Review Articles

The Kidney in Heart Failure: The Role of Venous Congestion



Heart failure can lead to renal impairment, an interaction now termed “cardiorenal syndrome.” The prevalent physiological explanation for the renal impairment that accompanies heart failure centers around the forward failure hypothesis, which emphasizes the role of left ventricular dysfunction in causing edema, and the backward failure hypothesis, which singles out venous congestion as the dominant mechanism of edema and reduced glomerular filtration rate. In this review, we provide an appraisal on venous congestion, an extremely important contributor that has received little attention. We also summarize the pharmacology of loop diuretics, explain current understanding of diuretic resistance, and address controversies regarding decongestive treatments.


heart failurecardiorenal syndromevenous congestionglomerular filtration rate
  • Year: 2022
  • Volume: 18 Issue: 4
  • Page/Article: 4-10
  • DOI: 10.14797/mdcvj.1121
  • Submitted on 19 Apr 2022
  • Accepted on 6 May 2022
  • Published on 6 Sep 2022
  • Peer Reviewed