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Kittleson MM. Management of Heart Failure in Hospitalized Patients. Ann Intern Med 2023; 176:ITC177-ITC192. [PMID: 38079639 DOI: 10.7326/aitc202312190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Heart failure affects more than 6 million people in the United States, and hospitalizations for decompensated heart failure confer a heavy toll in morbidity, mortality, and health care costs. Clinical trials have demonstrated effective interventions; however, hospitalization and mortality rates remain high. Key components of effective hospital care include appropriate diagnostic evaluation, triage and risk stratification, early implementation of guideline-directed medical therapy, adequate diuresis, and appropriate discharge planning.
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Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California (M.M.K.)
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2
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Kenneally LF, Lorenzo M, Romero-González G, Cobo M, Núñez G, Górriz JL, Barrios AG, Fudim M, de la Espriella R, Núñez J. Kidney function changes in acute heart failure: a practical approach to interpretation and management. Clin Kidney J 2023; 16:1587-1599. [PMID: 37779845 PMCID: PMC10539207 DOI: 10.1093/ckj/sfad031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Indexed: 10/03/2023] Open
Abstract
Worsening kidney function (WKF) is common in patients with acute heart failure (AHF) syndromes. Although WKF has traditionally been associated with worse outcomes on a population level, serum creatinine concentrations vary greatly during episodes of worsening heart failure, with substantial individual heterogeneity in terms of their clinical meaning. Consequently, interpreting such changes within the appropriate clinical context is essential to unravel the pathophysiology of kidney function changes and appropriately interpret their clinical meaning. This article aims to provide a critical overview of WKF in AHF, aiming to provide physicians with some tips and tricks to appropriately interpret kidney function changes in the context of AHF.
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Affiliation(s)
- Laura Fuertes Kenneally
- Cardiology Department, General Hospital of Alicante, Dr Balmis. Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Gregorio Romero-González
- Nephrology Department, University Hospital Germans Trias I Pujol, Badalona, Spain, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Marta Cobo
- CIBER Cardiovascular
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Nephrology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Valencia, Spain
| | - Ana Garcia Barrios
- Cardiology Department, General Hospital of Alicante, Dr Balmis. Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante, Spain
| | - Marat Fudim
- Cardiology Department, Duke University Medical Center. Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
- CIBER Cardiovascular
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3
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Lorenzo M, Núñez G, Fuertes-Kenneally L, de la Espriella R, Villar S, Miró O, Llorens P, Santas E, Miñana G, Bodí V, Sanchis J, Carratalá A, Bayés-Genís A, Núñez J. Early glomerular filtration rates changes and risk of mortality in acute heart failure. The modifying role of admission renal function and decongestion. Eur J Intern Med 2023; 115:96-103. [PMID: 37316355 DOI: 10.1016/j.ejim.2023.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The pathophysiology of changes in estimated glomerular filtration rate (eGFR) in acute heart failure (AHF) is complex and multifactorial. We evaluated the associated mortality risk of early changes in eGFR across baseline renal function on admission and early changes in natriuretic peptides in patients admitted with AHF. METHODS We retrospectively evaluated 2,070 patients admitted with AHF. Renal dysfunction on admission was defined as eGFR<60 ml/min/1.73m2 and successful decongestion as NT-proBNP decreased >30% from baseline. We assessed the mortality risk associated with eGFR changes from baseline at 48-72 h after admission (ΔeGFR%) according to baseline renal function, and NT-proBNP changes at 48-72 h through Cox regression analyses. RESULTS The mean age was 74.4 ± 11.2 years, and 930 (44.9%) were women. The proportion of admission eGFR<60 ml/min/1.73m2 and 48-72 h changes in NT-proBNP>30% were 50.5% and 32.8%, respectively. At a median follow-up of 1.75 years, 928 deaths were registered. In the whole sample, changes in renal function were not associated with mortality (p = 0.208). The adjusted analysis revealed that the risk of mortality related to ΔeGFR% was heterogeneous across baseline renal function and changes in NT-proBNP (p-value for interaction=0.003). ΔeGFR% was not associated with mortality in patients with baseline eGFR≥60 ml/min/1.73m2. In those with eGFR<60 ml/min/1.73m2, a decrease in eGFR was associated with higher mortality, particularly in those with a reduction in NT-proBNP<30%. CONCLUSION In patients with AHF, early ΔeGFR% was associated with the risk of long-term mortality only in patients with renal dysfunction on admission and no early decline in NT-proBNP.
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Affiliation(s)
- Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | | | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Oscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pere Llorens
- Emergency Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Arturo Carratalá
- Department of Clinical Chemistry, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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4
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Tagaya T, Hayashi H, Ogata S, Takahashi K, Koide S, Inaguma D, Hasegawa M, Yuzawa Y, Tsuboi N. Tolvaptan's Association with Low Risk of Acute Kidney Injury in Patients with Advanced Chronic Kidney Disease and Acute Decompensated Heart Failure. Am J Nephrol 2023; 54:319-328. [PMID: 37385233 DOI: 10.1159/000531692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Furosemide, a loop diuretic, is often empirically used to treat acute decompensated heart failure (ADHF) initially. Conversely, decongestion using tolvaptan, an aquaretic, is thought to maintain renal function compared to furosemide. However, it has not been investigated in patients with advanced chronic kidney disease (CKD) at high risk of developing acute kidney injury (AKI). This study aimed to investigate AKI incidence using tolvaptan add-on treatment, compared to increased furosemide treatment for patients with ADHF complicated by advanced CKD. METHODS We retrospectively studied patients with advanced CKD (estimated glomerular filtration rate [eGFR] <45 mL/min/1.73 m2) who developed ADHF under outpatient furosemide treatment. The exposure was set to tolvaptan add-on treatment, and the control was set to increased furosemide treatment. RESULTS Of the 163 patients enrolled, 79 were in the tolvaptan group and 84 in the furosemide group. The mean age was 71.6 years, the percentage of males was 63.8%, the mean eGFR was 15.7 mL/min/1.73 m2, and patients with CKD stage G5 were 61.9%. AKI incidence was 17.7% in the tolvaptan group and 42.9% in the furosemide group (odds ratio [95% confidence interval]: 0.34 [0.13-0.86], p = 0.023 in multivariate logistic regression analysis). Persistent AKI incidence was 11.8% in the tolvaptan group and 32.9% in the furosemide group (odds ratio [95% confidence interval]: 0.34 [0.10-1.06], p = 0.066 in the multinomial logit analysis). CONCLUSION This study suggests that tolvaptan may be better than furosemide in patients with ADHF experiencing complicated advanced CKD.
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Affiliation(s)
- Tomoki Tagaya
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Soshiro Ogata
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuo Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Biomedical Molecular Sciences, Fujita Health University school of Medicine, Toyoake, Japan
| | - Shigehisa Koide
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Daijo Inaguma
- Department of Internal Medicine, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
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Dutta A, Saha S, Bahl A, Mittal A, Basak T. A comprehensive review of acute cardio-renal syndrome: need for novel biomarkers. Front Pharmacol 2023; 14:1152055. [PMID: 37288107 PMCID: PMC10242013 DOI: 10.3389/fphar.2023.1152055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Cardiorenal syndrome represents a wide-spectrum disorder involving the heart and kidneys as the primary affected organs. India has an increasingly high burden of acute CRS, coinciding with the rise in global statistics. Up to 2022, approximately 46.1% of all cardiorenal patients have been diagnosed with acute CRS in India. Acute CRS involves a sudden deterioration of kidney functionalities, referred to as acute kidney injury (AKI) in acute heart failure patients. The pathophysiology of CRS involves hyperactivation of the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS) following acute myocardial stress. The pathological phenotype of acute CRS is associated with perturbed inflammatory, cellular, and neurohormonal markers in circulation. These complications increase the risk of mortality in clinically diagnosed acute CRS patients, making it a worldwide healthcare burden. Hence, effective diagnosis and early prevention are crucial to prevent the progression of CRS in AHF patients. Present biomarkers, such as serum creatinine (sCr), cystatin C (CysC), glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum and/or urine neutrophil gelatinase-associated lipocalin (NGAL), B-type natriuretic peptide (BNP), and NT-proBNP, are clinically used to diagnose AKI stages in CRS patients but are limitedly sensitive to the early detection of the pathology. Therefore, the need for protein biomarkers is emerging for early intervention in CRS progression. Here, we summarized the cardio-renal nexus in acute CRS, with an emphasis on the present clinicopathological biomarkers and their limitations. The objective of this review is to highlight the need for novel proteomic biomarkers that will curb the burgeoning concern and direct future research trials.
