Antigen carbohydrate 125 and creatinine on admission for prediction of renal function response following loop diuretic administration in acute heart failure

Early effects of empagliflozin on exercise tolerance in patients with heart failure: A pilot study

“…In the present work, we cannot unravel the mechanisms by which empagliflozin improves exercise capacity so early in patients with HF; however, the significant improvement of exercise tolerance together with a reduction of CA125 (a surrogate of congestion) suggests a diuretic effect as the major contributor explaining the present findings. The absence of significant NT‐proBNP change may be due to a poor correlation between volume status and natriuretic peptides, especially in elderly patients and in those with renal dysfunction (most patients enrolled in this study) …”

Cardiorenal Syndrome in Acute Heart Failure: Revisiting Paradigms

“…In fact, it has been suggested that this double edged-sword of the effect of loop diuretics on renal function is largely determined by a delicate balance between renal perfusion and venous congestion. 62,63 On the harmful side, they can lead to intravascular volume depletion, reduced renal perfusion and deterioration in renal function. On the beneficial side, loop diuretics can decrease venous congestion, and therefore, improve GFR.…”

“…On the beneficial side, loop diuretics can decrease venous congestion, and therefore, improve GFR. 62,63 In addition, recent studies have suggested that, at least in some patients, WRF might be a surrogate for hemoconcentration after aggressive decongestion, and associated, at least temporary, with better outcomes. [64][65][66][67] In the DOSE (Diuretic Optimization Strategies Evaluation) trial, a transient WRF with the use of high-dose diuretics was associated with early clinical improvement and not worse prognosis at 60 days.…”

“…[64][65][66][67] Conversely, WRF occurring in the setting of persistent signs of congestion or in patients with presumable renal hypoperfusion might portend a worse prognosis. 15,44,[63][64][65][66][67] Baseline renal function and magnitude of renal changes. Recent observations have found that the clinical impact of changes in renal function within the first 48 hours to 72 hours after admission for AHF is largely determined by the presence of renal failure on admission and the magnitude of changes.…”

“…60 Consequently, diuretics have been envisioned as a double-edged sword, with harmful effects in those with renal failure and mild venous congestion, and beneficial effects (renal and prognostic) in patients with severe fluid overload and renal insufficiency. 60,62,63 Unfortunately, there are no data in the form of large well-controlled studies aiming to elucidate the optimal diuretic doses for CRS type 1 patients. Indeed, in the DOSE trial, a randomized clinical trial that aimed to investigate the optimal loop diuretic approach in 308 patients with AHF, the authors found that a high-compared with a lowdose strategy, was associated with greater net fluid loss, weight loss, and relief from dyspnea but also with transient WRF.…”