Zoccali Carmine
Renal Research Institute, New York, New York, USA.
Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy.
Cardiorenal Med. 2025;15(1):21-28. doi: 10.1159/000542628. Epub 2024 Nov 14.
The complex relationship between heart and kidney dysfunction has been a subject of medical inquiry since the 19th century. The term "cardio-renal syndrome" (CRS) was introduced in the early 2000s and has since become a focal point of research. CRS is typically categorized into five subtypes based on the sequence of cardiovascular and kidney disease events.
The cardiovascular-kidney-metabolic (CKM) syndrome, as defined by the American Heart Association, describes a set of interrelated metabolic risk factors and their effects on the kidneys and cardiovascular system. This syndrome emphasizes the complexity of managing patients with combined conditions and identifies several knowledge gaps, including disease mechanisms, clinical phenotype variability, and the impact of social determinants of health. The chronic cardiovascular-kidney disorder (CCKD) framework proposes a shift from the term "syndrome" to "disorder," focusing on concurrent cardiovascular and kidney problems regardless of their sequence.
(i) The CCKD concept calls for simplification and conceptual clarity, arguing that understanding the bidirectional acceleration of disease progression between heart and kidney dysfunction can lead to more effective treatment strategies. (ii) Both CKM and CCKD share common pathophysiological mechanisms and risk factors, including hypertension, diabetes, obesity, and dyslipidemia. Managing these conditions requires a comprehensive approach that addresses the underlying risk factors and pathophysiological mechanisms. (iii) Future directions include embracing precision medicine, public health strategies, interdisciplinary care models, and ongoing research and innovation. Both frameworks underscore the need for comprehensive, interdisciplinary care models and innovative treatment strategies to address the complex interplay between cardiovascular and kidney diseases.
自19世纪以来，心脏与肾脏功能障碍之间的复杂关系一直是医学研究的课题。“心肾综合征”（CRS）这一术语于21世纪初被提出，此后成为研究的焦点。CRS通常根据心血管和肾脏疾病事件的先后顺序分为五个亚型。
美国心脏协会定义的心血管 - 肾脏 - 代谢（CKM）综合征描述了一组相互关联的代谢危险因素及其对肾脏和心血管系统的影响。该综合征强调了管理合并症患者的复杂性，并指出了几个知识空白，包括疾病机制、临床表型变异性以及健康社会决定因素的影响。慢性心血管 - 肾脏疾病（CCKD）框架提议从“综合征”一词转变为“疾病”，关注同时存在的心血管和肾脏问题，而不考虑其先后顺序。
（i）CCKD概念要求简化和概念清晰，认为理解心脏和肾脏功能障碍之间疾病进展的双向加速可导致更有效的治疗策略。（ii）CKM和CCKD都有共同的病理生理机制和危险因素，包括高血压、糖尿病、肥胖和血脂异常。管理这些病症需要一种全面的方法，解决潜在的危险因素和病理生理机制。（iii）未来方向包括采用精准医学、公共卫生策略、跨学科护理模式以及持续的研究和创新。这两个框架都强调需要全面的、跨学科的护理模式和创新的治疗策略来应对心血管和肾脏疾病之间的复杂相互作用。
