Advances in device-based therapies for cardiorenal syndrome.

Purpose of review: Diuretic resistance presents a harrowing obstacle in patients with decompensated heart failure and cardiac-driven cardiorenal syndrome. This conundrum not only presents clinical decision-making challenges but also portends worse outcomes for these patients. The development of device-based therapies to provide support in these cases is an attractive alternative therapeutic option. This review will describe the growing evidence supporting developments in device-based therapies for cardiorenal syndrome in patients with heart failure.

Recent findings: We describe multiple emerging technologies in this space, each classified according to its mechanism of action. 'Pushers' are devices that increase blood flow and perfusion pressure to the renal arteries. 'Pullers' reduce renal afterload by decreasing pressure in the renal veins, and 'fluid shifters' decongest the interstitium through the lymphatic system.

Summary: While early results from small clinical studies piloting these devices are promising, randomized controlled trials are needed to fully evaluate their utility in patients with heart failure. In the future, these devices may work synergistically with pharmacologic therapy to reduce average inpatient length of stay, hospitalization rates, and potentially improve mortality.