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Affiliation(s)
- Abhi Dutta
- School of Biosciences and Bioengineering, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
- BioX Center, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
| | - Shubham Saha
- School of Biosciences and Bioengineering, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
- BioX Center, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Mittal
- Department of Translational and Regenerative Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Trayambak Basak
- School of Biosciences and Bioengineering, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
- BioX Center, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
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6
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Lee HW, Huang CC, Yang CY, Leu HB, Huang PH, Wu TC, Lin SJ, Chen JW. Renal function during hospitalization and outcome in Chinese patients with acute decompensated heart failure: A retrospective study and literature review. Clin Cardiol 2023; 46:57-66. [PMID: 36345665 PMCID: PMC9849437 DOI: 10.1002/clc.23934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The heart and kidneys had demonstrated a bidirectional interaction that dysfunction of the heart or kidneys can induce dysfunction in the other organ. HYPOTHESIS Renal function and its decline during hospitalization may have impact on cardiovascular outcomes in patients with acute decompensated heart failure (ADHF). METHODS A total of 119 consecutive Chinese patients admitted for ADHF were prospectively enrolled. The course of renal function was presented with estimated glomerular filtration rate (eGFR), calculated by the four-variable equation proposed by the Modification of Diet in Renal Disease (MDRD) Study. Worsening renal function (WRF) was defined as eGFR decline between admission (eGFRadmission ) and predischarge (eGFRpredischarge ). Clinical outcomes were defined as 4P-major adverse cardiovascular events (4P-MACE), including the composition of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and nonfatal HF hospitalization. RESULTS During an average 2.6 ± 3.2 years follow-up, 66 patients (55%) experienced 4P-MACE. Patients with impaired eGFRpredischarge (<60 ml/min/1.73 m2 ) had more 4P-MACE than those with preserved eGFRpredischarge (64.7% vs. 43.1%, p = .019). The Kaplan-Meier survival curves showed significantly higher incidence of 4P-MACE in patients with impaired eGFRpredischarge than those with preserved eGFRpredischarge (p = .002). Cox regression analysis revealed that impaired eGFRpredischarge was significantly correlated with the development of 4P-MACE (hazard ratio, 2.003; 95% confidence interval, 1.072-3.744; p = .029). In contrast, outcomes would be similar with regard to eGFR on admission and eGFR decline during hospitalization. CONCLUSIONS Impaired renal function before discharge, but not impaired renal function on admission or WRF, is a significant risk factor for poor outcomes in patients with ADHF.
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Affiliation(s)
- Hao-Wei Lee
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Yu Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tao-Cheng Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
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7
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Houseman BS, Martinelli AN, Oliver WD, Devabhakthuni S, Mattu A. High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med 2023; 63:74-78. [PMID: 36327753 DOI: 10.1016/j.ajem.2022.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Sympathetic crashing acute pulmonary edema (SCAPE) is a medical emergency in which severe, acute elevation in blood pressure results in acute heart failure and fluid accumulation in the lungs. Without prompt recognition and treatment, the condition often progresses rapidly to respiratory failure necessitating intubation and intensive care unit (ICU) admission. In addition to non-invasive positive pressure ventilation (NIPPV), high-dose nitroglycerin (HDN) has become a mainstay of treatment; however, an optimal dosing strategy has not been established. OBJECTIVE The purpose of this study was to describe the characteristics and outcomes of patients who received an HDN infusion (≥ 100 μg/min) for the management of SCAPE in the Emergency Department (ED) of a large urban academic medical center. Outcomes were also analyzed to determine predictors of safety and efficacy including use of adjunct medication therapies. RESULTS There were 67 adult patients who received HDN infusion for SCAPE from January 1, 2018 to December 31, 2018. The median (IQR) systolic blood pressure (SBP) on initiation of HDN infusion was 211 (192-233) mmHg. Patients were 63% male, 84% black, 51% had a history of heart failure (HF), and 36% had end-stage renal disease (ESRD). IV nitroglycerin (NTG) was initiated at a median (IQR) dose of 100 (100-200) mcg/min with median (IQR) peak rate in the first hour of 200 (127.5-200) mcg/min and an absolute maximum observed rate of 400 μg/min overall. 73% of patients received NIPPV, 48% sublingual (SL) or IV bolus nitroglycerin before HDN infusion, 58% loop diuretic, and 34% angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB). Rates of ICU admission, intubation, acute kidney injury (AKI) at 48 h, and hypotension were 37%, 21%, 13%, and 4% respectively. CONCLUSION This is the largest to date study describing the use of an HDN infusion (≥100 μg/min) strategy for the management of SCAPE. HDN infusion may be a safe alternative strategy to intermittent bolus HDN.
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Affiliation(s)
- Brandon S Houseman
- Department of Pharmacy, The University of Maryland Medical Center, Baltimore, MD, United States of America
| | - Ashley N Martinelli
- Department of Pharmacy, The University of Maryland Medical Center, Baltimore, MD, United States of America.
| | - Wesley D Oliver
- Department of Pharmacy, The University of Maryland Medical Center, Baltimore, MD, United States of America
| | - Sandeep Devabhakthuni
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States of America
| | - Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
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8
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Liu J, Hefni ME, Witthöft CM, Bergström M, Burleigh S, Nyman M, Hållenius F. On the effect of flavonoids and dietary fibre in lingonberries on atherosclerotic plaques, lipid profiles and gut microbiota composition in Apoe-/- mice. Int J Food Sci Nutr 2022; 73:1080-1090. [PMID: 35930435 DOI: 10.1080/09637486.2022.2106358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
It has not been clarified whether the anti-atherosclerotic effect of lingonberry can be ascribed to its content of flavonoids or dietary fibre or both. The aim of this study was to evaluate the metabolic effects of whole lingonberries compared with isolated flavonoid and fibre fractions on atherosclerotic plaques, plasma lipid profiles, gut microbiota and microbiota-dependent metabolites in an Apoe-/- mouse model. Mice fed whole lingonberries showed the lowest amount of atherosclerotic plaques, while mice fed the fibre fraction had the highest formation of caecal butyric acid. Flavonoids, rather than dietary fibre, were suggested to be the components that favour proliferation of Akkermansia, as judged by the lowest abundance of this bacterium in mice fed the fibre fraction. All groups fed lingonberry diets had both, lower Firmicutes/Bacteroidetes ratios and creatinine concentrations, compared with the control. To conclude, different components in lingonberries are associated with different physiological effects in Apoe-/- mice.
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Affiliation(s)
- Jiyun Liu
- Department of Chemistry and Biomedical Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Mohammed E Hefni
- Department of Chemistry and Biomedical Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,Food Industries Department, Faculty of Agriculture, Mansoura University, Mansoura, Egypt
| | - Cornelia M Witthöft
- Department of Chemistry and Biomedical Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Maria Bergström
- Department of Chemistry and Biomedical Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Stephen Burleigh
- Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden
| | - Margareta Nyman
- Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden
| | - Frida Hållenius
- Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden
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9
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Jang SY, Yang DH. Prognostic and Therapeutic Implications of Renal Insufficiency in Heart Failure. INTERNATIONAL JOURNAL OF HEART FAILURE 2022; 4:75-90. [PMID: 36263106 PMCID: PMC9383346 DOI: 10.36628/ijhf.2021.0039] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022]
Abstract
The heart and kidneys are closely related vital organs that significantly affect each other. Cardiorenal syndrome is the term depicting the various spectra of cardiorenal interaction mediated by the hemodynamic, neurohormonal, and biochemical cross-talk between these two organs. In patients with heart failure (HF), both the baseline and worsening renal function are closely related to prognosis. However, for both investigational and clinical purposes, the unified definition and classification of renal injury are still necessary. Renal insufficiency is caused by multiple factors, and categorizing them into monogenous subgroups of phenotype is difficult. Various clinical scenarios related to the chronicity of HF, progression of renal dysfunction, and issues related to pharmacologic therapies associated with the prognosis of patients with HF have been reviewed in this study.
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Affiliation(s)
- Se Yong Jang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Divison of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Divison of Cardiology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Divison of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Divison of Cardiology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
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10
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Liu J, Hefni ME, Witthöft CM, Bergström M, Burleigh S, Nyman M, Hållenius F. Effects of Whole Brown Bean and Its Isolated Fiber Fraction on Plasma Lipid Profile, Atherosclerosis, Gut Microbiota, and Microbiota-Dependent Metabolites in Apoe-/- Mice. Nutrients 2022; 14:nu14050937. [PMID: 35267913 PMCID: PMC8912725 DOI: 10.3390/nu14050937] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 12/21/2022] Open
Abstract
The health benefits of bean consumption are widely recognized and are largely attributed to the dietary fiber content. This study investigated and compared the effects of whole brown beans and an isolated bean dietary fiber fraction on the plasma lipid profile, atherosclerotic plaque amount, gut microbiota, and microbiota-dependent metabolites (cecal short-chain fatty acids (SCFAs) and plasma methylamines) in Apoe−/− mice fed high fat diets for 10.5 weeks. The results showed that both whole bean and the isolated fiber fraction had a tendency to lower atherosclerotic plaque amount, but not plasma lipid concentration. The whole bean diet led to a significantly higher diversity of gut microbiota compared with the high fat diet. Both bean diets resulted in a lower Firmicutes/Bacteroidetes ratio, higher relative abundance of unclassified S24-7, Prevotella, Bifidobacterium, and unclassified Clostridiales, and lower abundance of Lactobacillus. Both bean diets resulted in higher formation of all cecal SCFAs (higher proportion of propionic acid and lower proportion of acetic acid) and higher plasma trimethylamine N-oxide concentrations compared with the high fat diet. Whole beans and the isolated fiber fraction exerted similar positive effects on atherosclerotic plaque amount, gut microbiota, and cecal SCFAs in Apoe−/− mice compared with the control diets.
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Affiliation(s)
- Jiyun Liu
- Department of Chemistry and Biomedical Sciences, Faculty of Health and Life Sciences, Linnaeus University, 39231 Kalmar, Sweden; (M.E.H.); (C.M.W.); (M.B.)
