Cardiac Output and Renal Function: An Association
Ibad Ghori1, Irbaz Ahmed1, Fareeha Bukhari1 and Hassaan Tohid2*
1California Institute of Behavioral Neurosciences and Psychology (The Neuro-Cal Institute), Davis, USA
2Center for Mind and Brain, University of California, Davis (UC Davis), USA
- *Corresponding Author:
- Tohid H
California Institute of Behavioral Neurosciences
and Psychology (The Neuro-Cal Institute)
4751 Mengels Blvd, Fairfield
California, 94534, USA
E-mail: [email protected]
Received date: August 29, 2016; Accepted date: September 27, 2016;; Published date: September 29, 2016
Citation: Ghori I, Ahmed I, Bukhari F, Tohid H (2016) Cardiac Output and Renal Function: An Association. J Cell Sci Ther 7:252. doi: 10.4172/2157-7013.1000252
Copyright: © 2016 Ghori I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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In this article, we discussed a clinical problem known as cardio renal syndrome (CRS). In CRS, both, the affected cardiovascular system, either low output or high output failure leads to the renal dysfunction or vice versa. As already known, the heart failure is the leading cause of readmission in the US and worldwide. The patients suffering with cardiac failure need extra care, as they may develop various complications. Cardiac output is affected in heart failure and does have an impact on the renal function. High cardiac output and low cardiac output, both can lead to renal dysfunction. In conclusion, we will also highlight some information about the prevention of the renal damage associated with the CVS. However, future research is recommended to understand more about the exact pathophysiology involved in this association.
Cardiac output renal; Cardiac output kidney; Heart
output kidney; Heart output renal; Cardiac renal; Heart renal
“I had been living with dialysis for three years or so, and the new
kidney felt like a reprieve, a new gift of life. I felt alive again and I guess
that has had an effect on my use of colour”. Peter wright .
The following anecdote is described by one of the authors (IG), and
is written word for word. He describes,
“Once I was working in a hospital and saw a patient with heart
failure. After his condition worsened, he also developed renal failure. I
told him about his condition and he replied to me in a depressive tone,
“Doctor! The heart failure was enough for me, why I also developed renal
failure? “. I was shocked at that time and it triggered a thought that why
does that happen, and how it can be prevented.” Obviously, this is a
striking mystery, enough to astound anyone dealing with these kinds
of patients. Imagine a new clinician handling these kinds of patients
alone… the condition can not only be fearful for the clinician but can be
lethal for the patient. This review is our attempt to bring our attention
toward this phenomenon called cardio renal syndrome (CRS).
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” [2,3].
As we already know that kidney failure causes heart dysfunction
, but we want to know that how the heart dysfunction and cardiac
output effects the kidney? What are the markers, which could be raised
before serum creatinine rise in blood so that we can diagnose and
prevent disease . Because it is a mini-review, the size of this paper
does not allow us to focus on all the answers that are not fully known.
However, this review surely can be helpful for a new clinician and a
researcher, who is not fully aware of this medical condition. Therefore,
any new clinician who deals with a situation similar to the one faced by
one of the co-authors (IG), should not be surprised and in fact should
be able to deal with the patients suffering from cardio renal syndrome
and treat the patients successfully.
Some Studies Relevant to the Theme of Cardiac Output
and its Effect on Kidneys
To conduct this mini review, we searched databases like PubMed,
google scholar, Embase and Cochrane library. A total of 500 articles were initially reviewed. Then out of those a total of 26 articles were
finally selected, later only 15 met our inclusion/exclusion criteria. All
the articles were included according to their relevance with “effect of
cardiac output on renal function”. Keywords included but not limited
to cardiac output renal, cardiac output kidney, heart output kidney,
heart output renal, cardiac renal, heart renal. The inclusion criteria
included all the articles relevant to the theme of cardiac output and
renal failure. Moreover, all the articles published after the year 2009
were selected. All the animal studies, case reports and case studies were
excluded to keep the data minimum to fit for a mini-review. All the
papers before the year 2009 were excluded.
Congestive heart failure is the leading cause of 30-day hospital
readmission in the US. The problem almost costs 17 billion US dollars
to medicare alone every year. Not only it is the leading cause of rehospitalization,
it is in fact one of the most common causes of mortality
seen in the hospitals in the USA and worldwide. The death associated
with heart failure could be due to many reasons. In this article, we
will highlight how the heart output can be deleterious to the patient’s
As already mentioned, the heart failure patients are increasingly
hospitalized and the mortality in these patients is increased,
exceptionally in the patients with kidney dysfunction. Studies
conducted in the recent past, suggest that kidney function and renal
congestion, are one of most important factors to determine the
prognosis. Kidney congestion in heart failure results from low cardiac
output (forward failure), tubuloglomerular feedback, increased intraabdominal
pressure or increased venous pressure [6-8]. Thus, multiple
factors might be involved in worsening of renal function, including low
In sepsis, in which the patient has low cardiac output and worsening
of the renal function. When the patient is given fluids, the renal
function improves . Goren et al. reported that acute kidney injury is
also present in surgical patients specifically in the emergency and major
surgeries i.e. cardiac and transplantation surgeries. In these cases an
anesthetist is required to identify the patients at risk of AKI to correct
anemia or hypovolemia. Hypotension should be avoided, because even
short interval of mean arterial pressure reduction of less than 55 mm
Hg to 60 mm Hg carries a risk of AKI postoperatively. These kinds of
studies also point toward an idea that the kidney function is dependent
on the cardiac output .
Evidence supports that HTN is associated with acute worsening
of renal function, with preserved and reduced ejection fraction. Some
conditions leading to hypertension include a reduction in functional
kidney mass, excess aldosterone or angiotensin production, and
increased resistance to blood flow in the renal arteries. All of these
conditions raise the total blood volume that ultimately increases the
cardiac output. Therefore, it’s not only the reduced cardiac output
which leads to renal dysfunction. Increased cardiac output can also be
associated with the kidney dysfunction .
From the discussion above, the association of kidney with heart
is very clear. Many other studies have also mentioned about this
association [12-14]. The risk is not just confined with heart failure
alone. Ischemic heart disease can also affect the kidneys . A lot of
published literature is available on the subject, and it will continue to
grow and expand our knowledge in the future. Yet there will always be
some gaps in our knowledge. We concluded that increase or decrease
in cardiac output deteriorates renal function. In this study we found
out that the mortality is increased in the patients with heart failure
if there is low cardiac output. Similarly, it is observed in the case of
sepsis, that the low cardiac output can lead to kidney damage. In cases
of major surgeries and transplantation, the renal function is disturbed,
when there is low cardiac output and causes increased mortality. We
also found out that it’s not only low cardiac output that affects renal
function, but the high cardiac output also affects renal function in the
The association of heart with kidney has long been discussed. It is
a well-known fact that, the Low renal function can have an effect on
the cardiovascular system. However, is this association in reverse? For
example, does the heart problem affect the renal function or not? We
highlighted this aspect of this pathophysiological association.
This study point toward the notion that, if we want to prevent
the kidney damage, then we have to stabilize the cardiac output. If
we optimize the cardiac output, the mortality can be decreased. We
suggest more research needs to be conducted about this topic as many
factors relevant to cardio renal syndrome and the effect of low cardiac
output on the kidney still remain unknown (Table 1).
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