A consensus conference on cardio-renal syndromes (CRS) was held in Venice Italy, in September 2008 under the auspices of the Acute Dialysis Quality Initiative (ADQI). The following topics were matter of discussion after a systematic literature review and the appraisal of the best available evidence: definition/classification system; epidemiology; diagnostic criteria and biomarkers; prevention/protection strategies; management and therapy. The umbrella term CRS was used to identify a disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. Different syndromes were identified and classified into five subtypes. Acute CRS (type 1): acute worsening of heart function (AHF–ACS) leading to kidney injury and/or dysfunction. Chronic cardio-renal syndrome (type 2): chronic abnormalities in heart function (CHF-CHD) leading to kidney injury and/or dysfunction. Acute reno-cardiac syndrome (type 3): acute worsening of kidney function (AKI) leading to heart injury and/or dysfunction. Chronic reno-cardiac syndrome (type 4): chronic kidney disease leading to heart injury, disease, and/or dysfunction. Secondary CRS (type 5): systemic conditions leading to simultaneous injury and/or dysfunction of heart and kidney. Consensus statements concerning epidemiology, diagnosis, prevention, and management strategies are discussed in the paper for each of the syndromes.

Observational and clinical trial data have accrued to show that acute/chronic heart disease can directly contribute to and/or accelerate acute/chronic worsening kidney function and vice versa. A description of the epidemiology of heart–kidney interaction, as defined by the proposed consensus cardio-renal syndrome (CRS) definitions, is a critical initial step towards understanding not only the overall burden of disease for each of the proposed CRS subtypes, but also their natural history, associated morbidity and mortality and potential health resource implications [1]. Importantly, these CRS subtypes may have important discriminating features in terms of predisposing or precipitating events, risk identification, natural history and outcomes. Likewise, a surveillance of the epidemiology is vital for determining whether there exist important gaps in knowledge and for the design of future epidemiologic investigations and clinical trials. Accordingly, this article will summarize the epidemiology of CRS.

The high incidence and poor prognosis of heart failure (HF) patients affected with diabetes (DM) is in part related to a specific cardiac remodeling currently recognized as diabetic cardiomyopathy (DCM). This cardiac frame occurs regardless of the presence of coronary artery diseases (CAD) and it can account for 15–20% of the total diabetic population. The pathogenesis of DCM remains controversial, and several molecular and cellular alterations including myocardial hypertrophy, interstitial fibrosis, oxidative stress and vascular inflammation, have been postulated. The main cardio-vascular alterations associated with hyperglycemia comprise endothelial dysfunction, adverse effects of circulating free fatty acids (FFA) and increased systemic inflammation. High glucose concentrations lead to a loss of mitochondrial networks, increased reactive oxygen species (ROS), endothelial nitric oxide synthase (eNOS) activation and a reduction in cGMP production related to protein kinase G (PKG) activity. Current mechanisms enhance the collagen deposition with subsequent increased myocardial stiffness. Several concerns regarding the exact role of DCM in HF development such as having an appearance as either dilated or as a concentric phenotype and whether diabetes could be considered a causal factor or a comorbidity in HF, remain to be clarified. In this review, we sought to explain the different DCM subtypes and the underlying pathophysiological mechanisms. Therefore, the traditional and new molecular and signal alterations and their relationship with macroscopic structural abnormalities are described.

Peer reviewed article authored by (A Palazzuoli, M Gallotta, I Quatrini, et al). Read article or submit your manuscript for publishing.

Both cardiac and renal diseases are extremely common in the population and frequently coexist. Cardiac disease is often associated with worsening renal function and vice versa. The coexistence of cardiac and renal disease significantly increases mortality, morbidity and complexity and cost of care [1,2]. Syndromes describing the interaction between the heart and the kidney are recognized, but have never been clearly defined and classified. Several different definitions have been proposed [1,3–8] but none have been published as a result of a consensus process. As a result of the lack of consensus definition and classification, there is limited appreciation of its epidemiology, no standardized diagnostic criteria and no uniform approaches to prevention and treatment. Furthermore, treatment is often fragmented, single organ centred, with perceived competing priorities and specialty care is not necessarily integrated amongst relevant specialties. As a result, timing and appropriateness of care may suffer. In response to these issues, a consensus conference was organized under the auspices of the Acute Dialysis Quality Initiative (ADQI) by bringing together key opinion leaders and experts in the fields of nephrology, critical care, cardiac surgery, cardiology and epidemiology. A meeting was held in Venice, Italy from September 3 to 6, 2008. In this manuscript, we present the consensus document and the methodology by which a consensus definition and classification system for Cardio-Renal Syndromes was reached [9].