2023
DOI: 10.3389/fcvm.2022.1098553
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How to interpret serum creatinine increases during decongestion

Abstract: During decongestion in acute decompensated heart failure (ADHF), it is common to observe elevations in serum creatinine (sCr) values due to vascular congestion, a mechanism that involves increased central venous pressure that has a negative impact on the nephron, promoting greater absorption of water and sodium, increased interstitial pressure in an encapsulated organ developing “renal tamponade” which is one of main physiopathological mechanism associated with impaired kidney function. For the treatment of th… Show more

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Cited by 8 publications
(7 citation statements)
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“…The KFR based on sCr in patients with CRS1 has been an intuitively positive goal, assuming that it would represent a functional improvement of this organ, but during decongestion with diuretics, paradoxically, it has been observed that the increase in sCr has been associated with better cardiorenal survival [20]. Patients who have an increase in sCr achieve more effective decongestion, receive more doses of diuretics, produce more diuresis, and experience greater natriuresis and weight loss [32][33][34].…”
Section: Discussionmentioning
confidence: 99%
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“…The KFR based on sCr in patients with CRS1 has been an intuitively positive goal, assuming that it would represent a functional improvement of this organ, but during decongestion with diuretics, paradoxically, it has been observed that the increase in sCr has been associated with better cardiorenal survival [20]. Patients who have an increase in sCr achieve more effective decongestion, receive more doses of diuretics, produce more diuresis, and experience greater natriuresis and weight loss [32][33][34].…”
Section: Discussionmentioning
confidence: 99%
“…It has been reported that half of patients have increased serum creatinine (sCr) levels [21] or experience a 20% change in sCr during decongestion [10,22,23]. Although this event may be related to greater and effective decongestion and better clinical evolution, the evidence has not been consistent with these findings since it has also been associated with a worse prognosis [20,24]. It is intuitive to think that in patients with CRS1, guiding decongestion using VExUS could optimize the diuretic dose and thereby KFR, avoiding subclinical congestion and reducing hospitalization days and mortality, but to the best of our knowledge, this has not been done in a clinical trial.…”
Section: Introductionmentioning
confidence: 99%
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“…Although minor increases in serum creatinine of <0.5mg/dL are permissible during treatment, it is possible that more significant increases could be beneficial in preventing medium and long-term cardiorenal events. Ultimately, the priority should be on achieving effective decongestion, even if this results in modest deterioration of kidney function (20).…”
Section: Biomarkers For Diagnosis Aki During Cardiac Failurementioning
confidence: 99%
“…Although minor increases in serum creatinine of <0.5 mg/dL are permissible during treatment, it is possible that more significant increases could be beneficial in preventing medium and long-term cardiorenal events. Ultimately, the priority should be on achieving effective decongestion, even if this results in modest deterioration of kidney function [20].…”
Section: Biomarkers For Diagnosing Aki During Cardiac Failurementioning
confidence: 99%