- Correspondence: ; Tel.: +46-072-451-6957
| | - Mohammed E. Hefni
- Department of Chemistry and Biomedical Sciences, Faculty of Health and Life Sciences, Linnaeus University, 39231 Kalmar, Sweden; (M.E.H.); (C.M.W.); (M.B.)
- Food Industries Department, Faculty of Agriculture, Mansoura University, Mansoura 35516, Egypt
| | - Cornelia M. Witthöft
- Department of Chemistry and Biomedical Sciences, Faculty of Health and Life Sciences, Linnaeus University, 39231 Kalmar, Sweden; (M.E.H.); (C.M.W.); (M.B.)
| | - Maria Bergström
- Department of Chemistry and Biomedical Sciences, Faculty of Health and Life Sciences, Linnaeus University, 39231 Kalmar, Sweden; (M.E.H.); (C.M.W.); (M.B.)
| | - Stephen Burleigh
- Department of Food Technology, Engineering and Nutrition, Lund University, 22100 Lund, Sweden; (S.B.); (M.N.); (F.H.)
| | - Margareta Nyman
- Department of Food Technology, Engineering and Nutrition, Lund University, 22100 Lund, Sweden; (S.B.); (M.N.); (F.H.)
| | - Frida Hållenius
- Department of Food Technology, Engineering and Nutrition, Lund University, 22100 Lund, Sweden; (S.B.); (M.N.); (F.H.)
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11
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Chen WC, Lin MH, Chen CL, Lai YC, Chen CY, Lin YC, Hung CC. Comprehensive Comparison of the Effect of Inotropes on Cardiorenal Syndrome in Patients with Advanced Heart Failure: A Network Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:4120. [PMID: 34575231 PMCID: PMC8471363 DOI: 10.3390/jcm10184120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022] Open
Abstract
Prevention of cardiorenal syndrome through treatment with inotropic agents remains challenging. This network meta-analysis evaluated the safety and renoprotective effects of inotropes on patients with advanced heart failure (HF) using a frequentist random-effects model. A systematic database search was performed until 31 January 2021, and a total of 37 trials were included. Inconsistency, publication bias, and subgroup analyses were conducted. The levosimendan group exhibited significantly decreased mortality compared with the control (odds ratio (OR): 0.62; 95% confidence interval (CI): 0.46-0.84), milrinone (OR: 0.50; 95% CI: 0.30-0.84), and dobutamine (OR: 0.75; 95% CI: 0.57-0.97) groups. In terms of renal protection, levosimendan (standardized mean difference (SMD): 1.67; 95% CI: 1.17-2.18) and dobutamine (SMD: 1.49; 95% CI: 0.87-2.12) more favorably improved the glomerular filtration rate (GFR) than the control treatment did, but they did not significantly reduce the incidence of acute kidney injury. Furthermore, levosimendan had the highest P-score, indicating that it most effectively reduced mortality and improved renal function (e.g., GFR and serum creatinine level), even in patients with renal insufficiency. In conclusion, levosimendan is a safe alternative for protecting renal function on cardiorenal syndrome in patients with advanced HF.
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Affiliation(s)
- Wei-Cheng Chen
- Graduate Institute of Biomedical Sciences, China Medical University, 91 Hsueh-Shih Road, Taichung 404333, Taiwan;
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, Taiwan; (C.-L.C.); (C.-Y.C.)
- Department of Education, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, Taiwan
| | - Meng-Hsuan Lin
- Department of Pharmacy, College of Pharmacy, China Medical University, 100 Jingmao Road, Bei-tun Dist., Taichung 406040, Taiwan;
| | - Chieh-Lung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, Taiwan; (C.-L.C.); (C.-Y.C.)
| | - Yi-Ching Lai
- Department of Cardiovascular Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, Taiwan;
| | - Chih-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, Taiwan; (C.-L.C.); (C.-Y.C.)
| | - Yu-Chao Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, 2 Yude Road, North Dist., Taichung 404332, Taiwan; (C.-L.C.); (C.-Y.C.)
- School of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung 404333, Taiwan
| | - Chin-Chuan Hung
- Department of Pharmacy, College of Pharmacy, China Medical University, 100 Jingmao Road, Bei-tun Dist., Taichung 406040, Taiwan;
- Department of Pharmacy, China Medical University Hospital, 2 Yude Road, Taichung 404332, Taiwan
- Department of Healthcare Administration, Asia University, 500 Lioufeng Road, Wufeng, Taichung 41354, Taiwan
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12
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Villacorta H, Villacorta AS, Villacorta LSDC, Xavier AR, Kanaan S, Rohen FM, Albuquerque LD, Bastilho DD, Cudischevitch CDO. Worsening Renal Function and Congestion in Patients with Acute Heart Failure: A Study with Bioelectrical Impedance Vector Analysis (BIVA) and Neutrophil Gelatinase-Associated Lipocalin (NGAL). Arq Bras Cardiol 2021; 116:715-724. [PMID: 33886716 PMCID: PMC8121398 DOI: 10.36660/abc.20190465] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/26/2019] [Indexed: 01/20/2023] Open
Abstract
Fundamento: O agravamento da função renal (AFR) é frequentemente observado na terapia agressiva com diuréticos para o tratamento de insuficiência cardíaca aguda descompensada (ICAD) e está associado com piores desfechos em alguns estudos. Objetivo: Avaliar a relação de AFR e congestão na alta hospitalar com ocorrência de eventos (morte cardíaca ou internação por insuficiência cardíaca). Métodos: Oitenta pacientes com ICAD foram estudados. O AFR foi definido por um aumento absoluto (≥0,5 mg/dL) nos níveis séricos de creatinina a partir dos valores obtidos na admissão. Concentrações de peptídeo natriurético do tipo B (BNP) e lipocalina associada à gelatinase neutrofílica (NGAL) foram medidas na admissão e na alta hospitalar. Congestão foi avaliada na alta utilizando a análise vetorial de bioimpedância elétrica (BIVA). O desfecho primário foi o tempo para o primeiro evento, definido como uma combinação de morte cardíaca ou hospitalização por insuficiência cardíaca. Análise de curva Característica de Operação do Receptor (curva ROC) foi realizada para determinar o ponto de corte de IH mais adequado para predição de eventos. Curvas Kaplan-Meier de sobrevida livre de eventos foram construídas e comparadas usando o teste de log-rank. Modelos de riscos proporcionais de Cox foram usados para investigar a associação com eventos. O critério para se estabelecer significância estatística foi um p<0.05. Resultados: A idade média foi 60,6 ± 15,0 anos, e 48 (60%) pacientes eram do sexo masculino. A fração de ejeção média foi 35,3±7,8%. O AFR ocorreu em 37,5% da amostra. A creatinina basal associou-se com AFR (p<0,001), mas nem BNP (p=0,35) nem NGAL (p=0,18) na admissão foram preditores de AFR. Usando modelos de riscos proporcionais de Cox, o índice de hidratação na alta, estimado por BIVA, associou-se significativamente com ocorrência de eventos (HR 1,39; IC95% 1,25-1,54, p<0,0001), mas não com AFR (HR 2,14; IC95% 0,62-7,35, p=0,22). Conclusão: A congestão persistente na alta associou-se com piores desfechos. O AFR parece estar relacionado com alterações hemodinâmicas durante o processo de descongestionamento, mas não com lesões renais.
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Affiliation(s)
| | | | | | | | - Salim Kanaan
- Universidade Federal Fluminense, Niterói, RJ - Brasil
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13
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Okina Y, Miura T, Senda K, Taki M, Kobayashi M, Kanai M, Okuma Y, Yanagisawa T, Hashizume N, Otagiri K, Shoin K, Watanabe N, Ebisawa S, Karube K, Nakajima H, Saigusa T, Miyashita Y, Kashiwagi D, Machida K, Abe N, Tachibana T, Kanzaki Y, Maruyama T, Nomi H, Sakai T, Yui H, Mochidome T, Kobayashi T, Kasai T, Ikeda U, Kuwahara K. Prognostic ability of mid-term worsening renal function after percutaneous coronary intervention: findings from the SHINANO registry. Heart Vessels 2021; 36:1496-1505. [PMID: 33825976 PMCID: PMC8379120 DOI: 10.1007/s00380-021-01837-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/15/2021] [Indexed: 12/03/2022]
Abstract
Chronic kidney disease is a prognostic factor for cardiovascular disease. Worsening renal function (WRF), specifically, is an important predictor of mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). We evaluate the prognostic impact of mid-term WRF after PCI on future cardiovascular events. We examined the renal function data of 1086 patients in the first year after PCI using the SHINANO 5-year registry. Patients were divided into two groups, mid-term WRF and non-mid-term WRF, and primary outcomes were major adverse cardiovascular events (MACE) and death. Mid-term WRF was defined as an increase in creatinine (≥ 0.3 mg/dL) in the first year after PCI. Mid-term WRF was found in 101 patients (9.3%), and compared to non-mid-term WRF, it significantly increased the incidence of MACE (p < 0.001), and all-cause death (p < 0.001), myocardial infarction (p = 0.001). Furthermore, mid-term WRF patients had higher incidence of future heart failure (p < 0.001) and new-onset atrial fibrillation (p = 0.01). Patients with both mid-term WRF and chronic kidney disease had increased MACE compared to patients with either condition alone (p < 0.001). Similarly, patients with mid-term WRF and acute kidney injury had increased MACE compared to patients with either condition alone (p < 0.001). Multivariate Cox regression analysis revealed mid-term WRF as a strong predictor of MACE (hazard ratio: 2.50, 95% confidence interval 1.57–3.98, p < 0.001). Mid-term WRF after PCI negatively affects MACE, as well as future admission due to heart failure and new-onset atrial fibrillation, chronic kidney disease, and acute kidney injury.
