Traditional and Novel Invasive Hemodynamic Indices in the Evaluation of Congestive Heart Failure in Cardiorenal Syndrome

Cardiovascular disease, especially heart failure, is common among patients with kidney disease, and vice versa. Acute or chronic dysfunction of the heart or kidneys triggers and sustains dysfunction of the other, through a combination of hemodynamic, neurohormonal, sympathetic nervous system and biochemical feedback mechanisms, among others. Hemodynamic changes such as increased afterload, venous congestion, hypervolemia, decreased cardiac contractility, low cardiac output, and impaired renal perfusion are commonly noted among patients with cardiorenal dysfunction and are shown to have varying degrees of prognostic relevance. The gold standard test for invasive assessment of cardiac hemodynamics is right heart catheterization using the pulmonary artery catheter. In this chapter, we discuss the evidence surrounding several invasive hemodynamic parameters in acute and chronic cardiorenal syndrome. We review pre and postcapillary mechanisms contributing to the development of pulmonary hypertension in chronic kidney disease and explore the role for invasive hemodynamic assessment for guiding treatment among those affected by heart failure and/or pulmonary hypertension within this population.