Contemporary Trends in the Pharmacological and Extracorporeal Management of Heart Failure

Kazory, Amir; Ross, Edward A.

doi:10.1161/circulationaha.107.742270

Cited by 85 publications

(70 citation statements)

References 91 publications

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“…When the acute kidney injury results from acute cardiac dysfunction, it is called cardiorenal syndrome type 1 and is present in 30% to 50% of patients hospitalized with acute HF 8,9 . The criterion for diagnosis is the increase in serum creatinine ≥ 0.3 mg/dL or an increase > 50% of the hospital admission one.…”

Section: Cardiorenal Syndromementioning

confidence: 99%

Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011

Montera¹,

Pereira²,

Colafranceschi³

et al. 2012

Arq. Bras. Cardiol.

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In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009.In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinicalhemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined.The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated.This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.

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Section: Cardiorenal Syndromementioning

confidence: 99%

Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011

Montera¹,

Pereira²,

Colafranceschi³

et al. 2012

Arq. Bras. Cardiol.

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“…Meanwhile, glomerular filtration is simultaneously damaged by a peculiar type of unfavorable vasomotor kidney reaction (14,15) consisting in intense vasoconstriction of the afferent arteriolar bed, as elicited by macula densa chemoceptor apparatus highly sensitive to increased delivery of sodium to tubules due to diuretic administration. According to several authors (31,38) this "vasomotor nephropathy" could be minimized using slow mechanical fluid removal by ultrafiltration. In this manner, we could avoid engaging renal excretory pathways and their inherent tubulo-glomerular feedback, whose role in nephrotoxic effect of diuretics in syndromes with reduced effective circulating volume (CHF, cirrhosis of the liver) has been focused in other studies (38,39).…”

Section: Diuretic-related Wrf: Interpretative Theoriesmentioning

confidence: 99%

“…According to several authors (31,38) this "vasomotor nephropathy" could be minimized using slow mechanical fluid removal by ultrafiltration. In this manner, we could avoid engaging renal excretory pathways and their inherent tubulo-glomerular feedback, whose role in nephrotoxic effect of diuretics in syndromes with reduced effective circulating volume (CHF, cirrhosis of the liver) has been focused in other studies (38,39).…”

Section: Diuretic-related Wrf: Interpretative Theoriesmentioning

confidence: 99%

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Vecchis¹,

Ariano²,

Fusco³

et al. 2012

Anadolu Kardiyol Derg

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Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study ABSTRACTObjective: In chronic heart failure (CHF), collapsibility index of the inferior vena cava (IVCCI) is used for noninvasive ultrasonographic appraisal of central venous pressure, but it also may be related both to estimated glomerular filtration rate (eGFR) and renal outcome. Methods: On the basis of retrospective observational cohort study, we analyzed 49 patients with right or biventricular CHF in III NYHA class, who had undergone intravenous intensive treatment with furosemide. Aggravated renal dysfunction (ARD) was defined by serum creatinine (Cr) increase of ≥0.3 mg/dL from baseline. IVCCI was categorized in three layers (IVCCI ≤15%, IVCCI 16-40% and IVCCI >40%). The predictors of ARD were searched for as well as any relation between basal IVCCI and both eGFR at admission and occurrence of ARD. Results: Overall, 15 cases and 34 controls were compared. Multivariate predictors of ARD were a lower basal eGFR (HR: 0.82 CI: 0.72-0.94 p=0.0045) and intravenous furosemide daily mean dose >80 mg (HR: 48.62 CI: 1.62-3841.5 p=0.0430). A very significant positive correlation was found between IVCCI at admission ≤ 15% and basal eGFR (r=0.96 p<0.0001), while a negative correlation with eGFR was detected in the IVCCI highest (>40%) range (r=-0.696 p=0.0013). Furthermore, the category with basal IVCCI >40% showed a higher rate of ARD compared to that with basal IVCCI 16-40% (p<0.05). Conclusion:On the basis of the demonstrated u-shaped relationship between IVCCI and eGFR both the stratum with the highest (>40%) and the one with the lowest (≤15%) basal IVCCI may be associated with increased risk of ARD. (Anadolu Kardiyol Derg 2012; 12: 391-400) Key words: Heart failure, ultrasound monitoring, inferior vena cava, diuretics, acute kidney injury, regression analysis

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“…CRRT, however, is not a panacea without concern. For instance, one obvious potential well-recognized hazard is overly aggressive fluid removal evoking hypotension, renal hypoperfusion, prerenal azotemia, and de novo renal injury or even ARF (11). An inaccurate volume assessment, if left unattended, may thus lead to the inappropriate implementation of therapy and the clinical consequence may be costly.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury in cancer patients and impedance cardiography‑assisted renal replacement therapy: Experience from the onconephrology unit of a Chinese tertiary hospital

Wang

Zhang²,

et al. 2017

Exp Ther Med

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Abstract. Acute kidney injury (AKI) in cancer patients may disrupt anticarcinogenic treatment and greatly increase associated mortality rates. The present study reported on the management of cancer patients with AKI and, from the nephrologic viewpoint, on the significance of fine volume control during the continuous renal replacement therapy (CRRT). The records of 117 cancer patients with AKI treated over three years were reviewed and their data were compared with those of 120 healthy controls. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria with serum creatinine levels determined on initial admission and for the diagnosis of AKI. CRRT with concomitant impedance cardiography (ICG) monitoring was performed in 79 patients. On average, AKI manifested as a 1.68±0.38-fold increase in serum creatinine within 10.2±5.7 days. The causes of AKI were diverse, with the major ones being nephrotoxic agents, hypotension and obstructive nephropathy. Renal biopsy confirmed two cases of thrombotic microangiopathy, due to the use of interfon-α and sunitinib malate, respectively, and a third case of cast nephropathy caused by immunoglobulin D multiple myeloma. The patients were generally marantic and had compromised cardiac function compared with the healthy controls. The CRRT prescription was discriminatingly optimized by the ICG parameters effecting discreet fluid balance, as the thoracic fluid content was significantly correlated with the ultrafiltration rate. By considering the causative mechanisms and applying subtle ICG-assisted volume control, the present study may thus help to improve the safety and efficacy of CRRT in cancer patients with AKI. In addition, it provided information to bring advances in onconephrology, a novel nephrological subspecialty field.

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Contemporary Trends in the Pharmacological and Extracorporeal Management of Heart Failure

Cited by 85 publications

References 91 publications

Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011

Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011

Ultrasound evaluation of the inferior vena cava collapsibility index in congestive heart failure patients treated with intravenous diuretics: new insights about its relationship with renal function: An observational study

Acute kidney injury in cancer patients and impedance cardiography‑assisted renal replacement therapy: Experience from the onconephrology unit of a Chinese tertiary hospital

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