{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:35:07Z","timestamp":1760146507173,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T00:00:00Z","timestamp":1731024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Heart failure and kidney diseases often coexist and are difficult to clinically manage. Dysfunction in either organ exacerbates dysfunction in the other, potentially leading to cardiorenal syndrome (CRS). CRS has five different subtypes, with CRS type 5 being the most problematic given that it consists of an acute insult superimposed upon chronic CRS. Additionally, type 5 CRS can be complicated by heart failure-related cardiogenic shock (HF-CS), which is associated with increased hospitalizations and has a high 1-year mortality rate. The standard treatment for patients with HF-CS consists of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) as tolerated, along with inotropic therapies and surgical mechanical left ventricular (LV) support, guided by invasive hemodynamic monitoring. Case Presentation: This case study reports the presentation of a 57-year-old man who presented with type 5 CRS who rapidly decompensated to stage E HF-CS and was effectively and safely treated with aggressive intravenous hydration, a defined plant-based diet (DPBD), and reduction of guideline-directed prescription medications without invasive hemodynamic monitoring. Conclusions: Hydration, a DPBD, and a reduction in medication burden may be effective in CRS. Pilot studies are warranted to evaluate the efficacy of this intervention in CRS in a larger cohort.<\/jats:p>","DOI":"10.3390\/reports7040094","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T06:05:41Z","timestamp":1731045941000},"page":"94","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Aggressive Intravenous Hydration and a Defined Plant-Based Diet Safely and Effectively Treated Type 5 Cardiorenal Syndrome with Stage E Heart Failure-Related Cardiogenic Shock: A Case Report"],"prefix":"10.3390","volume":"7","author":[{"given":"Baxter Delworth","family":"Montgomery","sequence":"first","affiliation":[{"name":"Montgomery Heart & Wellness Center, 10480 S Main St., Houston, TX 77025, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille V.","family":"Owens","sequence":"additional","affiliation":[{"name":"Montgomery Heart & Wellness Center, 10480 S Main St., Houston, TX 77025, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5348-3008","authenticated-orcid":false,"given":"Rami Salim","family":"Najjar","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Sciences, Georgia State University, 161 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mawadda","family":"Saad","sequence":"additional","affiliation":[{"name":"Montgomery Heart & Wellness Center, 10480 S Main St., Houston, TX 77025, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"488","DOI":"10.15585\/mmwr.mm7218a3","article-title":"Provisional Mortality Data\u2014United States, 2022","volume":"72","author":"Ahmad","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1161\/CIRCULATIONAHA.117.028814","article-title":"Cardiorenal Syndrome Revisited","volume":"138","author":"Zannad","year":"2018","journal-title":"Circulation"},{"key":"ref_3","unstructured":"Kousa, O., Mullane, R., and Aboeata, A. (2024). Cardiorenal Syndrome. StatPearls, StatPearls Publishing LLC."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.jcmg.2019.02.029","article-title":"Should We Test for Diastolic Dysfunction? How and How Often?","volume":"13","author":"Litwin","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.jchf.2023.04.010","article-title":"Management of Heart Failure-Related Cardiogenic Shock: Practical Guidance for Clinicians","volume":"11","author":"Narang","year":"2023","journal-title":"JACC Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Aryal, D., Roy, T., Chamcheu, J.C., and Jackson, K.E. (2020). Chronic Metabolic Acidosis Elicits Hypertension via Upregulation of Intrarenal Angiotensin II and Induction of Oxidative Stress. Antioxidants, 10.","DOI":"10.3390\/antiox10010002"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1002\/clc.22863","article-title":"A defined, plant-based diet utilized in an outpatient cardiovascular clinic effectively treats hypercholesterolemia and hypertension and reduces medications","volume":"41","author":"Najjar","year":"2018","journal-title":"Clin. 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Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e232080","DOI":"10.1136\/bcr-2019-232080","article-title":"Plant-based dietary approach to stage 3 chronic kidney disease with hyperphosphataemia","volume":"12","author":"Campbell","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Owens, C.V., Najjar, R.S., Bruce, M.A., Beech, B.M., and Montgomery, B.D. (2024). A Defined, Plant-Based Diet and Other Integrative Therapies Improve Functional Status and Ejection Fraction While Reducing Medications in Patients With Heart Failure: A Case Series. Am. J. 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