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Affiliation(s)
- Yoshiteru Okina
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan.
| | - Takashi Miura
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Keisuke Senda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Minami Taki
- Department of Cardiology, Shinshu Ueda Medical Center, Ueda, Japan
| | | | - Masafumi Kanai
- Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | - Yukari Okuma
- Epartment of Cardiology, Suwa Red Cross Hospital, Suwa, Japan
| | | | - Naoto Hashizume
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | | | - Kyoko Shoin
- Department of Cardiology, Aizawa Hospital, Matsumoto, Japan
| | - Noboru Watanabe
- Department of Cardiology, Hokushin General Hospital, Nagano, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Kenichi Karube
- Department of Cardiology, Okaya Municipal Hospital, Okaya, Japan
| | - Hiroyuki Nakajima
- Department of Cardiology, Matsushiro General Hospital, Nagano, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Yusuke Miyashita
- Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | - Daisuke Kashiwagi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | | | - Naoyuki Abe
- Department of Cardiology, Nagano Red Cross Hospital, Nagano, Japan
| | | | - Yusuke Kanzaki
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Takuya Maruyama
- Department of Cardiology, Shinonoi General Hospital, Nagano, Japan
| | - Hidetomo Nomi
- Department of Cardiology, Saku Central Hospital, Saku, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Tomoaki Mochidome
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Takahiro Kobayashi
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Toshio Kasai
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Uichi Ikeda
- Department of Cardiology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-0006, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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14
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Deferrari G, Cipriani A, La Porta E. Renal dysfunction in cardiovascular diseases and its consequences. J Nephrol 2021; 34:137-153. [PMID: 32870495 PMCID: PMC7881972 DOI: 10.1007/s40620-020-00842-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
It is well known that the heart and kidney and their synergy is essential for hemodynamic homeostasis. Since the early XIX century it has been recognized that cardiovascular and renal diseases frequently coexist. In the nephrological field, while it is well accepted that renal diseases favor the occurrence of cardiovascular diseases, it is not always realized that cardiovascular diseases induce or aggravate renal dysfunctions, in this way further deteriorating cardiac function and creating a vicious circle. In the same clinical field, the role of venous congestion in the pathogenesis of renal dysfunction is at times overlooked. This review carefully quantifies the prevalence of chronic and acute kidney abnormalities in cardiovascular diseases, mainly heart failure, regardless of ejection fraction, and the consequences of renal abnormalities on both organs, making cardiovascular diseases a major risk factor for kidney diseases. In addition, with regard to pathophysiological aspects, we attempt to substantiate the major role of fluid overload and venous congestion, including renal venous hypertension, in the pathogenesis of acute and chronic renal dysfunction occurring in heart failure. Furthermore, we describe therapeutic principles to counteract the major pathophysiological abnormalities in heart failure complicated by renal dysfunction. Finally, we underline that the mild transient worsening of renal function after decongestive therapy is not usually associated with adverse prognosis. Accordingly, the coexistence of cardiovascular and renal diseases inevitably means mediating between preserving renal function and improving cardiac activity to reach a better outcome.
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Affiliation(s)
- Giacomo Deferrari
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Via Mario Puchoz 25, 16035, Rapallo, GE, Italy.
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy.
| | - Adriano Cipriani
- Grown-Up Congentital Heart Disease Center (GUCH Center), Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Rapallo, GE, Italy
| | - Edoardo La Porta
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Via Mario Puchoz 25, 16035, Rapallo, GE, Italy
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy
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15
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Clinical Impact of Worsening Renal Function in Elderly Patients with Acute Decompensated Heart Failure. INTERNATIONAL JOURNAL OF HEART FAILURE 2021; 3:128-137. [PMID: 36262877 PMCID: PMC9536691 DOI: 10.36628/ijhf.2020.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 01/08/2023]
Abstract
Background and Objectives The clinical significance of worsening renal function (WRF) in elderly patients with acute decompensated heart failure (ADHF) is not completely understood. We compared the clinical conditions between younger and elderly patients with ADHF after the appearance of WRF to establish its prognostic influence. Methods We included 654 consecutive patients (37% women) admitted for ADHF. We divided the patients into four groups according to their age (<80 years, under-80, n=331; ≥80 years, over-80, n=323) and to their WRF statuses (either WRF or non-WRF group). We defined WRF as an increase in serum creatinine level ≥0.3 mg/dL or ≥150% within 48 hours after hospital arrival (under-80, n=62; over-80, n=75). The primary endpoint was a composite of cardiac events within 1 year. Results The survival analyses revealed that the WRF group had significantly more cardiac events than the non-WRF group in patients in the over-80 group (log-rank p=0.025), but not in those of the under-80 group (log-rank p=0.50). The patients in the over-80, WRF group presented more significant mean blood pressure (MBP) drops than those in the over-80 non-WRF group (p=0.003). Logistic regression analyses revealed that higher MBP at admission was a significant predictor of WRF. Conclusions WRF is a predictor of poor outcomes in elderly patients with ADHF.
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16
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Feng S, Janwanishstaporn S, Teerlink JR, Metra M, Cotter G, Davison B, Felker GM, Filippatos G, Pang P, Ponikowski P, Sama IE, Voors AA, Greenberg B. Association of left ventricular ejection fraction with worsening renal function in patients with acute heart failure: insights from the RELAX-AHF-2 study. Eur J Heart Fail 2020; 23:58-67. [PMID: 32964537 DOI: 10.1002/ejhf.2012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/12/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Whether risk of worsening renal function (WRF) during acute heart failure (AHF) hospitalization or the association between in-hospital WRF and post-discharge outcomes vary according to left ventricular ejection fraction (LVEF) is uncertain. We assessed incidence of WRF, factors related to its development and impact of WRF on post-discharge outcomes across the spectrum of LVEF in patients enrolled in RELAX-AHF-2. METHODS AND RESULTS A total of 6112 patients who had LVEF measured on admission and renal function determined prospectively during hospitalization were included. WRF, defined as a rise in serum creatinine ≥0.3 mg/dL from baseline through day 5, occurred in 1722 patients (28.2%). Incidence increased progressively from lowest to highest LVEF quartile (P < 0.001). After baseline adjustment, WRF risk in Q4 (LVEF >50%) remained significantly greater than in Q1 (LVEF ≤29%; hazard ratio 1.2, 95% confidence interval 1-1.43; P = 0.050). Age and comorbidity burden including chronic kidney disease increased as LVEF increased. Neither admission haemodynamic abnormalities, extent of diuresis during hospitalization nor residual congestion explained the increased incidence of WRF in patients with higher LVEF. Serelaxin treatment and diuretic responsiveness were associated with reduced risk of WRF in all LVEF quartiles. WRF in patients in the upper three LVEF quartiles increased risk of post-discharge events. CONCLUSIONS Worsening renal function incidence during AHF hospitalization increases progressively with LVEF. Greater susceptibility of patients with higher LVEF to WRF appears more related to their advanced age and worse underlying kidney function rather than haemodynamic or treatment effects. WRF is associated with increased risk of post-discharge events except in patients in the lowest LVEF quartile.
