A novel approach to pediatric cardiorenal syndrome

Cardiorenal syndrome describes the complex interplay between the heart and the kidney, where failure of one organ can lead to dysfunction and failure in the other. We describe an adolescent who presented with advanced kidney disease necessitating dialysis, who was found to have severe systolic and diastolic heart failure. Consideration was initially given for joint kidney and heart transplant over concerns about the severity of his cardiac dysfunction.During transplant evaluation, he was treated with a strategy of intermittent hemodialysis in combination with peritoneal dialysis. His hemodynamics improved to the point that he was able to undergo kidney transplant alone. In the days immediately following kidney transplant, his cardiac function rapidly improved, completely normalized within 6 weeks of transplant, and has remained normal.This case describes the improvement of severe systolic and diastolic heart failure from cardiorenal syndrome with combined hemodialysis and peritoneal dialysis in a pediatric patient whose fluid management had previously been suboptimal on nightly peritoneal dialysis. This strategy led to better fluid management and significant improvement in cardiac function and hemodynamics, which allowed for successful kidney transplant alone, and avoidance of heart transplant. Following successful kidney transplant, cardiac function rapidly and completely normalized. Combined dialysis is an uncommon strategy that has not previously been reported for the purpose of cardiac rehabilitation and avoidance of multiorgan transplant in pediatric patients.