Patient handout

Chronic cardiorenal syndrome (CRS type 2/4, cross-system)

PRODUCTION

1. Your condition

This handout is for chronic cardiorenal syndrome (crs type 2/4, cross-system). Your care team identified this based on: worsening renal function during hf gdmt titration.

Other reasons your team may use this plan: hf + ckd (bidirectional cardiorenal); hyperkalemia limiting rasi/mra up-titration; refractory congestion with renal dysfunction (diuretic resistance).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
dapagliflozin	10 mg	PO	once daily	DAPA-HF/DELIVER (HF) + DAPA-CKD (CKD) — single agent benefits both organs; 2022 ACC/AHA HF + KDIGO 2024 Class I
empagliflozin	10 mg	PO	once daily	EMPEROR-Reduced/Preserved + EMPA-KIDNEY — cardiorenal benefit across spectrum (2022 ACC/AHA HF; KDIGO 2024)

Plan: Cardiorenal — shared SGLT2i/finerenone pillar + RASi-enablement + decongestion (2022 AHA/ACC/HFSA HF; KDIGO 2024)

3. When to call your provider

Contact your care team if any of the following happen:

Severe hyperK / refractory congestion / uremia → acute cardiorenal pathway — 2022 ACC/AHA HF
eGFR <20 + persistent volume issues → SGLT2i reassessment + nephrology — KDIGO 2024
End-stage cardiorenal → ultrafiltration / heart-kidney transplant — 2022 ACC/AHA HF

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

K 5.1–6.0 limiting RASi/MRA — add patiromer/SZC + dietary K + review K-sparing co-meds to KEEP the four foundational heart-failure medications (severe/ECG hyperK → emergency pathway) — 2022 ACC/AHA HF
Diuretic-resistant congestion — sequential nephron blockade (loop + metolazone ± acetazolamide/SGLT2i), then ultrafiltration if refractory — 2022 ACC/AHA HF
End-stage cardiorenal (eGFR severely reduced + refractory HF) — combined heart-kidney transplant / LVAD / palliative pathway — 2022 ACC/AHA HF(life-threatening)
Pregnancy with cardiorenal disease — STOP RAS/SGLT2i/finerenone/spironolactone; BB ± hydralazine + careful volume; cardio-obstetric + nephrology — ESC 2018 Pregnancy
Accelerated eGFR decline / rising UACR — KDIGO risk-based intensification + nephrology co-management — KDIGO 2024

5. Follow-up

Lifelong cardiorenal co-management; advanced-therapy timing; re-phenotype

6. Sources

Guideline: 2022 AHA/ACC/HFSA HF Guideline + KDIGO 2024 CKD Guideline; DAPA-HF/DELIVER/DAPA-CKD/EMPA-KIDNEY; FIDELIO/FIGARO/FINEARTS-HF