Elevated Intra-Abdominal Pressure in Acute Decompensated Heart Failure

Mullens, Wilfried; Abrahams, Zuheir; Skouri, Hadi; Francis, Gary S.; Taylor, David O.; Starling, Randall C.; Paganini, Emil P.; Tang, W.H. Wilson

doi:10.1016/j.jacc.2007.09.043

Cited by 385 publications

(226 citation statements)

References 27 publications

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“…It has been know for several years that high central venous pressure (CVP) and even high intra-abdominal pressure from ascites may reduce GFR (40,41). Animal studies have consistently shown that increasing renal venous pressure by approximately 20-25 mmHg in the isolated dog or rat kidneys caused a profound decrease in renal perfusion accompanied by a sharp drop in the GFR, sodium excretion, and urine flow.…”

Section: Role Of High Venous Pressure In the Pathogenesis Of Crsmentioning

confidence: 99%

“…Hence, the exact mechanisms to explain the inverse relationship between high renal venous pressure and GFR in patients with HF are likely to be highly complex. Nevertheless, in patients with ascites or raised CVP, paracentesis or ultrafiltration has been shown to improve renal dysfunction (41). However, in the Cardiorenal Rescue Study in Acute Decompensated Heart Failure, ultrafiltration was not associated with improvement in renal function, although that study was not designed to address this particular question (45).…”

Section: Role Of High Venous Pressure In the Pathogenesis Of Crsmentioning

confidence: 99%

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Cardiorenal Syndrome

Anand

2013

Clinical Journal of the American Society of Nephrology

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Summary The cardiorenal syndrome has recently been defined as “disorders of the heart and kidney whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other.” The syndrome is extremely common and independently associated with poor clinical outcomes. However, no pharmacological therapy has been shown to improve its outcomes. Unfortunately, the mechanisms that initiate the development of renal dysfunction in heart failure are still debated. This review tries to clarify some of the misunderstanding regarding the principle hemodynamic factors that drive the kidneys to retain salt and water.

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Section: Role Of High Venous Pressure In the Pathogenesis Of Crsmentioning

confidence: 99%

Section: Role Of High Venous Pressure In the Pathogenesis Of Crsmentioning

confidence: 99%

Cardiorenal Syndrome

Anand

2013

Clinical Journal of the American Society of Nephrology

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“…IAP is an independent risk factor for AKI development and may also explain the cardiorenal syndrome [40][41][42][43] . Dalfino et al [44] put IAP into relation with RIFLE criteria by showing intra-abdominal hypertension to be an independent predictive factor of acute renal failure, defined as failure class of RIFLE criteria [45,46] .…”

Section: Acute Respiratory Distress Syndromementioning

confidence: 99%

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

Lin

Chen

2012

WJCCM

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Acute kidney injury (AKI) is a common and serious complication in critically ill patients. The mortality rate remains high despite improved renal replacement techniques. A possible cause of the high mortality rate is that intensive care unit patients tend to be older and more debilitated than before. Pathophysiological factors associated with AKI are also implicated in the failure of other organs, indicating that AKI is often part of a multiple organ failure syndrome. Until recently, there was a lack of consensus as to the best definition, characterization, and evaluation of acute renal failure. This lack of a standard definition has been a major impediment to progress in clinical and basic research. The introduction of the risk, injury, failure, loss, and end-stage kidney disease criteria and the modified version proposed by the Acute Kidney Injury Network have increased the conceptual understanding of AKI syndrome, and these criteria have been successfully tested in clinical studies. This article reviews current findings concerning the application of these criteria for assessing epidemiology and predicting outcome in specific homogeneous critically ill patient groups.

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“…Among them, Damman et al (16) investigated the cardiorenal interactions in a retrospective manner across the entire spectrum of cardiovascular diseases with or without overt picture of heart failure, while Uthoff et al (9) explored the impact of the hemodynamic congestion on renal function in the setting of the acute decompensated heart failure requiring hospitalization. Besides, our search was influenced also by interesting insights ensued from some studies by Mullens et al (17,18) which would suggest that the presence of venous congestion may be the strongest hemodynamic determinant for the development of worsened renal function. Overall these studies would corroborate the concept that impact of systemic and renal venous congestion overcomes even that exerted by low cardiac output as regards the genesis and/or aggravation of renal dysfunction in CHF patients.…”

Section: Introductionmentioning

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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Elevated Intra-Abdominal Pressure in Acute Decompensated Heart Failure

Abstract: Elevated IAP is prevalent in patients with ADHF and is associated with impaired renal function. In the setting of intensive medical therapy for ADHF, changes in IAP were better correlated with changes in renal function than any hemodynamic variable.

Cited by 385 publications

References 27 publications

Cardiorenal Syndrome

Cardiorenal Syndrome

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

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

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