Cardiorenal Syndrome Type 1 in Patients with Heart Failure with Preserved Ejection Fraction

Cardiorenal syndrome type 1 (CRS-1) is defined as acute kidney injury (AKI) caused by acute decompensated heart failure (ADHF). Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent subtype of heart failure. A significant number of patients with HFpEF during episodes of acute decompensation (ADHFpEF) develop CRS-1. The most important pathophysiological mechanisms leading to the development of CRS-1 in these patients are hemodynamic disturbances (elevated central venous pressure, elevated intra-abdominal pressure and pulmonary hypertension) and inflammation. Loop diuretics alone or in combination with thiazide diuretics and mineralocorticosteroid receptor antagonists are the mainstay therapeutic option for treating congestion in patients with ADHFpEF and CRS-1. Introducing SGLT-2 inhibitors as soon as clinically possible can further enhance diuresis and have a positive impact on reducing cardiorenal adverse events. Development of CRS-1 is a well known independent predictor of a worse outcome in patients with heart failure, although this impact appears to be less associated in patients with HFpEF, as compared to patients with HF with reduced EF. Further studies are needed to achieve a better understanding of pathophysiological mechanisms, and to introduce new treatment protocols, which would have a positive impact on cardiac and renal outcomes in these patients.