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Parapiboon W, Kingjun T, Wongluechai L, Leawnoraset W. Outcomes after Acute Peritoneal Dialysis for Critical Cardiorenal Syndrome Type 1. Cardiorenal Med 2021; 11:184-192. [PMID: 34315169 DOI: 10.1159/000517362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of the study was to demonstrate the outcomes of peritoneal dialysis (PD) in critically ill cardiorenal syndrome type 1 (CRS1). METHODS A cohort of 147 patients with CRS1 who received PD from 2011 to 2019 in a referral hospital in Thailand was analyzed. The primary outcome was 30-day in-hospital mortality. Ultrafiltration and net fluid balance among survivors and nonsurvivors in the first 5 PD sessions were compared. RESULTS The 30-day mortality rate was 73.4%. Most patients were critically ill CRS1 (all patients had a respiratory failure of which 68% had cardiogenic shock). Blood urea nitrogen and creatinine at the commencement of PD were 60.1 and 4.05 mg/dL. In multivariable analysis, increasing age, unstable hemodynamics, and positive fluid balance in the first 5 PD sessions were associated with the risk of in-hospital mortality. The change of fluid balance per day during the first 5 dialysis days was significantly different among survivor and nonsurvivor groups (-353 vs. 175 mL per day, p = 0.01). CONCLUSIONS PD is a viable dialysis option in CRS1, especially in a resource-limited setting. PD can save up to 27% of lives among patients with critically ill CRS1.
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Affiliation(s)
- Watanyu Parapiboon
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhonratchasima, Thailand
| | - Tanit Kingjun
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhonratchasima, Thailand
| | - Laddaporn Wongluechai
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhonratchasima, Thailand
| | - Waraporn Leawnoraset
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhonratchasima, Thailand
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Lee JH, Kim MS, Yoo BS, Park SJ, Park JJ, Shin MS, Youn JC, Lee SE, Jang SY, Choi S, Cho HJ, Kang SM, Choi DJ. KSHF Guidelines for the Management of Acute Heart Failure: Part II. Treatment of Acute Heart Failure. Korean Circ J 2019; 49:22-45. [PMID: 30637994 PMCID: PMC6331324 DOI: 10.4070/kcj.2018.0349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 10/14/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic HF were introduced in March 2016. However, chronic and acute HF represent distinct disease entities. Here, we introduce the Korean guidelines for the management of acute HF with reduced or preserved ejection fraction. Part II of this guideline covers the treatment of acute HF.
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Affiliation(s)
- Ju Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Min Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Sung Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seok Min Kang
- Division of Cardiology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Siddiqui WJ, Kohut AR, Hasni SF, Goldman JM, Silverman B, Kelepouris E, Eisen HJ, Aggarwal S. Readmission rate after ultrafiltration in acute decompensated heart failure: a systematic review and meta-analysis. Heart Fail Rev 2018; 22:685-698. [PMID: 28900774 DOI: 10.1007/s10741-017-9650-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Significance of ultrafiltration in acute decompensated heart failure remains unclear. We performed meta-analysis to determine its role in reducing readmissions after acute decompensated heart failure. MEDLINE was searched using PUBMED from inception to March 22, 2017 for prospective randomized control trials comparing ultrafiltration to diuretics in acute decompensated heart failure. Five hundred ninety studies were found; nine studies with 820 patients were included. Studies with renal replacement therapy bar ultrafiltration, chronic decompensated heart failure, and non-English language were excluded. RevMan Version 5.3 was used for analysis. The primary outcomes analyzed were cumulative and 90 days readmissions secondary to heart failure and all-cause readmissions. Baseline characteristics were similar. One hundred eighty-eight patients were readmitted with heart failure, 77 vs 111 favoring ultrafiltration; risk ratio (RR) = 0.71 (95% confidence interval (CI), 0.49-1.02, p = 0.07, I 2 = 47%). Ninety days readmissions were 43 vs 67 favoring ultrafiltration; RR = 0.65 (95%CI, 0.47-0.90, p = 0.01, I 2 = 0%). Ultrafiltration showed significantly higher fluid removal and weight loss. Hypotension was common in ultrafiltration (24 vs 13, OR = 2.06, 95%CI = 0.98-4.32, p = 0.06, I 2 = 0%). Ultrafiltration showed reduced 90 days heart failure readmissions and trend towards reduced cumulative hospital readmissions. Renal and cardiovascular outcomes and hospital stay were similar.
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Affiliation(s)
- Waqas Javed Siddiqui
- Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA. .,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA.
| | - Andrew R Kohut
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Syed F Hasni
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Jesse M Goldman
- Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Benjamin Silverman
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Ellie Kelepouris
- Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Howard J Eisen
- Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA, 19129, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
| | - Sandeep Aggarwal
- Department of Medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.,Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA, 19102, USA
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Prins KW, Thenappan T, Markowitz JS, Pritzker MR. Cardiorenal Syndrome Type 1: Renal Dysfunction in Acute Decompensated Heart Failure. JOURNAL OF CLINICAL OUTCOMES MANAGEMENT : JCOM 2015; 22:443-454. [PMID: 27158218 PMCID: PMC4855293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To present a review of cardiorenal syndrome type 1 (CRS1). METHODS Review of the literature. RESULTS Acute kidney injury occurs in approximately one-third of patients with acute decompensated heart failure (ADHF) and the resultant condition was named CRS1. A growing body of literature shows CRS1 patients are at high risk for poor outcomes, and thus there is an urgent need to understand the pathophysiology and subsequently develop effective treatments. In this review we discuss prevalence, proposed pathophysiology including hemodynamic and nonhemodynamic factors, prognosticating variables, data for different treatment strategies, and ongoing clinical trials and highlight questions and problems physicians will face moving forward with this common and challenging condition. CONCLUSION Further research is needed to understand the pathophysiology of this complex clinical entity and to develop effective treatments.
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Affiliation(s)
- Kurt W Prins
- Cardiovascular Division, Department of Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Thenappan Thenappan
- Cardiovascular Division, Department of Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Jeremy S Markowitz
- Cardiovascular Division, Department of Internal Medicine, University of Minnesota, Minneapolis, MN
| | - Marc R Pritzker
- Cardiovascular Division, Department of Internal Medicine, University of Minnesota, Minneapolis, MN
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