Hello, I'm Wilfried Mullens from Genk, Belgium. I just gave a talk on cardiorenal syndrome, a highly prevalent condition in which renal function deteriorates in patients hospitalized with heart failure.

Historically, we believed that this decline in kidney function was primarily due to poor forward flow—reduced cardiac output. However, recent insights have shifted our understanding. It's now clear that congestion—not low flow—is the key driver. Specifically, elevated filling pressures, and in particular right-sided filling pressures, contribute significantly to worsening renal function.

Another important factor is elevated intra-abdominal pressure, which further compromises kidney perfusion. Additionally, intra-renal hemodynamics and an imbalance in gut microcirculation also play a role in the complex interplay between the heart and kidneys in these patients.