Pharmacologic therapies for chronic and acute decompensated heart failure: specific insights on cardiorenal syndromes.

In the setting of cardiorenal syndrome(s) (CRS), the main pathophysiological triggers of renal disease progression include increases in renal venous pressure, maladaptive activation of the renin-angiotensin-aldosterone (RAAS) and the sympathetic nervous systems, and a chronic inflammatory state. In acute decompensated heart failure (HF)/type 1 CRS, diuretics remain the mainstay of first-line therapy in order to prevent congestion and renal venous hypertension. In chronic HF/type 2 CRS, RAAS multiple inhibition has been recommended in addition to diuretics. However, cotreatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and mineralocorticoid receptor antagonists is likely to lead to more frequent occurrences of hyperkalemia and worsening renal function. In this review, the main pharmacological therapies of acute and chronic CRS are discussed regarding their indication as well as intended and side effects. Future therapies are suggested, underlining that a multidisciplinary approach to a deeper understanding of the pathophysiology of CRS is still required to improve specific treatment and clinical outcome.