Selective Cytopheretic Device for Cardio-Renal Syndrome

Cardio-renal syndrome is the term given to the combination of cardiovascular and renal pathology, which is the interaction of cardiac and renal dysfunction occurring simultaneously and in a similar fashion. The name of the syndrome was first suggested by Sir Arthur R. Evans in 1964.\n\nThe syndrome's causes were unknown until the end of the 19th Century and has since been thought to have multiple etiologies.\n\nThis disease is not yet completely known which explains the wide range of treatments used.\n\nThere are several important treatments in regards to cardiac and renal surgery that can be used with cardiac transplants.

Some signs and symptoms of the syndrome include excessive thirst, and excessive urination. There is little consensus among healthcare providers regarding optimal intervention. Some clinicians treat patients with ACE inhibitors with the goal of reducing symptoms. However, there is evidence both for and against use of ACE inhibitors for congestive heart failure.

The data presented in this review demonstrate that patients with cardio-renal syndrome frequently do not receive appropriate pharmacological and medical treatment for their medical conditions.

Despite the limited experience, these preliminary results suggest that patients who present with mild forms of CRS are at risk of poor outcome. More patients with CRS in this series underwent curative therapy than previously reported. These data have shown that patients with mild forms of CRS have a high risk of poor survival.

About 12% of people with suspected cardiomyopathy in this study are found to have cardiac dysfunction and a diagnosis of CKD based on SCr level. Further study is needed to elucidate the link between cardiac disease and CKD and its risk of cardiovascular mortality.

It is clear that a combination of cardiovascular disease and nephrotic syndrome result in cardiac arrest and renal failure. The pathophysiology of this combined syndrome remains unclear. However, one theory suggests that the pathogenesis of renal failure due to nephrotic syndrome and cardiovascular disease may be similar. If true, renal failure is likely to appear during cardiovascular disease. However, if this is the case, the pathogenesis of acute kidney injury resulting from cardiovascular disease may be identical when nephrotic syndrome is present. However, further data and experiments will be needed to determine whether nephrotic syndrome and cardiovascular disease are similar entities or two distinct entities.

Until a randomized controlled trial is done to assess if selective cytopheretic devices will improve long-term survival in this population and to evaluate short-term and long-term outcomes compared to standard hemodialysis therapy we cannot recommend selective cytopheretic devices.

This case would lend credence to a hypothesis that chronic venous congestion may be an important cause of cardio-renal syndrome. This is one reason why patients with significant chronic venous hypertension should be encouraged to initiate an anti-coagulant regimen in an attempt to reduce venous hyper-vigilance and thereby ameliorate or eliminate the syndrome.

A cytopheretic device is able to decrease the volume of fluid output and is well tolerated in this population. However, it was not an independent predictor of HRQoL-assessed quality-of-life. When comparing HRQoL and volume of fluid output in this population, other treatment modalities may be required for the management of heart failure and renal failure.

[The majority of current information about CRS is based on very brief presentations on clinical guidelines. As a consequence there is an urgent need for guidelines to be derived from large, high quality clinical trials that include more than a hundred patients, and ideally long-term follow-up data in order to estimate how long patients need to continue taking their drugs. This is urgently missing in patients with CRS who have undergone several investigations but not had long-term outcome data collected to help manage drug use, prognosis, and lifestyle factors.

S.C.D.s may have advantages when used for selective filtration of large blood volumes. However, larger studies are required to further evaluate the role of S.C.D. in routine clinical practice.