Managing acute renal failure in patients with acute decompensated heart failure: The cardiorenal syndrome

Shah, Ravi; Givertz, Michael M.

doi:10.1007/s11897-009-0025-5

Cited by 17 publications

(14 citation statements)

References 58 publications

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“…Although various definitions for cardiorenal syndrome have been proposed, the most clinically relevant describe renal dysfunction in patients with AHF at baseline and during treatment. 8,9 We used novel statistical modeling on nearly 2000 patients with AHF and renal dysfunction to describe the trajectories of BUN and creatinine during and immediately after a heart failure admission and show for the first time the relationship between these trajectories and outcomes. First, we noted that serum creatinine rises during the first few days of admission and then varies in trajectory depending on the day of discharge.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Multiple mechanisms have been identified, including renal venous hypertension, neurohormonal activation, and diuretic toxicity, as well as reduced cardiac output and renal vasoconstriction. However, renal dysfunction at admission and WRF during hospitalization may simply reflect a sicker group of patients (ie, cardiorenal syndrome 60 Circ Heart Fail January 2014…”

Section: Clinical Perspective On P 67mentioning

confidence: 99%

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Renal Function Trajectories and Clinical Outcomes in Acute Heart Failure

Givertz

Postmus

Hillege

et al. 2014

Circ: Heart Failure

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Background-Prior studies have demonstrated adverse risk associated with baseline and worsening renal function in acute heart failure, but none has modeled the trajectories of change in renal function and their impact on outcomes. Methods and Results-We used linear mixed models of serial measurements of blood urea nitrogen and creatinine to describe trajectories of renal function in 1962 patients with acute heart failure and renal dysfunction enrolled in the Placebo-Controlled Randomized Study of the Selective A 1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function study. We assessed risk of 180-day mortality and 60-day cardiovascular or renal readmission and used Cox regression to determine association between renal trajectories and outcomes. Compared with patients alive at 180 days, patients who died were older, had lower blood pressure and ejection fraction, and higher creatinine levels at baseline. On average for the entire cohort, creatinine rose from days 1 to 3 and increased further after discharge, with the trajectory dependent on the day of discharge. Blood urea nitrogen, creatinine, and the rate of change in creatinine from baseline were the strongest independent predictors of 180-day mortality and 60-day readmission, whereas the rate of change of blood urea nitrogen from baseline was not predictive of outcomes. Baseline blood urea nitrogen >35 mg/ dL and increase in creatinine >0.1 mg/dL per day increased the risk of mortality, whereas stable or decreasing creatinine was associated with reduced risk. Conclusions-Patients with acute heart failure and renal dysfunction demonstrate variable rise and fall in renal indices during and immediately after hospitalization. Risk of morbidity and mortality can be predicted based on baseline renal function and creatinine trajectory during the first 7 days. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458.(Circ Heart Fail. 2014;7:59-67.)

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective On P 67mentioning

confidence: 99%

Renal Function Trajectories and Clinical Outcomes in Acute Heart Failure

Givertz

Postmus

Hillege

et al. 2014

Circ: Heart Failure

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“…In a large multicenter controlled trial in 200 patients with HF and fluid overload, compared to standard diuretic treatment, ultrafiltration has been associated with no difference in symptoms' improvement, slight increase in serum creatinine, and reduction in rehospitalization rates after discharge [105]. The ongoing CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) trial will further define the use of this treatment in patients with acute decompensated HF and acute CRS [106].…”

Section: Othersmentioning

confidence: 99%

Can we prevent or treat renal dysfunction in acute heart failure?

et al. 2011

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Most patients with heart failure (HF) already have or develop renal dysfunction; this might contribute to their poor outcome. Current treatment for HF can also contribute to worsen renal function. High furosemide doses are traditionally associated with worsening renal function (WRF), but patients with fluid overload may benefit of aggressive fluid removal. Unfortunately, promising therapies like vasopressin antagonists and adenosine antagonists have not been demonstrated to improve outcomes. Likewise, correction of low renal blood flow through dopamine, inotropic agents, or vasodilators does not seem to be associated with a clear benefit. However, transient WRF associated with acute HF treatment may not necessarily portend a poor prognosis. In this review, we focus on the strategies to detect renal dysfunction in acute HF, the underlying pathophysiological mechanisms, and the potential treatments.

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“…Concomitant cardiac and renal dysfunction has been termed the cardiorenal syndrome (CRS), a major clinical problem of growing magnitude [1,2,3,4,5]. …”

Section: Introductionmentioning

confidence: 99%

“…Multiple pathophysiological mechanisms have been implicated in this cross-talk between organs and the associated progression of the disease both in the kidney and in the heart [4,6,7]. van Dokkum and colleagues [8] have recently established a model in rats in which myocardial infarction (MI) was induced 2 weeks post-subtotal nephrectomy (STN).…”

Section: Introductionmentioning

confidence: 99%

Accelerated Renal Fibrosis in Cardiorenal Syndrome Is Associated with Long-Term Increase in Urine Neutrophil Gelatinase-Associated Lipocalin Levels

Entin–Meer

Ben-Shoshan²,

Maysel-Auslender³

et al. 2012

Am J Nephrol

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Background: Cardiac events are the main cause of death among patients with end-stage renal failure. Even a mild renal disease is currently considered a major risk factor for cardiovascular complications following myocardial infarction (MI). The aim of the present study was to detect histological, sera and urine characteristics of kidney injury in cardiorenal syndrome (CRS) compared to chronic kidney disease (CKD) with an intact cardiac function. Methods: We employed a rat model for CRS, in which an acute MI (AMI) was induced 4 weeks after establishment of subtotal nephrectomy. Four weeks later, left ventricular function was assessed by echocardiography and changes in renal performance were examined using histological and biochemical parameters. Results: Increased interstitial fibrosis as well as renal inflammation were observed in renal sections derived from CRS rats, compared to subtotal nephrectomy (CKD)-only animals. Moreover, we found that even though AMI on the background of CKD was not associated with a further decrease in creatinine clearance or a further increase in sera BUN levels compared to CKD only, a significant long-term elevation in urine neutrophil gelatinase-associated lipocalin (Ngal) levels was detectable post-MI induction. Conclusions: AMI in the CKD setting is associated with accelerated renal fibrosis and long-term elevated urine Ngal values, suggesting that cardiac dysfunction contributes to accelerated intrinsic kidney injury in CKD. The data indicate that elevated urine Ngal may potentially serve as an early non-invasive laboratory parameter for a left ventricular dysfunction-related renal injury.

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Managing acute renal failure in patients with acute decompensated heart failure: The cardiorenal syndrome

Cited by 17 publications

References 58 publications

Renal Function Trajectories and Clinical Outcomes in Acute Heart Failure

Renal Function Trajectories and Clinical Outcomes in Acute Heart Failure

Can we prevent or treat renal dysfunction in acute heart failure?

Accelerated Renal Fibrosis in Cardiorenal Syndrome Is Associated with Long-Term Increase in Urine Neutrophil Gelatinase-Associated Lipocalin Levels

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