The kidney in heart failure: friend or foe?

Heart failure constitutes a significant source of morbidity and mortality in the United States and its incidence and prevalence continue to grow, increasing its burden on the health care system. Renal dysfunction in patients with heart failure is common and has been associated with adverse clinical outcomes. This complex interaction is characterized by a pathophysiological disequilibrium between the heart and the kidney, in which cardiac malfunction promotes renal impairment, which in turn feeds back for further deterioration of cardiovascular function. Multiple neurohumoral and hemodynamic mechanisms are involved in this cardiorenal dyshomeostasis, including the deficiency of and/or resistance to compensatory natriuretic peptides, leading to sodium retention, volume overload and organ remodeling. Management of patients with cardiorenal dysfunction can be challenging and should be individualized. Emerging therapies must address the impairment of both organs to secure better clinical outcomes. To this end, a multidisciplinary approach is warranted to achieve optimal results.

El síndrome cardiorenal en insuficiencia cardíaca: un paradigma en evolución / The cardiorenal syndrome in heart failure: an envolving paradigm

Background: Heart failure constitutes a significant source of morbidity and mortality in the United States and its incidence and prevalence continue to grow, increasing its burden on the health care system. Renal dysfunction in patients with heart failure is common and has been associated with adverse clinical outcomes. This interaction, termed the cardiorenal syndrome, is a complex phenomenon characterized by a pathophysiological disequilibrium between the heart and the kidney, in which malfunction of one organ subsequently promotes the impairment of the other. Multiple neuro-humoral mechanisms are involved in this cardiorenal interaction, including the deficiency of and/or resistance to compensatory natriuretic peptides, leading to sodium retention, volume overload and organ remodeling. Management of patients with the cardiorenal syndrome can be challenging and should be individualized. Emerging therapies must address the function of both organs in order to secure better clinical outcomes. To this end, a multidisciplinary approach is recommended to achieve optimal results.

The cardiorenal syndrome in heart failure: an evolving paradigm.

Heart failure constitutes a significant source of morbidity and mortality in the United States, and its incidence and prevalence continue to grow, increasing its burden on the healthcare system. Renal dysfunction in patients with heart failure is common and has been associated with adverse clinical outcomes. This interaction, termed the cardiorenal syndrome, is a complex phenomenon characterized by a pathophysiologic disequilibrium between the heart and the kidney, in which malfunction of 1 organ consequently promotes the impairment of the other. Multiple neurohumoral mechanisms are involved in this cardiorenal interaction, including the deficiency of and/or resistance to compensatory natriuretic peptides, leading to sodium retention, volume overload and organ remodeling. Management of patients with the cardiorenal syndrome can be challenging and should be individualized. Emerging therapies must address the function of both organs to secure better clinical outcomes. To this end, a multidisciplinary approach is recommended to achieve optimal results.

Positive association between the course of vitamin D intake and bone mineral density at 36 years in men.

INTRODUCTION: Studies on the association of vitamin D and bone mineral density (BMD) in adolescence and young adults have shown contrasting results. None of these studies have examined the course and baseline in vitamin D intake. The purpose of this study was to examine the association between baseline and the course of dietary vitamin D intake on the BMD. METHODS: Vitamin D intake was assessed 3-8 times between the age of 13 and 36 years in 152 men and 168 women from the Amsterdam Growth and Health Longitudinal Study. The BMD of the femoral neck, lumbar spine, total hip and total body was measured at the age of 36 years with dual-energy X-ray absorptiometry. Linear regression analyses were used to determine the vitamin D intake pattern in time for each subject. The models provide a baseline, course and fluctuation of the vitamin D intake for each subject. These were used in separate regression analyses with the dependent variable BMD. RESULTS: Mean baseline vitamin D was 6.86 (SD: 2.18) microg/day for men and 4.90 (1.19) microg/day for women. Mean course of vitamin D was -0.10 (0.12) microg/day/year and -0.05 (0.18) microg/day/year for men and women respectively. After adjustment for potential confounders and correcting for the other parameters of vitamin D intake, the associations between baseline vitamin D intake and BMD were significant in the total hip (0.018 g/cm(2) per -1 microg/day; 95% CI 0.001-0.035) and total body (0.015 per -1 microg/day; 0.001-0.029). The course of vitamin D intake was associated with BMD in the lumbar spine (0.50 g/cm(2) per -1 microg/day/year; 0.130-0.867), femoral neck (0.42 g/cm(2) per -1 microg/day/year; 0.10-0.743), total body (0.34 g/cm(2) per -1 microg/day/year; 0.09-0.59) and total hip (0.44 g/cm(2) per -1 microg/day/year; 0.11-0.77) in men. No significant associations were found in women. CONCLUSION: In men, the level of vitamin D intake in adolescence and the course of vitamin D intake from adolescence into adulthood are positively related with BMD in adulthood. In women, however, no significant associations are found.