Abstract:
Introduction. Type 2 cardiorenal syndrome (CRS-2) is a complex pathological entity characterized
by decompensated chronic heart failure, leading to progressive deterioration of renal function. For
patients with CRS-2 who have reached the end stage of chronic kidney disease (CKD), therapeutic
options are limited, and renal transplantation remains the only long-term curative solution. The
objective of this study is to highlight the clinical challenges, prognostic factors, and therapeutic
strategies applied to an advanced CRS-2 patient on hemodialysis who was evaluated for renal
transplantation.
Materials and Methods. A retrospective analysis was conducted on a 62-year-old patient diagnosed
with heart failure with reduced ejection fraction (HFrEF—LVEF 35%) and stage V chronic kidney
disease, secondary to ischemic nephropathy, who had been enrolled in a hemodialysis program for 18
months. The pre-transplant evaluation included clinical and biological parameters (NT-proBNP, urea,
creatinine, urea/creatinine ratio, and creatinine clearance); cardiovascular risk stratification tests
(vascular calcification index, Doppler echocardiography, and cardiopulmonary exercise test); and
immunological compatibility analysis. Descriptive and inferential statistical methods assessed
correlations between cardiac parameters and post-transplant prognosis.
Results. The patient experienced accelerated progression of heart failure, with repeated episodes of
refractory cardiac decompensation, necessitating frequent adjustments to hemodialysis parameters
(controlled ultrafiltration, individualized sodium profile). The vascular calcification index indicated
advanced atherosclerosis and elevated NT-proBNP levels (>15,000 pg/mL). The immunological
evaluation revealed a high panel-reactive antibody (PRA > 50%), requiring personalized pre-transplant
immunomodulation strategies. Although the patient was deemed eligible for renal transplantation, the
perioperative risk was significantly increased due to severe left ventricular dysfunction and associated
pulmonary hypertension.
Conclusions. Renal transplantation in end-stage CRS-2 patients poses significant challenges both in
candidate selection and perioperative management. Rigorous multidisciplinary evaluation,
optimization of cardiorenal therapy, and monitoring of cardiac stress biomarkers can improve patient
selection and post-transplant prognosis. Further studies are needed to develop personalized risk
stratification algorithms for this patient population.
