Biomarkers of cardiac and kidney dysfunction in cardiorenal syndromes.

The role of biomarkers is rapidly emerging as an important tool in the management of the cardiorenal syndromes (CRS). Natriuretic peptides (NPs), due to their low cost and rapid and accurate ability to provide additional information not surmised from clinical evaluation, are the standard bearer for the newer biomarkers. Although the NP-guided therapy has been shown to improve patient outcomes, this has yet to be demonstrated for the novel renal biomarkers. Most of the renal biomarkers studies in CRS have been performed in the setting of cardiac surgery. It will be critical to validate these new biomarkers in multicenter and prospective studies encompassing a broad spectrum of patients. Work with NPs has also shown that novel biomakers are not to be used as 'stand-alone' tests; rather they are best used as adjuncts to everything else the health care provider brings to the table. It is likely that panels of multiple biomarkers will be needed for optimal evaluation, risk stratification, timely treatment initiation and follow-up of patients with CRS.