Acute heart failure: Emerging from the shadows

Hollenberg, Steven M.; Teerlink, John R.

doi:10.1097/01.ccm.0000296275.47600.b3

Cited by 5 publications

(3 citation statements)

References 20 publications

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“…The use of renal replacement therapy (RRT) in ICU patients is increasing over the years [1-3]. This increase may be explained by a higher number of ICU patients with older age and increased comorbidity, as well as by a decrease of exclusion criteria for RRT, such as in special groups of ICU patients - for example, those with haemodynamic instability and bleeding.…”

Section: Introductionmentioning

confidence: 99%

Clinical review: Use of renal replacement therapies in special groups of ICU patients

Hoste

Dhondt

2011

Crit Care

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Acute kidney injury (AKI) in ICU patients is typically associated with other severe conditions that require special attention when renal replacement therapy (RRT) is performed. RRT includes a wide range of techniques, each with specific characteristics and implications for use in ICU patients. In the present review we discuss a wide range of conditions that can occur in ICU patients who have AKI, and the implications this has for RRT. Patients at increased risk for bleeding should be treated without anticoagulation or with regional citrate anticoagulation. In patients who are haemodynamically unstable, continuous therapies are most often employed. These therapies allow slow removal of volume and guarantee a stable blood pH. In patients with cerebral oedema, continuous therapy is recommended in order to prevent decreased cerebral blood flow, which will lead to cerebral ischemia. Continuous therapy will also prevent sudden change in serum osmolality with aggravation of cerebral oedema. Patients with hyponatraemia, as in liver failure or decompensated heart failure, require extra attention because a rapid increase of serum sodium concentration can lead to irreversible brain damage through osmotic myelinolysis. Finally, in patients with severe lactic acidosis, RRT can be used as a bridging therapy, awaiting correction of the underlying cause. Especially in ICU patients who have severe AKI, treatment with RRT requires balancing the pros and cons of different options and modalities. Exact and specific guidelines for RRT in these patients are not available for most clinical situations. In the present article we provide an update on the existing evidence.

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Section: Introductionmentioning

confidence: 99%

Clinical review: Use of renal replacement therapies in special groups of ICU patients

Hoste

Dhondt

2011

Crit Care

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“…The majority of clinical studies in ICU patients have found that AKI was associated with increased in-hospital mortality [8,9]. This effect persists after correction for other confounders in multivariate analyses.…”

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AKI patients have worse long-term outcomes, especially in the immediate post-ICU period

Hoste

Corte

2012

Critical Care

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Acute kidney injury (AKI) is associated with worse outcome in the acute phase of acute illness but also in the chronic phase. In a large Danish study in this issue of Critical Care, 1-year mortality was higher in patients with AKI than in patients without AKI. Mortality was most important during the first 50 days after admission to the intensive care unit (ICU), whereas after 2 months the survival curves of patients with AKI and those of patients without AKI were similar. The reasons for this observation are not clear, but protracted critical illness and fragility after acute critical illness probably play important roles. Because we see more and more of these patients, they should be the focus of ICU research. Consequently, ICU and post-ICU care for these patients requires focus and a more integrated approach to the specific problems of these survivors of acute critical illness.

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“…BNP appears to be the most promising and clinically useful biomarker 22,23 for the heart, and NGAL is the emerging biomarker for detection and diagnosis of AKI. 24 An ideal biomarker should be sensitive (early sign of organ injury) and specific (typical of the organ damage).…”

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confidence: 99%

Volume Overload and Cardiorenal Syndromes

Ronco

Maisel

2010

Congestive Heart Failure

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To include the vast array of interrelated derangements and to stress the bidirectional nature of the heart‐kidney interactions, the classification of the cardiorenal syndrome today includes 5 subtypes whose terminology reflects their primary and secondary pathology, time frame, and the presence of concomitant cardiac and renal dysfunction. Cardiorenal syndromes (CRSs) are pathophysiologic disorders of the heart and kidneys whereby acute or chronic dysfunction of one organ may induce acute or chronic dysfunction of the other. Type 1 CRS reflects an abrupt worsening of cardiac function leading to acute kidney injury. Type 2 CRS describes chronic abnormalities in cardiac function causing progressive chronic kidney disease. Type 3 CRS consists in an abrupt worsening of renal function causing acute cardiac disorder. Type 4 CRS describes a state of chronic kidney disease contributing to decreased cardiac function, cardiac hypertrophy, and/or increased risk of adverse cardiovascular events. Type 5 CRS reflects a systemic condition (eg, sepsis) simultaneously causing both cardiac and renal dysfunction. Biomarkers can help characterize the subtypes of CRS as well as suggest the timing of treatment initiation and its likely effectiveness. The identification of patients and the pathophysiologic mechanisms underlying each syndrome subtype, including fluid overload or, in general, altered conditions of fluid status, can help physicians understand clinical derangements, provide the rationale for management strategies, and allow the design of future clinical trials with more accurate selection and stratification of the population under investigation. Congest Heart Fail. 2010;16(4)(suppl 1):Si–Siv. ©2010 Wiley Periodicals, Inc.

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Acute heart failure: Emerging from the shadows

Cited by 5 publications

References 20 publications

Clinical review: Use of renal replacement therapies in special groups of ICU patients

Clinical review: Use of renal replacement therapies in special groups of ICU patients

AKI patients have worse long-term outcomes, especially in the immediate post-ICU period

Volume Overload and Cardiorenal Syndromes

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