanisms are incompletely understood. In turn, CKD considerably increases the risk of developing CVD. Autonomic dysfunction, vascular pathology, and cardiac pathology contribute to CVD progression in patients with CKD. Moreover, CKD patients on dialysis have increased risk of pericarditis, infective endocarditis, and cardiac arrhythmias. Management of CVD in patients with CKD requires judicious extrapolation of treatment derived from observational studies and with consideration of CKD pathophysiology. Notably, many cardiovascular drugs are eliminated from the body by the kidneys and dose adjustments of some of these drugs are therefore necessary in patients with CKD.