From Cardio Renal Syndrome to Chronic Cardiovascular and Kidney Disorder: A Conceptual Transition.
Fiche publication
Date publication
octobre 2023
Journal
Clinical journal of the American Society of Nephrology : CJASN
Auteurs
Membres identifiés du Cancéropôle Est :
Pr ROSSIGNOL Patrick
Tous les auteurs :
Zoccali C, Mallamaci F, Halimi M, Rossignol P, Serafidis P, De Caterina R, Giugliano R, Zannad F
Lien Pubmed
Résumé
The association between cardiac and kidney dysfunction has received exponentially increasing attention over the last two decades. A putatively unique syndrome, the "cardio-renal syndrome", distinguishing five subtypes based on the chronology of cardiac and kidney events, has been widely adopted. This review discusses the methodological and practical problems inherent to the current classification of cardio renal syndrome. The term disorder is more appropriate than the term "syndrome" to describe concomitant cardiovascular and kidney dysfunction and/or damage. Indeed, the term disorder designates a disruption induced by disease states to the normal function of organs or organ systems. We apply Occam's razor to the chronology-based construct to arrive at a simple definition based on the coexistence of cardiovascular disease and chronic kidney disease (CKD), the "chronic cardiovascular -kidney disorder" (CCKD). This conceptual framework builds upon the fact that cardiovascular and CKD share common risk factors and pathophysiological mechanisms. Biological changes set in motion by kidney dysfunction accelerate cardiovascular disease progression and vice-versa. Depending on various combinations of risk factors and precipitating conditions, patients with CCKD may present initially with cardiovascular disease or with hallmarks of CKD. Treatment targeting cardiovascular or kidney dysfunction may improve the outcomes of both. The portfolio of interventions targeting the -kidney cardiovascular continuum is in an expanding phase. In the medium term, applying the new omics sciences may unravel new therapeutic targets and further improve the therapy of CCKD. Trials based on cardiovascular and kidney composite endpoints are an attractive and growing area. Targeting pathways common to cardiovascular and kidney diseases will help prevent the adverse health effects of CCKD.
Référence
Clin J Am Soc Nephrol. 2023 10 30;: