Future therapeutic prospects for treatment of cardiorenal syndromes

Abstract

Cardiorenal syndromes (CRS) have been characterized as disorders or clinical scenarios where there is injury or dysfunction in both the heart and the kidneys. When the temporal sequence of injury or dysfunction can be elicited, then a subtype classification can be assigned in both the acute (inpatient) and chronic (outpatient) settings. This paper will focus on acute CRS type 1, where there is acutely decompensated heart failure (ADHF) and then shortly after hospitalization, there is an abrupt loss of renal filtration function, reduced responsiveness to loop diuretics, and then a progressive rise in serum creatinine and blood urea nitrogen associated with worsened congestion, prolonged length of hospital stay, and increased mortality. Moreover, once the syndrome has abated and the patient has been discharged, there is a markedly increased risk of rehospitalization and death over the next several months. Because the pathophysiology of CRS 1 is poorly understood, and occurs in only 25% of those with ADHF, this review will focus on the most promising agents being developed for ADHF (ularitide and serelaxin) which are being designed to reduce symptoms, rehospitalization and death, and as a concurrent benefit, may hold the promise as preventive or therapeutic drugs for CRS.