ADQI 7: the clinical management of the Cardio-Renal syndromes: work group statements from the 7th ADQI consensus conference.

Many patients with heart failure have underlying renal dysfunction, and similarly, patients with kidney failure are prone to cardiac failure. This has led to the concept of cardio-renal syndromes, which can be an acute or chronic cardio-renal syndrome, when cardiac failure causes deterioration in renal function, or acute and/or chronic Reno-Cardiac syndrome, when renal dysfunction leads to cardiac failure. Patients who develop these syndromes have increased risk of hospital admission and mortality. Although there are clinical guidelines for managing both heart failure and chronic kidney disease, there are no agreed guidelines for managing patients with cardio-renal and/or Reno-Cardiac syndromes, as these patients have typically been excluded from clinical trials. We have therefore reviewed the currently available published literature to outline a consensus of current best clinical practice for these patients.

Extracorporeal ultrafiltration for acute exacerbations of chronic heart failure: report from the Acute Dialysis Quality Initiative.

This report from a work group affiliated with the Acute Dialysis Quality Initiative is a critical assessment of the use of extracorporeal ultrafiltration (UF) in the management of acutely decompensated heart failure (HF). In addition to assessing UF in this setting, the report also provides background information on HF, including classification, pathophysiology, and the importance of concomitant renal failure. A summary of important results from clinical trials in this area is provided, along with a discussion of technical considerations. Finally, specific recommendations for future clinical evaluations are given.

Benefits of combination angiotensin-converting enzyme inhibitor and calcium antagonist therapy for diabetic patients.

Effective control of blood pressure is important in slowing renal disease progression in diabetic nephropathy. However, blood pressure is often difficult to control with monotherapy, especially in this patient population in whom three medications are sometimes required to attain goal blood pressures of less than 130/85 mm. Further, physicians are often reluctant to increase the dose or add another agent to an existing regimen. The advent of low-dose, fixed-dose combination therapy allows physicians the ability to prescribe two drugs in one pill and, hence, to improve compliance. In fact, the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) recommends adding a second antihypertensive agent as an option if goal blood pressure is not achieved with a single agent. The combination of an angiotensin-converting enzyme (ACE) inhibitor and calcium antagonist may confer additive antihypertensive benefit, and may even improve the side-effect profile. This paper reviews the importance of aggressive blood pressure control in diabetic patients and the clinical trials supporting the use of combination ACE inhibitor/calcium antagonist therapy in the diabetic patient population.