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International Journal of Nephrology
Volume 2011, Article ID 634903, 7 pages
http://dx.doi.org/10.4061/2011/634903
Review Article

Cardiorenal Syndrome Caused by Heart Failure with Preserved Ejection Fraction

1Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
2Department of Internal Medicine, University of Florence, 50134 Florence, Italy

Received 25 August 2010; Accepted 3 January 2011

Academic Editor: Claudio Ronco

Copyright © 2011 Chiara Lazzeri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Since cardiorenal dysfunction is usually secondary to multiple factors acting in concert (and not only reduced cardiac output) in the present paper we are going to focus on the interrelationship between heart failure with normal ejection fraction and the development of cardiorenal syndrome. The coexistence of renal impairment in heart failure with preserved ejection fraction (CRS type 2 and 4) is common especially in older females with hypertension and/or diabetes. It can be hypothesized that the incidence of this disease association is growing, while clinical trials enrolling these patients are still lacking. The main mechanisms thought to be involved in the pathophysiology of this condition are represented by the increase of intra-abdominal and central venous pressure and the activation of the renin-angiotensin system. Differently from CRS in heart failure with reduced ejection fraction, the involvement of the kidney may be under-diagnosed in patients with heart failure and preserved ejection fraction and the optimal therapeutic strategy in this condition, though challenging, is far to be completely elucidated. Further studies are needed to assess the best therapeutic regimen in patients with renal dysfunction (and worsening) and heart failure and preserved ejection fraction.