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Affiliation(s)
- Siting Feng
- Division of Cardiology, University of California, San Diego, CA, USA.,Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Satit Janwanishstaporn
- Division of Cardiology, University of California, San Diego, CA, USA.,Faculty of Medicine Siriraj Hospital, Mahidol University, Salaya, Thailand
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, CA, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Gerasimos Filippatos
- School of Medicine, University of Cyprus, Nicosia, Cyprus.,National and Kapidistrian University of Athens, School of Medicine, Athens, Greece
| | - Peter Pang
- Department of Emergency Medicine, Indiana University School of Medicine, and the Regenstrief Institute, Indianapolis, IN, USA
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wrocław, Poland
| | - Iziah E Sama
- University of Groningen, Groningen, The Netherlands
| | | | - Barry Greenberg
- Division of Cardiology, University of California, San Diego, CA, USA
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17
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Sahin E, Gökçay Bek S, Eren N, Karauzum I, Ergul M, Yildiz N, Sahin T, Dervisoglu E, Kalender B. Usefulness of Peritoneal Ultrafiltration in Patients with Diuretic Resistant Heart Failure without End-Stage Renal Disease. Cardiorenal Med 2020; 10:429-439. [PMID: 33022682 DOI: 10.1159/000510249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/11/2020] [Indexed: 11/19/2022] Open
Abstract
AIM This study aimed to explore the role of peritoneal ultrafiltration (UF) in cardiorenal syndrome (CRS) patients for fluid and metabolic control. BACKGROUND Peritoneal UF is safely and efficiently used for the management of CRS. It has been shown to provide efficient UF in hypervolemic patients. METHODS Thirty (20 males and 10 females) CRS patients were treated by peritoneal dialysis (PD) and UF. The baseline data of the patients (demographics, causes of heart failure, the presence of pacemaker or implantable cardioverter-defibrillator, the need for extracorporeal UF or paracentesis or thoracentesis, comorbidity, drugs, left ventricular ejection fraction [LVEF] and pulmonary artery systolic pressure [PAPs], pericardial effusion, physical examination, body weight, NYHA class, dialysis regime, urine output, N-terminal pro-B-type natriuretic peptide [NT-proBNP] level, hemoglobin, estimated glomerular filtration rate [eGFR], and other routine biochemical determinations) were recorded at the onset, every 6 months, and then annually. Echocardiograms were performed at baseline and after 6 and 12 months. The time points of complications associated with PD, the need for hemodialysis, the day of death, and causes of death were documented. RESULTS Mean age was 69 ± 8 years (range 49-84 years). The average PD duration was 18.25 ± 14.87 months. According to the CKD-EPI, initial mean GFR was 34.34 ± 11.9 mL/min/1.73 m2 (range 16.57-59.0), and this increased to 45.48 ± 26.04, 45.10 ± 28.58, and 41.10 ± 25.68 mL/min/1.73 m2 in the third, sixth, and twelfth months, respectively. There was a significant increase in the first 3 months and a significant decrease between the third and twelfth months (respectively, p = 0.018 and p = 0.043). There was no difference in eGFR levels between baseline and the end of the first year (p = 0.217). In the first 3 months, there was a significant decline in urea levels to 79.38 ± 36.65 from 109.92 ± 42.44 mg/dL and this was maintained until the end of the first year of PD therapy (after 3 months, p = 0.002; after 1 year, p = 0.024). However, there was no significant change in creatinine levels within the first year (p = 0.312). There was a significant increase in hemoglobin level up to the end of the first year of PD (after 3 months, p = 0.000; after 12 months, p = 0.013). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). Functional capacity (according to NYHA classification) improved in all patients by the third month of PD treatment (p < 0.001). This early improvement was maintained in many patients during the following 12 months (p < 0.001). There was a marked decrease in NT-proBNP levels in the first 6 months (p = 0.011). At the end of the first year, there was an approximate 15% reduction in NT-proBNP levels (p = 0.647). Hospitalizations decreased to 6 ± 15 days/patient-year (range 18-122 days) from 62 ± 24 days/patient-year (p = 0.000). CONCLUSION Peritoneal UF is a treatment method that maintains renal function and electrolyte balance, improves cardiac function, and reduces hospitalizations in CRS patients. We observed that this treatment significantly increased functional capacity and quality of life and significantly reduced hospital admissions.
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Affiliation(s)
- Elif Sahin
- Internal Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Necmi Eren
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Irem Karauzum
- Cardiology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Metin Ergul
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Nuriye Yildiz
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
| | - Tayfun Sahin
- Cardiology, Kocaeli University Hospital, Kocaeli, Turkey
| | | | - Betul Kalender
- Nephrology, Kocaeli University Hospital, Kocaeli, Turkey
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18
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Feola M, Rossi A, Testa M, Ferreri C, Palazzuoli A, Pastorini G, Ruocco G. Six-Month Predictive Value of Diuretic Resistance Formulas in Discharged Heart Failure Patients after an Acute Decompensation. J Clin Med 2020; 9:jcm9092932. [PMID: 32932794 PMCID: PMC7564613 DOI: 10.3390/jcm9092932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background. The diuretic response has been shown to be a robust independent marker of cardiovascular outcomes in acute heart failure patients. The objectives of this clinical research are to analyze two different formulas (diuretic response (DR) or response to diuretic (R-to-D)) in predicting 6-month clinical outcomes. Methods: Consecutive patients discharged alive after an acute decompensated heart failure (ADHF) were enrolled. All patients underwent N-terminal-pro hormone BNP (NT-proBNP) and an echocardiogram together with DR and R-to-D calculation during diuretic administration. Death by any cause, cardiac transplantation and worsening heart failure (HF) requiring readmission to hospital were considered cardiovascular events. Results: 263 patients (62% male, age 78 years) were analyzed at 6-month follow-up. During the follow-up 58 (22.05%) events were scheduled. Patients who experienced CV-event had a worse renal function (p = 0.001), a higher NT-proBNP (p = 0.001), a lower left ventricular ejection fraction (p = 0.01), DR (p = 0.02) and R-to-D (p = 0.03). Spearman rho’s correlation coefficient showed a strong direct correlation between DR and R to D in all patients (r = 0.93; p < 0.001) and both in heart failure with reduced ejection fraction (HFrEF) (r = 0.94; p < 0.001) and HF preserved ejection fraction (HFpEF) (r = 0.91; p < 0.001). At multivariate analysis, a value of R-to-D <1.69 kg/40 mg, but only <0.67 kg/40 mg for DR were significantly related to poor 6-month outcome (p = 0.04 and p = 0.05, respectively). Receiver operating characteristic (ROC) curve analyses demonstrated that DR and R-to-D are equivalent in predicting prognosis (area under curve (AUC): 0.39 and 0.40, respectively). Only R-to-D was inversely related to in-hospital stay (r = −0.23; p = 0.01). Conclusion: Adding diuresis to DR seemed to provide a better risk assessment in alive HF patients discharged after an acute decompensation.
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Affiliation(s)
- Mauro Feola
- Cardiology Division, Ospedale Regina Montis Regalis, Mondovi’ ASL CN1, 12084 Cuneo, Italy; (M.T.); (C.F.); (G.P.); (G.R.)
- Correspondence: ; Fax: +39-0174677306
| | - Arianna Rossi
- School of Geriatry, Universita’ degli Studi Torino, 10124 Torino, Italy;
| | - Marzia Testa
- Cardiology Division, Ospedale Regina Montis Regalis, Mondovi’ ASL CN1, 12084 Cuneo, Italy; (M.T.); (C.F.); (G.P.); (G.R.)
| | - Cinzia Ferreri
- Cardiology Division, Ospedale Regina Montis Regalis, Mondovi’ ASL CN1, 12084 Cuneo, Italy; (M.T.); (C.F.); (G.P.); (G.R.)
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Ospedale Le Scotte Universita’ Siena, 53100 Siena, Italy;
| | - Guido Pastorini
- Cardiology Division, Ospedale Regina Montis Regalis, Mondovi’ ASL CN1, 12084 Cuneo, Italy; (M.T.); (C.F.); (G.P.); (G.R.)
| | - Gaetano Ruocco
- Cardiology Division, Ospedale Regina Montis Regalis, Mondovi’ ASL CN1, 12084 Cuneo, Italy; (M.T.); (C.F.); (G.P.); (G.R.)
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La Franca E, Manno G, Ajello L, Di Gesaro G, Minà C, Visconti C, Bellavia D, Falletta C, Romano G, Dell' Oglio S, Licata P, Caronia A, Gallo M, Clemenza F. Physiopathology and Diagnosis of Congestive Heart Failure: Consolidated Certainties and New Perspectives. Curr Probl Cardiol 2020; 46:100691. [PMID: 33012532 DOI: 10.1016/j.cpcardiol.2020.100691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 12/01/2022]
Abstract
Volume overload and fluid congestion are a fundamental issue in the assessment and management of patients with heart failure (HF). Recent studies have found that in acute decompensated heart failure (ADHF), right and left-sided pressures generally start to increase before any notable weight changes take place preceding an admission. ADHF may be a problem of volume redistribution among different vascular compartments instead of, or in addition to, fluid shift from the interstitial compartment. Thus, identifying heterogeneity of volume overload would allow guidance of tailored therapy. A comprehensive evaluation of congestive HF needs to take into account myriad parameters, including physical examination, echocardiographic values, and biomarker serum changes. Furthermore, potentially useful diagnostic tools include bioimpedance to measure intercompartmental fluid shifts, and evaluation of ultrasound lung comets to detect extravascular lung water.
