Clinical profile and outcomes of patients with cardiorenal syndrome managed in a cardiorenal unit
E Fuente Gonzalez, M Galvan Ruiz, E Gomez Flores, J C Quevedo Reina, M V Groba Marco, C A Santana Quintana, J Leon Santana, M Fernandez De Sanmamed Giron, F A Romano Matos, S Martinez Gutierres, Y Daruiz D'orazio, L Burgos Ramirez, A Garcia QuintanaAbstract
Introduction
Chronic kidney disease (CKD) is highly prevalent among patients with heart failure (HF) and is associated with poorer prognosis and frequent hospital admissions. Cardiorenal syndrome (CRS) represents a high-risk condition due to the interaction between cardiac and renal dysfunction. Integrated cardiorenal units (CRUs) have been developed to improve the management of these complex patients; however, real-world evidence regarding their clinical impact remains limited.
Purpose
This study aims to evaluate the clinical impact of implementing a dedicated CRU for patients with CRS.
Methods
We conducted an ambispective, single-centre observational study including patients referred to the CRU between February 2023 and December 2025. Patients were stratified according to the occurrence of a HF event, defined as HF hospitalisation, an emergency department visit due to HF, or death from any cause during follow-up. Survival analysis based on baseline characteristics was performed using Kaplan–Meier curves.
Results
A total of 205 patients were included (mean age 72 ± 12 years; 31% female), with a high burden of : hypertension (91%), dyslipidaemia (73%), diabetes mellitus (59%) and atrial fibrillation (51%). The median Charlson Comorbidity Index (CCI) was 5. Ischaemic heart disease was the most common HF aetiology (47.8%, n = 98), followed by valvular disease (21.5%, n = 44). Diabetic nephropathy was the leading cause of CKD (31.2%, n = 64), followed by congestive nephropathy (16.1%, n = 31). One-third of patients were receiving renal replacement therapy (16.7% peritoneal dialysis and 17% haemodialysis). The median left ventricular ejection fraction (LVEF) was 48% (37–60), and 31% had reduced ejection fraction. The most frequent baseline NYHA class was II (55.1%), followed by class III (30.2%). At baseline, 79% received beta-blockers, 78% loop diuretics, 70.4% sodium–glucose cotransporter 2 inhibitors, 42% angiotensin receptor–neprilysin inhibitors, and 41% mineralocorticoid receptor antagonists. During follow-up, 30.2% of patients experienced an HF event: 23% HF decompensation and 16.5% all-cause mortality (47% due to HF). HF events were more frequent in female patients and in those with higher CCI, atrial fibrillation, previous HF admissions, congestive nephropathy, peritoneal dialysis, worse VEXUS scores, NYHA class III, and higher levels of natriuretic peptides and C-reactive protein. No differences were observed in LVEF or baseline HF therapy between groups (Figures 1–2).
Conclusion
In this real-world cohort of patients with CRS managed in a CRU, we highlight the marked clinical complexity of patients followed in the unit. HF events were more prevalent among patients with a higher comorbidity burden, elevated biomarkers, worse NYHA functional class and congestion-related features. These findings reinforce the need for an integrated cardiorenal approach to enable accurate risk stratification and optimise clinical management.Subanalysis of the composite endpointFor image description, please refer to the figure legend and surrounding text.Kaplan–Meier survival analysisFor image description, please refer to the figure legend and surrounding text.