Device therapies in cardiorenal syndrome: an expert review

Abstract

Managing cardiorenal syndrome in acute decompensated heart failure remains a major challenge in contemporary cardiology. While pharmacological decongestion with diuretics is the cornerstone of therapy and is effective in most patients, worsening renal function and diuretic resistance continue to pose challenges in selected cases. Device-based therapies are increasingly explored to target key pathophysiological mechanisms underlying cardiorenal dysfunction. This expert review builds on a conceptual framework for device-based therapies. Rather than cataloguing individual technologies, we apply a functional framework that classifies devices according to their primary mode of action: reduction of venous or lymphatic congestion (‘pullers’), augmentation of arterial perfusion (‘pushers’), and direct removal of sodium and/or fluid (‘removers’). For each category, we integrate pathophysiological rationale with available clinical evidence, highlighting the predominance of early-phase physiological evidence and the need for randomized studies demonstrating benefit beyond optimized contemporary medical care.

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Cite

BibTeX RIS

BibTeX

@article{dauw2026device,
  title = {{Device therapies in cardiorenal syndrome: an expert review}},
  author = {Jeroen Dauw and Guillaume Baudry and Marta Cobo Marcos and Mateusz Guzik and Juan Carlos Lopez and Biykem Bozkurt and Gracjan Iwanek and Masatake Kobayashi and Òscar Miró and Peder Langeland Myhre and Alberto Palazzuoli and Jeffrey M Testani and Marco Metra and Piotr Ponikowski and Wilfried Mullens and Jan Biegus},
  journal = {ESC Heart Failure},
  year = {2026},
  month = aug,
  doi = {10.1093/eschf/xvag195},
  url = {https://hal.univ-lorraine.fr/hal-05732719v1},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Device therapies in cardiorenal syndrome: an expert review
AU  - Jeroen Dauw
AU  - Guillaume Baudry
AU  - Marta Cobo Marcos
AU  - Mateusz Guzik
AU  - Juan Carlos Lopez
AU  - Biykem Bozkurt
AU  - Gracjan Iwanek
AU  - Masatake Kobayashi
AU  - Òscar Miró
AU  - Peder Langeland Myhre
AU  - Alberto Palazzuoli
AU  - Jeffrey M Testani
AU  - Marco Metra
AU  - Piotr Ponikowski
AU  - Wilfried Mullens
AU  - Jan Biegus
PY  - 2026
DA  - 2026/08/04
JO  - ESC Heart Failure
DO  - 10.1093/eschf/xvag195
UR  - https://hal.univ-lorraine.fr/hal-05732719v1
AB  - Managing cardiorenal syndrome in acute decompensated heart failure remains a major challenge in contemporary cardiology. While pharmacological decongestion with diuretics is the cornerstone of therapy and is effective in most patients, worsening renal function and diuretic resistance continue to pose challenges in selected cases. Device-based therapies are increasingly explored to target key pathophysiological mechanisms underlying cardiorenal dysfunction. This expert review builds on a conceptual framework for device-based therapies. Rather than cataloguing individual technologies, we apply a functional framework that classifies devices according to their primary mode of action: reduction of venous or lymphatic congestion (‘pullers’), augmentation of arterial perfusion (‘pushers’), and direct removal of sodium and/or fluid (‘removers’). For each category, we integrate pathophysiological rationale with available clinical evidence, highlighting the predominance of early-phase physiological evidence and the need for randomized studies demonstrating benefit beyond optimized contemporary medical care.
SN  - 2055-5822
ER  -

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