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Bouabdallaoui N, Beaubien-Souligny W, Denault AY, Rouleau JL. Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure. ESC Heart Fail 2020; 7:1723-1734. [PMID: 32400036 PMCID: PMC7373894 DOI: 10.1002/ehf2.12732] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/10/2020] [Accepted: 04/03/2020] [Indexed: 12/24/2022] Open
Abstract
Aims Venous congestion is a major determinant of worsening renal function (WRF) in acute decompensated heart failure (ADHF), particularly when associated with right ventricular (RV) dysfunction. Whether the individual impacts of hemodynamic variables on renal outcomes in ADHF is modified according to RV function remains unclear. We aimed to determine the association between hemodynamic parameters and early changes in renal function during depletive therapy and explore the association of these changes with clinical outcomes. Methods and results WRF was defined as any increase in creatinine after 24 h of depletive therapy and improvement in renal function (IRF) as any decrease. Assessments were prospectively obtained on admission, 24 h later and at discharge. Out of the 105 patients enrolled, 45% had IRF, and 41% had poor RV. At baseline, patients evolving towards IRF had a lower mean arterial pressure (84.7 ± 13.9 vs. 90.9 ± 15.2 mmHg), a lower renal perfusion pressure (69.4 ± 16.2 vs. 75.4 ± 15.1 mmHg), and a poorer RV function (tricuspid annular plan systolic excursion 16.5 ± 6.0 vs. 18.8 ± 5.6 mm) in comparison with those with WRF (all P < 0.05). In a multivariate linear regression model, tricuspid annular plane systolic excursion was the dominant parameter correlated with early changes in creatinine when RV was poor (β = 0.337), whereas mean arterial pressure (β = −0.334) and cardiac output (β = −0.298) were the only parameters correlated with renal function in patients with preserved RV function (all P < 0.05). RV dysfunction, but not early changes in renal function, was associated with post‐discharge clinical events. Conclusions RV dysfunction is a predictor of an early but transient progression to IRF during depletive therapy. RV dysfunction modifies the individual impact of various hemodynamic variables on the early trajectory of renal function in ADHF.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Medicine of the Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - William Beaubien-Souligny
- Department of Nephrology, Centre Hospitalier de l'université de Montréal (CHUM), Montreal, Québec, Canada
| | - André Y Denault
- Department of Anesthesia and Critical Care of the Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Jean L Rouleau
- Department of Medicine of the Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
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Long B, Koyfman A, Gottlieb M. Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review. West J Emerg Med 2019; 20:875-884. [PMID: 31738714 PMCID: PMC6860389 DOI: 10.5811/westjem.2019.9.43732] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023] Open
Abstract
Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure. Acute heart failure is the gradual or rapid decompensation of heart failure, resulting from either fluid overload or maldistribution. Typical symptoms can include dyspnea, orthopnea, or systemic edema. The physical examination may reveal pulmonary rales, an S3 heart sound, or extremity edema. However, physical examination findings are often not sensitive or specific. ED assessments may include electrocardiogram, complete blood count, basic metabolic profile, liver function tests, troponin, brain natriuretic peptide, and a chest radiograph. While often used, natriuretic peptides do not significantly change ED treatment, mortality, or readmission rates, although they may decrease hospital length of stay and total cost. Chest radiograph findings are not definitive, and several other conditions may mimic radiograph findings. A more reliable modality is point-of-care ultrasound, which can facilitate the diagnosis by assessing for B-lines, cardiac function, and inferior vena cava size. These modalities, combined with clinical assessment and gestalt, are recommended.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Alex Koyfman
- University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Clinical impacts of changes of renal function during hospitalization depend on grades of renal dysfunction in acute decompensated heart failure. Heart Vessels 2019; 35:509-520. [PMID: 31560111 DOI: 10.1007/s00380-019-01511-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/20/2019] [Indexed: 12/12/2022]
Abstract
Clinical impact of changes of renal function (RF) in heart failure (HF) hospitalization is controversial. This study aimed to clarify whether clinical impact of changes of RF during HF hospitalization depends on the intrinsic RF. In 786 hospitalized HF patients, RF were classified into 3 grades based on estimated glomerular filtration rate (eGFR, mL/min/1.73 m2) at discharge; ≥ 60 (n = 243), < 60 and ≥ 30 (n = 400), and < 30 (n = 143). Increase and decrease of serum creatinine over 0.3 mg/dL during HF hospitalization were defined as worsening renal function (WRF) and improved renal function (IRF), respectively, and remaining subjects were defined as stable RF. The primary endpoint was a composite of cardiovascular death and rehospitalization for HF. In all patients, WRF was not associated with clinical outcomes, although eGFR has a significant association with prognosis. Clinical outcomes did not differ between changes of RF patterns in both preserved and severely impaired RF groups. In contrast, IRF, not WRF, was an independent predictor of clinical outcomes in the moderately impaired RF group (HR 1.965, 95% CI 1.09-3.18, p = 0.01). Only in patients with moderately impaired RF, changes of RF were associated with clinical outcome, and IRF was an independent predictor of clinical outcomes.
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Hollenberg SM, Warner Stevenson L, Ahmad T, Amin VJ, Bozkurt B, Butler J, Davis LL, Drazner MH, Kirkpatrick JN, Peterson PN, Reed BN, Roy CL, Storrow AB. 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2019; 74:1966-2011. [PMID: 31526538 DOI: 10.1016/j.jacc.2019.08.001] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Acute kidney injury in acute decompensated heart failure leads to increased readmissions regardless of being transient or sustained at the time of discharge. Timely identification of acute kidney injury and worsening heart failure in patients with acute decompensated heart failure is of utmost importance to optimize different components of heart failure treatment. Acute kidney injury is a strong predictor of poor outcomes and early death in patients with pulmonary artery hypertension and acute right-sided heart failure. Extracorporeal ultrafiltration should not be used as an initial or alternative to diuretic therapy. It should be reserved for diuretic-resistant individuals.
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Affiliation(s)
- Prakash S Gudsoorkar
- Division of Nephrology Kidney C.A.R.E. Program, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
| | - Charuhas V Thakar
- Division of Nephrology Kidney C.A.R.E. Program, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA; Division of Nephrology, VA Medical Center, Cincinnati, OH, USA
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Fudim M, Loungani R, Doerfler SM, Coles A, Greene SJ, Cooper LB, Fiuzat M, O'Connor CM, Rogers JG, Mentz RJ. Worsening renal function during decongestion among patients hospitalized for heart failure: Findings from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Am Heart J 2018; 204:163-173. [PMID: 30121018 DOI: 10.1016/j.ahj.2018.07.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/25/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Worsening renal function (WRF) can occur throughout a hospitalization for acute heart failure (HF). However, decongestion can be measured in different ways and the prognostic implications of WRF in the setting of different measures of decongestion are unclear. METHODS Patients (N = 433) from the ESCAPE were classified by measures of decongestion during hospitalization: hemodynamic (right atrial pressure ≤8 mmHg and/or wedge pressure ≤15 mmHg at discharge), clinical (≤1 sign of congestion at discharge), hemoconcentration (any increase in hemoglobin) and estimated plasma volume using the Hakim formula (5% reduction in plasma volume). WRF was defined as creatinine increase ≥0.3 mg/dl during hospitalization. The association between WRF and 180-day all-cause death was assessed. RESULTS Successful decongestion was observed in 124 (60%) patients by hemodynamics, 204 (49%) by clinical exam, 173 (47%) by hemoconcentration, and 165 (45%) by plasma volume. There was no agreement between the hemodynamic assessment and other decongestion measures in up to 43% of cases. Persistent congestion with concomitant WRF at discharge was associated with worse outcomes compared to patients without congestion and WRF. Among patients decongested at discharge, in-hospital WRF was not significantly associated with 180-day all-cause death, when using hemodynamic, clinical or estimated plasma volume as measures of decongestion (P > .05 for all markers). CONCLUSIONS In patients hospitalized for HF, although there was disagreement across common measures of decongestion, in-hospital WRF was not associated with increased hazard of all-cause mortality among patients successfully decongested at discharge.
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Uduman J. Epidemiology of Cardiorenal Syndrome. Adv Chronic Kidney Dis 2018; 25:391-399. [PMID: 30309456 DOI: 10.1053/j.ackd.2018.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/20/2022]
Abstract
Cardiorenal syndrome is a spectrum of disorders that emphasizes the bidirectional nature of cardiac and kidney injury. Observational and retrospective studies have helped us to understand the prevalence and burden of each of the 5 types of cardiorenal syndromes. Cardiorenal syndrome type 1 is the most common. The nature of epidemiologic data limits clear delineation between cardiorenal syndrome types 2 and 4. Overall, the presence of cardiac or renal dysfunction strongly predicts a poor outcome of the contrary organ.
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Feola M, Testa M, Ferreri C, Cardone M, Sola M, Ariotti S, Rosso GL. Role of Response-to-Diuretic in Predicting Prognosis in Discharged Heart Failure Patients After an Acute Decompensation. Arch Med Res 2018; 49:198-204. [DOI: 10.1016/j.arcmed.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Kang J, Park JJ, Cho YJ, Oh IY, Park HA, Lee SE, Kim MS, Cho HJ, Lee HY, Choi JO, Hwang KK, Kim KH, Yoo BS, Kang SM, Baek SH, Jeon ES, Kim JJ, Cho MC, Chae SC, Oh BH, Choi DJ. Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry. J Am Heart Assoc 2018. [PMID: 29535141 PMCID: PMC5907555 DOI: 10.1161/jaha.117.007910] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Worsening renal function (WRF) is associated with adverse outcomes in patients with heart failure. We investigated the predictors and prognostic value of WRF during admission, in patients with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF). Methods and Results A total of 5625 patients were enrolled in the KorAHF (Korean Acute Heart Failure) registry. WRF was defined as an absolute increase in creatinine of ≥0.3 mg/dL. Transient WRF was defined as recovery of creatinine at discharge, whereas persistent WRF was indicated by a nonrecovered creatinine level. HFpEF and HFrEF were defined as a left ventricle ejection fraction ≥50% and ≤40%, respectively. Among the total population, WRF occurred in 3101 patients (55.1%). By heart failure subgroup, WRF occurred more frequently in HFrEF (57.0% versus 51.3%; P<0.001 in HFrEF and HFpEF). Prevalence of WRF increased as creatinine clearance decreased in both heart failure subgroups. Among various predictors of WRF, chronic renal failure was the strongest predictor. WRF was an independent predictor of adverse in‐hospital outcomes (HFrEF: odds ratio; 2.75; 95% confidence interval, 1.50–5.02; P=0.001; HFpEF: odds ratio, 9.48; 95% confidence interval, 1.19–75.89; P=0.034) and 1‐year mortality (HFrEF: hazard ratio, 1.41; 95% confidence interval, 1.12–1.78; P=0.004 versus HFpEF: hazard ratio, 1.72; 95% confidence interval, 1.23–2.42; P=0.002). Transient WRF was a risk factor for 1‐year mortality, whereas persistent WRF had no additive risk compared to transient WRF. Conclusions In patients with acute heart failure patients, WRF is an independent predictor of adverse in‐hospital and follow‐up outcomes in both HFrEF and HFpEF, though with a different effect size. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01389843.
