Importance of the Cardiorenal Unit for the Management and Monitoring of Highly Complex Patients with Cardiorenal Syndrome

Background: Around 70% of patients with heart failure(HF) have kidney disease. The objective of the study is to evaluate the short and long-term clinical performance of patients with CRS who are followed-up by the cardiorenal units(CRU) Methods: Fifty-four patients admitted in the CRU from April 1 to 30, 2022 at the Vall d'Hebron Hospital were included. Clinical follow-up was performed until October 31, 2023. Anthropometric measurements, signs of tissue and vascular congestion by US, and laboratory parameters were recorded Results: A total of 47(87%) and 16(30%) patients completed follow-up in the CRU at 6 and 12 months. Baseline characteristics are shown in Table 1. Mean age 70 years(±1.6), 65% men, ischemic heart disease HF(48%), functional classes II and III were most frequent (60% and 35%, respectively). Cardiac ejection fraction (EF) of 40%(±1.6), and HFrEF reduced by 61%. Congestion studies: 15%of patients had pulmonary B lines, 23% vena cava>20mm, and 30% discontinuous renal venous pattern. NT-proBNP and CA-125 were 4623pg/mL[898-28229] and 20.2U/mL[3.9-171], respectively. Mean follow-up 8.6 months(±0.6). Comparing the baseline visit with the control at 6 months, treatment was optimized with sacubitril-valsartan 33% vs 49%(p=0.02) and SGLT2i 48% vs 72%(p=0.008) without significant deterioration in renal function, and a reduction of more than 50% in the number of hospital admissions(p=0.002). 22% required peritoneal dialysis and 20%hemodialysis. Ten(19%)patients died, 5of them due to cardiovascular(CV)events Conclusion: We showed that the CRU is vital for the management of complex patients since it guarantees greater implementation of drugs that reduce CV mortality and the number of hospital admissions in HF