• Document link of hypertension and cardiac and renal disease states

  • Type 1 Cardio-Renal Syndrome: abrupt worsening of cardiac function leads to acute kidney injury (e.g., acute congestive heart failure causing acute kidney injury)
  • Type 2 Cardio-Renal Syndrome: chronic worsening of cardiac function leads to chronic kidney disease (e.g., hypertension causing CKD)
  • Type 3 Cardio-Renal Syndrome: abrupt worsening of renal function causing cardiac dysfunction (e.g., pyelonephritis causing acute renal failure with fluid overload causing congestive heart failure)
  • Type 4 Cardio-Renal Syndrome: chronic kidney disease causing decreased cardiac function, cardiac hypertrophy and/or increased risk of acute cardiovascular events (e.g., CKD causing hypertension leading to coronary artery disease)
  • Type 5 Cardio-Renal Syndrome: a systemic condition causing both cardiac and renal dysfunction (e.g., sepsis causing acute congestive heart failure and acute kidney injury)

• Document extent of chronic kidney disease:
  Chronic kidney disease (CKD) – most commonly due to diabetes and hypertension

  • Stage 1 CKD – GFR > 90 ml/min/1.73 m2
  • Stage 2 CKD – GFR 60-90 ml/min/1.73 m2
  • Stage 3 CKD – GFR 30-59 ml/min/1.73 m2
  • Stage 4 CKD – GFR 15-29 ml/min/1.73 m2
  • Stage 5 CKD – GFR <15 ml/min/1.73 m2
  • End-stage renal disease (ESRD) – patients with stage 4 or 5 CKD who have been on dialysis for three months

• Document type of heart failure:

  • Right heart failure or left heart failure
  • Suspected etiology (e.g., coronary artery disease, chronic hypertension)
  • Acute, chronic, or acute on chronic. If acute exacerbation, suspected etiology of acute exacerbation
  • Type
    • Systolic heart failure – typically an ejection fraction < 40%
    • Diastolic heart failure – typically an ejection fraction of 50% or higher. The diagnosis is supported with concentric left ventricular hypertrophy or remodeling on echocardiogram.
    • Combined heart failure – systolic and diastolic heart failure
  • Did the patient have a myocardial infarction with in the last four weeks? If so, is the myocardial infarction causing the patient’s decompensation?
  • If the patient has chronic renal failure, did volume overload lead to the patient’s decompensation?

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