Cardiorenal Syndrome in End-Stage Kidney Disease

Background: Cardiorenal syndrome (CRS) in patients with end-stage kidney disease (ESKD) represents mainly cardiovascular disease (CVD) due to various complications associated with renal dysfunction—defined as type 4 CRS by Ronco et al.—because the effect of cardiac dysfunction on the kidneys does not need to be taken into consideration, unlike in non-dialysis dependent chronic kidney disease (CKD). Summary: Patients with ESKD are often in a state of chronic inflammation due to the upregulation of proinflammatory cytokines. Chronic inflammation leads to malnutrition and consequently to vascular endothelial dysfunction and vascular calcification, which is referred to as malnutrition-inflammation-atherosclerosis (MIA) syndrome and acts as a major risk factor for CVD. Anemia also plays a crucial role in CVD, and individuals with erythropoietin-resistant anemia have a particularly high risk of CVD. However, caution is emphasized because not only anemia itself, but also the overtreatment of anemia with erythropoiesis-stimulating agents aimed at elevating hemoglobin to ≥ 13 g/dl can also increase the risk of CVD. In CKD-mineral and bone disorder (CKDPublished online: November 17, 2015 Kazuhiko Tsuruya, MD, PhD Department of Integrated Therapy for Chronic Kidney Disease Graduate School of Medical Sciences, Kyushu University 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 (Japan) E-Mail tsuruya @ intmed2.med.kyushu-u.ac.jp © 2015 S. Karger AG, Basel 0253–5068/15/0404–0337$39.50/0