Changes in circulating norepinephrine with hemofiltration in advanced congestive heart failure

Cipolla, Carlo M.; Grazi, S; Rimondini, Andrea; Susini, G.; Guazzi, Marco; Bella, Paolo Della; Guazzi, Maurizio D.

doi:10.1016/0002-9149(90)90938-w

Cited by 61 publications

(35 citation statements)

References 25 publications

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“…UF has also been shown to improve neurohormonal activation (e.g. significant reduction in serum levels of renin, norepinephrine, and aldosterone), which is believed to play a major role in the development and progression of HF and is consistent with the concept of potential reversal in the pathophysiology of HF [33,34]. Moreover, extracorporeal therapies are reported to be associated with a significant reduction in circulating levels of pro-inflammatory cytokines (e.g.…”

Section: Ultrafiltration For Heart Failurementioning

confidence: 90%

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

Ross

Kazory

2012

Blood Purif

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Background: Heart failure (HF) has a high readmission rate in part due to conventional and recently developed therapeutic options having suboptimal results. Extracorporeal and peritoneal ultrafiltration have been advocated as more beneficial methods for fluid removal in decompensated or refractory HF, respectively. Methods: Traditional and emerging concepts explaining the pathophysiology of HF and the cardiorenal syndrome are reviewed. Extracorporeal and peritoneal ultrafiltration clinical trials are then discussed in terms of potential physiologic benefits, feasibility and their effects on both cardiac and renal function. Results: Ultrafiltration therapy can efficiently correct volume overload in the acute setting, improve cardiac functional and quality of life parameters, and is associated with long-lasting benefits such as reduced HF-related readmissions. Although excessive fluid removal can adversely affect the kidneys, there is evidence that careful protocols can restore diuretic sensitivity and maintain stable renal function; crafting safe parameters has yet to be studied. Conclusion: While extracorporeal ultrafiltration is an appealing therapeutic option for patients with acute decompensated HF, determining the optimal fluid removal rate and the impact on renal function need further investigation. Peritoneal dialysis may be an appropriate alternative in the setting of chronic refractory HF, but controlled studies are needed. Further trials are warranted to determine the long-term outcomes from both ultrafiltration modalities in HF.

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Section: Ultrafiltration For Heart Failurementioning

confidence: 90%

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

Ross

Kazory

2012

Blood Purif

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“…with UF, 23,27,29,39,40 though one study demonstrated a slight decrease, 41 while other electrolytes remain stable. 28,38,42,43 UF also has a favorable effect on pulmonary function, ventilation efficiency, water content in the lungs, 33,36,37,44 plasma neurohormones including norepinephrine, renin and aldosterone, 38,42,45 and diuretic responsiveness 29,39,42,45,46 ( Table III).…”

Section: Clinical Experience With Uf For Hfmentioning

confidence: 99%

Ultrafiltration for Congestive Heart Failure

Thorsgard¹,

Bart²

2009

Congestive Heart Failure

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Relief of congestive symptoms is a primary goal in treating heart failure. Ultrafiltration is a tool that can be used to safely remove sodium and water from whole blood at a controlled rate. Ultrafiltration decreases symptoms, relieves congestion, and improves hemodynamics, neurohormonal balance, and exercise capacity. This article describes the importance of congestion as a therapeutic target in heart failure and outlines the development of ultrafiltration as a treatment to address this important physiologic state.

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“…Other patients may be admitted to the intensive care unit (ICU) for the treatment of refractory edema and diuretic-resistant oliguria despite such interventions. In this pathophysiological state, the critical care physician can effectively apply hemofiltration (HF) [1, 2]to safely remove large amounts (3–4 liters over 10 h) of isotonic fluid. The removal of isotonic fluid by filtration results in the resolution of edema, improved myocardial function, maintained blood pressure, reduced intracardiac filling and improved renal perfusion pressure.…”

Section: The Patient With Preoperative Congestive Heart Failurementioning

confidence: 99%

“…It also entirely avoids electrolyte imbalances. In addition, the neurohumoral response to heart failure is blunted, and noradrenaline, aldosterone and renin levels fall [1, 2]. Renal function is often significantly improved.…”

Section: The Patient With Preoperative Congestive Heart Failurementioning

confidence: 99%

Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open Heart Surgery

2001

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Fluid overload is common before, during and after cardiac surgery. The fluid associated with cardiopulmonary bypass (CPB) and cardioplegia is a particularly important source of such fluid overload. In addition, renal dysfunction, which is common in these patients, participates in the pathogenesis of a positive sodium and water balance. Such fluid overload is physiologically undesirable and participates in the pathogenesis of several clinically important complications. Fluid overload can be partly prevented with the use of diuretics. However, in many patients, diuretics do not achieve sufficient sodium and water diuresis. In these patients, the application of hemofiltration (HF) during CPB and also immediately after CPB is an effective and safe approach to the maintenance of fluid homeostasis. If acute renal failure occurs, early intervention with HF may even improve survival.

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Changes in circulating norepinephrine with hemofiltration in advanced congestive heart failure

Cited by 61 publications

References 25 publications

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

Ultrafiltration for Congestive Heart Failure

Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open Heart Surgery

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