Cardio-renal failure: an emerging clinical entity.

The progressive ageing of the population, the extensive application of cardiac interventional procedures and the improved prognosis of diseases with a so far dismal outcome have generated several predictable corollaries. Of remarkable importance is the rising number of ‘survivors’ who have combined heart and kidney failure [1,2]. More specifically, we do not refer to the severe cardiovascular disease accompanying chronic renal failure, nor to the so-called ‘kidney in heart failure’, a concept which assumes normally functioning kidneys facing a failing heart. Instead, we draw attention to the fragile equilibrium between simultaneously and often seriously compromised renal and cardiac function. Let us define this condition as cardio-renal failure. By definition, cardio-renal failure is more than renal failure and more than heart failure (HF) alone; therefore, its management may require strategies different from those for the two entities considered separately. The view presented herein is based on traditional concepts, personal observations and an oriented reading of the literature.