Heart and Kidney issues — Cardiorenal Syndrome

Cardiomyopathy and Chronic Kidney disease

by Rch - 2023-04-16 03:21:29

Hi

Sorry to hear about your Cardiomyopathy and the resultant kidney disease. You didn't mention which heart meds caused your kidney failure, nonetheless since the meds were discontinued and the EF is up almost to 60%, your kidney #s should improve as well- IMHO.  I suggest you keep in close touch with the Nephrologist to manage your care. 

EF & Kidneys

by Penguin - 2023-04-16 04:20:20

Hi, 

I'm sorry to read about your journey through pacing to this point.  Meds obviously impact on kidney function and I'm sorry that your kidneys haven't recovered above an EGFR of 30 since stopping them.  Presumably different drugs are now being prescribed?

I'm not sure when you get passed over to a renal specialist in your neck of the woods. Below an EGFR of 30 (?) or does the heart failure team manage your care without referral to specialists?  I hope that the iron infusion helps combat some of the symptoms of your anaemia when you get it. Hopefully that will be soon?

In terms of prognosis - that's a difficult question for anyone to answer and very individual. An EF of nearly 60% sounds encouraging (post CRT implant). Hopefully better heart function will have a positive effect on your kidney function.  Let's hope for no further deterioration in kidney function particularly if the drugs were the cause.  

Keep in touch for support and try to keep positive. 

EF &Kidneys

by datslt - 2023-04-16 06:08:07

Thanks for your replies. I was taking ENTRESTO, SPIRONOLACTONE, FORXIGA, BISOPROLOL, FUROSEMIDE (only if I gain more than 1.5kg overnite). The docs (Cardiologist and Nephrologist) are not sure which meds or combination made me crash. Since then, they have slowly reintroduce the meds but a baby dose of ENTRESTO with the plan to increase if blood test tomorrow comes back better. My EF increased prior to stopping the meds and not sure if that took a hit given the 2 mos without the medication. I can feel some of the HF symptoms are back (sob, cough, retaining fluids, etc) At this point the Cardiologist is waiting for the investigation with the Nephrologist to determine what the possible baseline is for my kidneys, but is still part of my team. Apparently, the anemia is a side issue with the kidneys. My GP mentioned Cardiorenal syndrome and the nephrologist eluded to it when he was preparing me in the event I end up back in hospital. I guess at this point, my biggest fear is the possibility of dialysis. Meanwhile, I am trying to stay positive and trust I am in good hands.

cheers,

Sherry

Sources of Help

by Penguin - 2023-04-16 08:02:09

I know a little about dialysis and kidney disease as a close friend was affected but clearly your doctors are the best source of advice.  Dialysis is not a pleasant choice to face and there's quite a lot to get your head round if your kidneys aren't functioning well. I hope you can avoid this. 

Re: Entresto & Potassium. 

This web link may explain the concerns about Entresto and possibly your diuretic.  I don't know whether Spirolactone (sp ?) has the effect on potassium which is stated below.  However, increased potassium is not a great idea when kidneys are not working.  If Entresto has this effect this is something to discuss with your doctors. Is there an alternative med for heart failure for example. 

'HIGH POTASSIUM: Taking Entresto can increase potassium levels in the body, which can lead to heart problems. The risk of this occurring is greater if you are on a high potassium diet or taking potassium supplements or other medications that have the same effect of raising serum potassium, such as potassium-sparing diuretics. The risk is also higher in people with kidney problems, diabetes, or a condition called hypoaldosteronism (low aldosterone). Avoid high-potassium foods, potassium supplements, and salt substitutes that contain potassium while on this medicine. Your doctor will monitor serum potassium periodically while you are on Entresto. Keep all lab appointments. Call your doctor immediately if you experience symptoms such as muscle weakness or irregular heartbeat.'

Re: your fear of dialysis. 

I gather this is a fear at this stage rather than an inevitability, although you have had the two hospital admissions for acute kidney failure. 

I don't know about you but for me it can help to face my fears and to find out more about what I might have to deal with slowly and gently so that I can acclimatise myself to the worst case scenario and diminish the shock if it comes.  Talking to an advisor from a local or national kidney support charity may help most as a first step. They will be used to the cardio/renal links and will listen and chat through your fears with you.  An EGFR of 30 does sound low to most people, but you may be surprised at what kidneys can manage at incredibly low filtration rates. 

Maybe also find out about local support networks for yourself.   Forums are helpful but sometimes people on the ground help most. 

I hope this information helps a little. Please talk to your doctors and kidney charities and keep in touch if we can help at all. 

Low EF and Kidney disease

by Rch - 2023-04-16 20:56:43

Cardiorenal syndrome as your GP and Nephrologist termed it, is essentially  decompensaton in one organ system inducing a dysfunction in another. It's aside from medication induced organ damage. You perhaps had some kidney disease due to poor heart function, which was augmented by the addition of medications especially Entresto and to some extent Spironolactone. You didn't mention any diabetes and so the Forxiga was probably prescribed for the Cardiorenal syndrome. IMHO, prognosis without diabetes and BP under control, is good. Please make sure however, your Nephrologist or PCP periodically checks your Potassium and Creatinine while on Entresto and Spironolactone. I have T2DM on Metformin and Lisinopril and my PCP closely monitors my labs. I wish you well! 

Low EF and Kidney disease

by datslt - 2023-04-16 22:53:28

Thanks for your reply. I was diagnosed years and years ago with Insulin Resistance and was on Metformin (2 tabs per day) up until my kidneys failed 2 mos ago. That is the only med I have not restarted. I was told my kidneys were already compromised and not that great -- but was stable until now, I'm having weekly blood test and the next one this week will be 6 days after restarting all my hf meds. The nephrologist is most concerned about the anemia and is talking about an iron infusion that hopefully will make me feel better. He also told me to stay away from stone fruit and bananas which may be the potassium issue you mentioned. My creatinine level is much too high as well. I guess this may be my new normal walking this tightrope between the kidneys and Heart. On a good note, the CRT-D seems to be doing its job of increasing my EF! 

Anemia

by Rch - 2023-04-17 03:15:10

In the absence of Metformin, I would suggest you check your fingerstick blood sugars at least once a day. I check mine at least 2 times day. As to your anemia, if your Nephrologist is very concerned and planning to treat with iron infusion, you probably have severe iron deficiency. Hopefully your providers have ruled out an occult blood loss as that would be unrelated to your heart or kidneys. I wish you well!!

Update

by datslt - 2023-04-21 08:59:39

Hi everyone,

Just a quick update on my situation. 2 blood tests this week. On Monday, kidney function was 28 down from 36 the previous week. On Thursday it was 24 and creatinine level was dangerously high at 180. Doctor ceased ENTRESTO and started me on RAMIPRIL which I was taking over a year ago before it was decided to replace my pm with a CRT-D. Another blood test on Thursday followed by another the following week. 24 is only 2 points higher than it was when I crashed the second time and ended back in hospital. Not sure if my heart has taken a hit with all the med changes, so I guess I'm okay until I'm not! Ready to get off this merry go round.

cheers and thanks again for your comments,

Sherry