Two studies have suggested that the use of ACEI alongside statins might be an effective regimen to prevent a substantial number of CRS cases in high risk patients and improve survival and quality of life in these people. There are data suggesting combined use of statin and an ACEI improves clinical outcome more than a statin alone and considerably more than ACE inhibitor alone.Natriuretic peptides
Nesiritide which is an analogue of brain natriuretic peptide (BNP) was shown to result in poorer kidney outcome or have no effect.Vasopressin antagonists
Tolvaptan showed to have no benefit. It is also a very costly drug.Adenosine antagonists
Adenosine is responsible for constriction of afferent arteriole and reduction in GFR. It was found that an adenosine A1-receptor antagonist called KW-3902 was able to improve kidney function in CRS patients.Ultrafiltration
Many case reports have shown improved kidney function with ultrafiltration.Inotropes
Their roles remain unknown. Epidemiology
Kidney failure is very common in patients with congestive heart failure. It was shown that kidney failure complicates one-third of all admissions for heart failure, which is the leading cause of hospitalization in the United States among adults over 65 years old. Not only is this the leading cause of hospitalization, it also increases the stays in the ICU.These complications led to longer hospital stay, higher mortality, and greater chance for readmission. The impatient mortality was seen to be much higher for patients with much more sever renal dysfunction. The increase of hospital and ICU stays also increases the cost of care in the hospital.
"As the population ages and the burden of renal disease and cardiovascular disease continue to rise, efforts to better understand the complicated relationship between these two organ systems are greatly needed." In addition, many trials on HF excluded patients with advanced kidney dysfunction. Therefore, our understanding of CRS management is still limited to this date. One study showes how ACE inhibitors and angiotensin II receptor antagonists have been found to prevent nephropathy in patients who have diabetes. Patients with kidney failure are less likely to get all guide-lined base therapies. Patients who have moderate to sever CKD was seen to have similar care when compared to those patients who had normal kidney function. This helps show how healthcare workers can do more to increase the outcome of those suffering. Diuretics
Used in the treatment of heart failure and CRS patients, however must be carefully dosed to prevent kidney injury. Diuretic resistance is frequently a challenge for physicians to overcome which they may tackle by changing the dosage, frequency, or adding a second drug.ACEI, ARB, renin inhibitors, aldosterone inhibitors
The use of ACE inhibitors have long term protective effect on kidney and heart tissue. However, they should be used with caution in patients with CRS and kidney failure. Although patients with kidney failure may experience slight deterioration of kidney function in the short term, the use of ACE inhibitors is shown to have prognostic benefit over the long term.