Acute Kidney Function Declines in the Context of Decongestion in Acute Decompensated Heart Failure

McCallum, Wendy; Tighiouart, Hocine; Testani, Jeffrey M.; Griffin, Matthew; Konstam, Marvin A.; Udelson, James E.; Sarnak, Mark J.

doi:10.1016/j.jchf.2020.03.009

Cited by 52 publications

(74 citation statements)

References 19 publications

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“…IRF without resolution of congestion, as assessed by changes in BNP, haematocrit, albumin or physical exam, indicates a need for further diuresis and optimization of disease-modifying therapies prior to discharge. [32][33][34] An inability to achieve appropriate decongestion identifies a high-risk population where advanced therapies and advanced care planning should be considered (Graphical Abstract). Thus, clinicians should recognize that the AHF patient with IRF is a high-risk patient but should pursue therapies that promote decongestion and have less concern about short-term changes in kidney function.…”

Section: Discussionmentioning

confidence: 99%

Decongestion discriminates risk for one‐year mortality in patients with improving renal function in acute heart failure

Wettersten

Horiuchi

Veldhuisen

et al. 2021

European J of Heart Fail

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Section: Discussionmentioning

confidence: 99%

Decongestion discriminates risk for one‐year mortality in patients with improving renal function in acute heart failure

Wettersten

Horiuchi

Veldhuisen

et al. 2021

European J of Heart Fail

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“…Distinguishing euvolemia from hypovolemia is sometimes challenging. Borderline blood pressure, reduced skin turgor, orthostatism, hypernatremia, significant increase of hematocrit and total protein, oliguria, and a creatinine increase of more than 30% from the baseline creatinine values at admission are proposed as surrogate markers of a clinically significant reduction of the effective blood volume [49]. Absolute and relative contraindications for in-hospital sac/val administration are shown in Table 2.…”

Section: Sac/val and Volume Statusmentioning

confidence: 99%

Angiotensin receptor-neprilysin inhibition in patients with acute decompensated heart failure: an expert consensus position paper

et al. 2021

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The short-term mortality and rehospitalization rates after admission for acute heart failure (AHF) remain high, despite the high level of adherence to contemporary practice guidelines. Observational data from non-randomized studies in AHF strongly support the in-hospital administration of oral evidence-based modifying chronic heart failure (HF) medications (i.e., b-blockers, ACE inhibitors, mineralocorticoid receptor antagonists) to reduce morbidity and mortality. Interestingly, a well-designed prospective randomized multicenter study (PIONEER-HF) showed an improved clinical outcome and stress/injury biomarker profile after in-hospital administration of sacubitril/valsartan (sac/val) as compared to enalapril, in hemodynamically stable patients with AHF. However, sac/val implementation during hospitalization remains suboptimal due to the lack of an integrated individualized plan or well-defined appropriateness criteria for transition to oral therapies, an absence of specific guidelines regarding dose selection and the up-titration process, and uncertainty regarding patient eligibility. In the present expert consensus position paper, clinical practical recommendations are proposed, together with an action plan algorithm, to encourage and facilitate sac/val administration during hospitalization after an AHF episode with the aim of improving efficiencies of care and resource utilization.

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“…Renal congestion induced by systemic congestion and volume overload may also participate in the pathogenesis ( 24 ). For patients with a “warm and wet” pattern, systemic congestion, increased pulmonary and/or renal congestion are the main hemodynamic profile.…”

Section: Pathogenesismentioning

confidence: 99%

Insights of Worsening Renal Function in Type 1 Cardiorenal Syndrome: From the Pathogenesis, Biomarkers to Treatment

Hui

et al. 2021

Front. Cardiovasc. Med.

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Type-1 cardiorenal syndrome refers to acute kidney injury induced by acute worsening cardiac function. Worsening renal function is a strong and independent predictive factor for poor prognosis. Currently, several problems of the type-1 cardiorenal syndrome have not been fully elucidated. The pathogenesis mechanism of renal dysfunction is unclear. Besides, the diagnostic efficiency, sensitivity, and specificity of the existing biomarkers are doubtful. Furthermore, the renal safety of the therapeutic strategies for acute heart failure (AHF) is still ambiguous. Based on these issues, we systematically summarized and depicted the research actualities and predicaments of the pathogenesis, diagnostic markers, and therapeutic strategies of worsening renal function in type-1 cardiorenal syndrome.

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Acute Kidney Function Declines in the Context of Decongestion in Acute Decompensated Heart Failure

Cited by 52 publications

References 19 publications

Decongestion discriminates risk for one‐year mortality in patients with improving renal function in acute heart failure

Decongestion discriminates risk for one‐year mortality in patients with improving renal function in acute heart failure

Angiotensin receptor-neprilysin inhibition in patients with acute decompensated heart failure: an expert consensus position paper

Insights of Worsening Renal Function in Type 1 Cardiorenal Syndrome: From the Pathogenesis, Biomarkers to Treatment

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