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Affiliation(s)
- Jeehoon Kang
- Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Jin Joo Park
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jin Cho
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il-Young Oh
- Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun-Ah Park
- Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sang Eun Lee
- University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seok Kim
- University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Oh Choi
- Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Kyung-Kuk Hwang
- Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kye Hun Kim
- Heart Research Center of Chonnam National University, Gwangju, Korea
| | - Byung-Su Yoo
- Yonsei University Wonju College of Medicine, Wonju, Korea
| | | | | | - Eun-Seok Jeon
- Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- University of Ulsan College of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Chungbuk National University College of Medicine, Cheongju, Korea
| | | | - Byung-Hee Oh
- University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Ju Choi
- Seoul National University Bundang Hospital, Seongnam, Korea
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Ruocco G, Nuti R, Giambelluca A, Evangelista I, De Vivo O, Daniello C, Palazzuoli A. The paradox of transient worsening renal function in patients with acute heart failure. J Cardiovasc Med (Hagerstown) 2017; 18:851-858. [DOI: 10.2459/jcm.0000000000000546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Inomata T, Ikeda Y, Kida K, Shibagaki Y, Sato N, Kumagai Y, Shinagawa H, Ako J, Izumi T. Effects of Additive Tolvaptan vs. Increased Furosemide on Heart Failure With Diuretic Resistance and Renal Impairment - Results From the K-STAR Study. Circ J 2017; 82:159-167. [PMID: 28835586 DOI: 10.1253/circj.cj-17-0179] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND , were randomized into 2 groups and administered either ≤15 mg/day additive tolvaptan (TLV) or ≤40 mg/day increased FUR for 7 days. Changes in urine volume between baseline and mean urine volume during treatment were significantly higher in the TLV than FUR group (P=0.0003). Although there was no significant decrease in body weight or improved signs and symptoms of congestion between the 2 groups, the increase in serum creatinine on Day 7 from baseline was significantly smaller in the TLV than FUR group (P=0.038). Multiple logistic regression analysis revealed that additive TLV (odds ratio 0.157, 95% confidence interval 0.043-0.605, P=0.001) was an independent clinical factor for improved renal function during treatment compared with increased FUR. CONCLUSIONS In HF patients with residual congestion and renal dysfunction refractory to standard therapy, additive TLV increased urine volume without further renal impairment compared with patients who received an increased dose of FUR.
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Affiliation(s)
- Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University
| | - Keisuke Kida
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Naoki Sato
- Internal Medicine and Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Yuji Kumagai
- Kitasato Academic Research Organization, Kitasato University
| | | | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University
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Prognostic Impact of BNP Variations in Patients Admitted for Acute Decompensated Heart Failure with In-Hospital Worsening Renal Function. Heart Lung Circ 2017; 26:226-234. [DOI: 10.1016/j.hlc.2016.06.1205] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 03/15/2016] [Accepted: 06/04/2016] [Indexed: 12/20/2022]
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Tamaki S, Sato Y, Yamada T, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, Kikuchi A, Kondo T, Ozaki T, Seo M, Ikeda I, Fukuhara E, Abe M, Nakamura J, Fukunami M. Tolvaptan Reduces the Risk of Worsening Renal Function in Patients With Acute Decompensated Heart Failure and Preserved Left Ventricular Ejection Fraction ― Prospective Randomized Controlled Study ―. Circ J 2017; 81:740-747. [DOI: 10.1253/circj.cj-16-1122] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Takumi Kondo
- Division of Cardiology, Osaka General Medical Center
| | | | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Center
| | - Iyo Ikeda
- Division of Cardiology, Osaka General Medical Center
| | - Eiji Fukuhara
- Division of Cardiology, Osaka General Medical Center
| | - Makoto Abe
- Division of Cardiology, Osaka General Medical Center
| | - Jun Nakamura
- Division of Cardiology, Osaka General Medical Center
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Hamo CE, Butler J, Gheorghiade M, Chioncel O. The bumpy road to drug development for acute heart failure. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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35
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Different diuretic dose and response in acute decompensated heart failure: Clinical characteristics and prognostic significance. Int J Cardiol 2016; 224:213-219. [DOI: 10.1016/j.ijcard.2016.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/24/2016] [Accepted: 09/08/2016] [Indexed: 11/22/2022]
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Wen S, Ning J, Collins S, Berry D. A response-adaptive design of initial therapy for emergency department patients with heart failure. Contemp Clin Trials 2016; 52:46-53. [PMID: 27838474 DOI: 10.1016/j.cct.2016.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 01/08/2023]
Abstract
Finding safe and effective treatments for acute heart failure syndrome (AHFS) is a high priority. More than 80% of patients with AHFS who present to emergency departments are treated identically with intravenous diuretics, despite recognition of the syndrome's heterogeneity. We hypothesize that matching patient profiles with "personalized" AHFS treatments will improve outcomes. Matching multiple heterogeneous clinical profiles with a number of potentially effective treatments requires an adaptive trial design that can adjust for these complexities. We propose a Bayesian response-adaptive randomization trial design for AHFS patients. Baseline information collected for each patient with AHFS prior to randomization includes blood pressure, renal function, and dyspnea severity. The primary outcome is discharge readiness within 23h of presentation and no unplanned emergency visits or admissions for acute heart failure within 7days of discharge. We use a Bayesian logistic regression model to characterize the association between primary outcome and patient profile. We adaptively randomize patients to one of five treatments, basing the randomization probability on the cumulative data from the ongoing trial and fitting results from the regression model. Simulations show high probability of selecting the best treatment corresponding to the patient's profile while allocating more patients to the efficacious treatments within the trial.
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Affiliation(s)
- Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV26506, USA
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX77030, USA
| | - Sean Collins
- Department of Emergency Medicine,Vanderbilt University, Nashville, TN37232, USA
| | - Donald Berry
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX77030, USA.
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Abstract
PURPOSE OF REVIEW It is well known that patients with heart failure also suffer from a large number of comorbid conditions, which confound their heart failure management and adversely affect the prognosis. The purpose of this review is to evaluate the latest developments of these conditions. RECENT FINDINGS Chronic lung disease commonly coexists with heart failure. It is more prevalent and worsens prognosis more in patients with preserved (heart failure with preserved ejection fraction) than with reduced ejection fraction (heart failure with reduced ejection fraction). Patients with diabetes have increased risk of incident heart failure, and as a comorbid condition it adversely affects prognosis. The relative impact on mortality and heart failure hospitalization remains controversial. Renal dysfunction is also common in patients with heart failure, with similar prevalence among those with preserved ejection fraction and those with reduced ejection fraction. The prognosis seems mainly related to long-term changes in kidney function, rather than to short-term changes in serum creatinine. Anemia and iron deficiency have a similar profile in terms of prevalence and impact on prognosis. Recent data suggest a benefit of intravenous iron infusion in patients who are iron deficient. SUMMARY As patients with comorbid conditions are frequently excluded from clinical trials, future clinical trials should recruit these patients and include endpoints that will be reflective of these conditions.
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Palazzuoli A, Lombardi C, Ruocco G, Padeletti M, Nuti R, Metra M, Ronco C. Chronic kidney disease and worsening renal function in acute heart failure: different phenotypes with similar prognostic impact? EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:534-548. [DOI: 10.1177/2048872615589511] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/10/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Alberto Palazzuoli
- Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy
| | - Carlo Lombardi
- Department of Experimental and Applied Medicine, University and Civil Hospital of Brescia, Italy
| | - Gaetano Ruocco
- Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy
| | | | - Ranuccio Nuti
- Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy
| | - Marco Metra
- Department of Experimental and Applied Medicine, University and Civil Hospital of Brescia, Italy
| | - Claudio Ronco
- Nephrology Dialysis and Transplantation International Renal Research Institute (IRRIV), St Bortolo Hospital, Italy
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Abstract
Cardio-renal syndrome is a commonly encountered problem in clinical practice. Its pathogenesis is not fully understood. The purpose of this article is to highlight the interaction between the cardiovascular system and the renal system and how their interaction results in the complex syndrome of cardio-renal dysfunction. Additionally, we outline the available therapeutic strategies to manage this complex syndrome.
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Affiliation(s)
- Joseph Gnanaraj
- Department of Cardiology, Bridgeport Hospital, Bridgeport, CT, USA
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Abstract
Acute kidney injury is a frequent complication of acute heart failure syndromes, portending an adverse prognosis. Acute cardiorenal syndrome represents a unique form of acute kidney injury specific to acute heart failure syndromes. The pathophysiology of acute cardiorenal syndrome involves renal venous congestion, ineffective forward flow, and impaired renal autoregulation caused by neurohormonal activation. Biomarkers reflecting different aspects of acute cardiorenal syndrome pathophysiology may allow patient phenotyping to inform prognosis and treatment. Adjunctive vasoactive, neurohormonal, and diuretic therapies may relieve congestive symptoms and/or improve renal function, but no single therapy has been proved to reduce mortality in acute cardiorenal syndrome.
