‘Don’t Throw the Baby out With the Bathwater’ Urine Galectin-3 in Heart Failure With Chronic Kidney Disease: Another Tool to Distinguish Intrinsic Kidney Disease From Chronic, Functional Cardiorenal Syndrome?

The burden of kidney disease in heart failure (HF) has been well described, but a comprehensive, integrated understanding of the underlying complex mechanisms and clinical implications of these cardiorenal interactions has remained elusive. We have made significant advances in understanding acute cardiorenal syndrome in the setting of acute HF (AHF). We now know that changes in kidney function during treatment of congestion are often benign hemodynamic fluctuations resulting from diuresis or medical therapy. 1 Testani JM Chen J McCauley BD Kimmel SE Shannon RP Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival. Circulation. 2010; 122: 265-272 Crossref PubMed Scopus (523) Google Scholar , 2 Testani JM Kimmel SE Dries DL Coca SG Prognostic importance of early worsening renal function after initiation of angiotensin-converting enzyme inhibitor therapy in patients with cardiac dysfunction. Circulation: Heart Fail. 2011; 4: 685-691 Crossref PubMed Scopus (187) Google Scholar , 3 Wettersten N Horiuchi Y van Veldhuisen DJ Ix JH Mueller C Filippatos G et al. Decongestion discriminates risk for one-year mortality in patients with improving renal function in acute heart failure. Eur J Heart Fail. 2021; (xx:xxx–x) Crossref PubMed Scopus (14) Google Scholar However, a substantial number of patients with AHF have marked changes in kidney function without adequate decongestion, and these individuals have the worst prognoses. We had hoped that novel kidney biomarkers of tubular function and injury would guide us, but most studies have shown that these markers are generally not increased in AHF, even in the subset of those with acute kidney injury. 4 Ahmad T Jackson K Rao VS Tang WHW Brisco-Bacik MA Chen HH et al. Worsening renal function in acute heart failure patients undergoing aggressive diuresis is not associated with tubular injury. Circulation. 2018; (xx:xxx–x) Crossref Scopus (197) Google Scholar ,5 Murray PT Wettersten N van Veldhuisen DJ Mueller C Filippatos G Nowak R et al. Utility of urine neutrophil gelatinase-associated lipocalin for worsening renal function during hospitalization for acute heart failure: primary findings for urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic heart faIlure Study (AKINESIS). J Card Fail. 2019; (xx:xxx–x) Abstract Full Text Full Text PDF Scopus (23) Google Scholar These gaps in understanding of cardiorenal syndromes also extend to the outpatient setting. Association of Urine Galectin-3 With Cardiorenal Outcomes in Patients With Heart FailureJournal of Cardiac FailurePreviewKidney dysfunction plays a significant role in the pathophysiology of heart failure (HF).1,2 Approximately one-half of all patients with HF have chronic kidney disease (CKD), and patients with comorbid CKD and HF are at a 2-fold higher risk of all-cause mortality.3–5 This spectrum of heart-kidney disorders, termed cardiorenal syndrome (CRS), arises from variable etiologies and is precipitated by a number of factors, including neurohormonal and hemodynamic factors.6–8 Yet serum creatinine, the primary laboratory measure to identify patients with CRS, are unable to distinguish the mechanistic causes behind changes in glomerular filtration rates (GFRs). Full-Text PDF