Cardiorenal biomarkers and therapeutic interventions in acute heart failure

Acute heart failure (AHF) is a syndrome that not only involves the heart, but affects many other organs as well. The presence of these co-morbidities makes the pathophysiology, phenotype and treatment of this heterogeneous syndrome very complicated. Renal dysfunction is one of the most prevalent comorbidities with a strong association with clinical outcome, but a deeper understanding of the pathophysiology is lacking. Several studies that tested the effect of drug treatment in AHF with concomitant renal dysfunction have shown neutral results similar to other randomized clinical studies in patients with AHF. To better understand the pathophysiology behind renal dysfunction in patients with heart failure, a crucial step is to seek a successful intervention for this high-risk subgroup. A biomarker is a powerful tool, not only for predicting prognosis, but also for examining the biological pathway of the disease. Numerous studies on renal biomarkers have been conducted and most showed their strong association with prognosis. However, currently available renal biomarkers are not capable of providing information on precipitating factors of renal dysfunction in heart failure, which can vary from patient to patient. Therefore, attempting to use preexisting and novel biomarkers to derive such information regarding renal pathophysiology is clinically relevant for developing effective treatment for AHF patients, including those with concomitant renal dysfunction.