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Affiliation(s)
- Jacob C Jentzer
- Department of Critical Care Medicine, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Lakhmir S Chawla
- Division of Intensive Care Medicine, Department of Medicine, Washington DC Veterans Affairs Medical Center, 50 Irving Street, Washington, DC 20422, USA; Division of Nephrology, Department of Medicine, Washington DC Veterans Affairs Medical Center, 50 Irving Street, Washington, DC 20422, USA.
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41
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Early administration of tolvaptan preserves renal function in elderly patients with acute decompensated heart failure. J Cardiol 2016; 67:399-405. [DOI: 10.1016/j.jjcc.2015.09.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/10/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022]
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Latini R, Aleksova A, Masson S. Novel biomarkers and therapies in cardiorenal syndrome. Curr Opin Pharmacol 2016; 27:56-61. [DOI: 10.1016/j.coph.2016.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/19/2016] [Accepted: 01/29/2016] [Indexed: 01/11/2023]
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Abstract
Conventional therapies for acute decongestion have yielded uniformly poor results in patients with acute heart failure (AHF). The failure of current strategies may be due to advanced disease in hospitalized patients, incomplete therapy, inherent limitations to existing therapy, or some combination of all three factors. Loop diuretics are the mainstay of current therapy and are in theory not ideal since while producing immediate intravascular volume reduction and relief of symptoms they activate neurohormonal forces that are deleterious to both the heart and the kidney. Ultrafiltration is an alternative to loop diuretics but has not proved advantageous in the setting of renal dysfunction, and if not carefully applied may also aggravate neurohormonal imbalance. In theory decongestive therapy for AHF should remove large volumes of fluid quickly and safely and improve symptoms, particularly dyspnea, without aggravating renal dysfunction or causing neurohormonal activation. Several studies have now suggested that the use of aquaretics such as antagonists to the V2 receptor for arginine vasopressin may be useful as adjunctive therapy in AHF, particularly when renal dysfunction and/or hyponatremia are present. These agents leverage osmotic forces to produce tissue decongestion while causing a water diuresis. They do not adversely affect renal function or neurohormonal balance. Building on the current base of knowledge about outcomes in AHF together with the only study of vasopressin antagonists as short-term monotherapy in chronic heart failure, it would be reasonable to design a trial in AHF in which the use of loop diuretics was minimized in favor of these agents.
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Affiliation(s)
- Steven R Goldsmith
- Hennepin County Medical Center and the University of Minnesota, Minneapolis, MN, USA.
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Núñez J, Núñez E, Miñana G, Bayés-Genis A, Sanchis J. Worsening Renal Function in Acute Decompensated Heart Failure. JACC-HEART FAILURE 2016; 4:232-3. [DOI: 10.1016/j.jchf.2015.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022]
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Vandenberghe W, Gevaert S, Kellum JA, Bagshaw SM, Peperstraete H, Herck I, Decruyenaere J, Hoste EAJ. Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis. Cardiorenal Med 2015; 6:116-28. [PMID: 26989397 DOI: 10.1159/000442300] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). SUMMARY We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOSICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOShosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOSICU = 10.6 days and that of LOShosp = 20.2 days). KEY MESSAGES Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.
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Affiliation(s)
- Wim Vandenberghe
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Sofie Gevaert
- Departments of Cardiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - John A Kellum
- Centre for Critical Care Nephrology, University of Pittsburgh, Pa., USA; The Clinical Research, Investigation, and Systems Modelling of Acute Illness (CRISMA) Centre, Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pa., USA
| | - Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta., Canada
| | - Harlinde Peperstraete
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ingrid Herck
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Johan Decruyenaere
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Eric A J Hoste
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium; The Clinical Research, Investigation, and Systems Modelling of Acute Illness (CRISMA) Centre, Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pa., USA
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Ural D, Çavuşoğlu Y, Eren M, Karaüzüm K, Temizhan A, Yılmaz MB, Zoghi M, Ramassubu K, Bozkurt B. Diagnosis and management of acute heart failure. Anatol J Cardiol 2015; 15:860-89. [PMID: 26574757 PMCID: PMC5336936 DOI: 10.5152/anatoljcardiol.2015.6567] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Acute heart failure (AHF) is a life threatening clinical syndrome with a progressively increasing incidence in general population. Turkey is a country with a high cardiovascular mortality and recent national statistics show that the population structure has turned to an 'aged' population.As a consequence, AHF has become one of the main reasons of admission to cardiology clinics. This consensus report summarizes clinical and prognostic classification of AHF, its worldwide and national epidemiology, diagnostic work-up, principles of approach in emergency department,intensive care unit and ward, treatment in different clinical scenarios and approach in special conditions and how to plan hospital discharge.
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Affiliation(s)
- Dilek Ural
- Department of Cardiology, Medical Faculty of Kocaeli University; Kocaeli-Turkey.
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The prognostic impact of worsening renal function in Japanese patients undergoing percutaneous coronary intervention with acute coronary syndrome. J Cardiol 2015; 66:326-32. [DOI: 10.1016/j.jjcc.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/12/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022]
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Reid R, Ezekowitz JA, Brown PM, McAlister FA, Rowe BH, Braam B. The Prognostic Importance of Changes in Renal Function during Treatment for Acute Heart Failure Depends on Admission Renal Function. PLoS One 2015; 10:e0138579. [PMID: 26380982 PMCID: PMC4575105 DOI: 10.1371/journal.pone.0138579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/01/2015] [Indexed: 11/28/2022] Open
Abstract
Background Worsening and improving renal function during acute heart failure have been associated with adverse outcomes but few studies have considered the admission level of renal function upon which these changes are superimposed. Objectives The objective of this study was to evaluate definitions that incorporate both admission renal function and change in renal function. Methods 696 patients with acute heart failure with calculable eGFR were classified by admission renal function (Reduced [R, eGFR<45 ml/min] or Preserved [P, eGFR≥45 ml/min]) and change over hospital admission (worsening [WRF]: eGFR ≥20% decline; stable [SRF]; and improving [IRF]: eGFR ≥20% increase). The primary outcome was all-cause mortality. The prevalence of Pres and Red renal function was 47.8% and 52.2%. The frequency of R-WRF, R-SRF, and R-IRF was 11.4%, 28.7%, and 12.1%, respectively; the incidence of P-WRF, P-SRF, and P-IRF was 5.7%, 35.3%, and 6.8%, respectively. Survival was shorter for patients with R-WRF compared to R-IRF (median survival times 13.9 months (95%CI 7.7–24.9) and 32.5 months (95%CI 18.8–56.1), respectively), resulting in an acceleration factor of 2.3 (p = 0.016). Thus, an increase compared with a decrease in renal function was associated with greater than two times longer survival among patients with Reduced renal function.
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Affiliation(s)
- Ryan Reid
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Justin A. Ezekowitz
- Division of Cardiology, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- * E-mail:
| | - Paul M. Brown
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Finlay A. McAlister
- Patient Health Outcomes Research and Clinical Effectiveness Unit, University of Alberta, Edmonton, Canada
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
| | - Brian H. Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Branko Braam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
- Department of Physiology, University of Alberta, Edmonton, Canada
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50
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Palazzuoli A, Ruocco G, Ronco C, McCullough PA. Loop diuretics in acute heart failure: beyond the decongestive relief for the kidney. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:296. [PMID: 26335137 PMCID: PMC4559070 DOI: 10.1186/s13054-015-1017-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Current goals in the acute treatment of heart failure are focused on pulmonary and systemic decongestion with loop diuretics as the cornerstone of therapy. Despite rapid relief of symptoms in patients with acute decompensated heart failure, after intravenous use of loop diuretics, the use of these agents has been consistently associated with adverse events, including hypokalemia, azotemia, hypotension, and increased mortality. Two recent randomized trials have shown that continuous infusions of loop diuretics did not offer benefit but were associated with adverse events, including hyponatremia, prolonged hospital stay, and increased rate of readmissions. This is probably due to the limitations of congestion evaluation as well as to the deleterious effects linked to drug administration, particularly at higher dosage. The impaired renal function often associated with this treatment is not extensively explored and could deserve more specific studies. Several questions remain to be answered about the best diuretic modality administration, global clinical impact during acute and post-discharge period, and the role of renal function deterioration during treatment. Thus, if loop diuretics are a necessary part of the treatment for acute heart failure, then there must be an approach that allows personalization of therapy for optimal benefit and avoidance of adverse events.
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Affiliation(s)
- Alberto Palazzuoli
- Department of Internal and Surgical Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena Viale Bracci, 53100, Siena, Italy.
| | - Gaetano Ruocco
- Department of Internal and Surgical Medicine, Cardiovascular Diseases Unit, Le Scotte Hospital, University of Siena Viale Bracci, 53100, Siena, Italy
| | - Claudio Ronco
- Nephrology Dialysis & Transplantation International Renal Research Institute (IRRIV) St. Bortolo Hospital, Viale Rodolfi 37, IT-36100, Vicenza, Italy
| | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, 621 North Hall Street, H030, Dallas, Texas, 75226, USA
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