Drugs involved in the treatment of Cardio renal syndrome (CRS) and types


Journal of Kidney Treatment and Diagnosis consists of the latest findings related to pathogenesis and treatment of kidney disease, hypertension, acid-base and electrolyte disorders, dialysis therapies, and kidney transplantation.

Cardio renal syndrome (CRS) is an umbrella term used in the medical field that defines disorders of the heart and kidneys whereby “acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other”. The heart and the kidneys are involved in maintaining hemodynamic stability and organ perfusion through an intricate network. This definition has since been challenged repeatedly but there still remains little consensus over a universally accepted definition for CRS. At a consensus conference of the Acute Dialysis Quality Initiative (ADQI), the CRS was classified into five subtypes primarily based upon the organ that initiated the insult as well as the acuity of disease


Ronco et al. first proposed a five-part classification system for CRS in 2008 which was also accepted at ADQI consensus conference in 2010. These include:


Inciting event

Secondary disturbance


Type 1 (acute CRS)

Abrupt worsening of heart function

kidney injury

acute cardiogenic shock or acute decompensation of chronic heart failure

Type 2 (chronic CRS)

Chronic abnormalities in heart function

progressive chronic kidney disease

chronic heart failure

Type 3 (acute renocardiac syndrome)

Abrupt worsening of kidney function

acute cardiac disorder (e.g. heart failure, abnormal heart rhythm, or pulmonary edema)

acute kidney failure or glomerulonephritis

Type 4 (chronic renocardiac syndrome)

Chronic kidney disease

decreased cardiac function, cardiac hypertrophy and/or increased risk of adverse cardiovascular events

chronic glomerular disease

Type 5 (secondary CRS)

Systemic condition

both heart and kidney dysfunction

diabetes mellitus, sepsis, lupus


Medical management of patients with CRS is often challenging as focus on treatment of one organ may have worsening outcome on the other. It is known that many of the medications used to treat HF may worsen kidney function. In addition, many trials on HF excluded patients with advanced kidney dysfunction. Therefore, our understanding of CRS management is still limited to this date.


Used in the treatment of heart failure and CRS patients, however must be carefully dosed to prevent kidney injury. Diuretic resistance is frequently a challenge for physicians to overcome which they may tackle by changing the dosage, frequency, or adding a second drug.

ACEI, ARB, renin inhibitors, aldosterone inhibitors

The use of  ACE inhibitors  have long term protective effect on kidney and heart tissue. However, they should be used with caution in patients with CRS and kidney failure. Although patients with kidney failure may experience slight deterioration of kidney function in the short term, the use of ACE inhibitors is shown to have prognostic benefit over the long term. Two studies have suggested that the use of ACEI alongside statins might be an effective regimen to prevent a substantial number of CRS cases in high risk patients and improve survival and quality of life in these people. There are data suggesting combined use of statin and an ACEI improves clinical outcome more than a statin alone and considerably more than ACE inhibitor alone.

    Journal of Kidney Treatment and Diagnosis publishes the manuscripts that are directly or indirectly based on variegated aspects of Articles that are submitted to our journal will undergo a double-blind peer-review process to maintain quality and the standards set for academic journals.  The review process will do by our external reviewers which are double-blind. The comments will upload directly to the editorial tracking system. Later the editor will check the comments whether it is acceptable or not.   The overall process will take around 21 days under with the editor. After acceptance by the editor, it will be published on the Press page.  Authors can submit their manuscripts to the online submission portal.

With Regards,
John Matthews                              
Managing Editor
Journal of Kidney Treatment and Diagnosis

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