Cardiorenal Interactions in Acute Decompensated Heart Failure: Contemporary Concepts Facing Emerging Controversies

Kazory, Amir; Elkayam, Uri

doi:10.1016/j.cardfail.2014.09.005

Cited by 40 publications

(24 citation statements)

References 56 publications

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“…16 WRF was defined as a ≥20% decrease in the estimated glomerular filtration rate during hospitalization. 17 In addition, patients in the top tertile of the hematocrit increase during hospitalization were defined as the hemoconcentration group. The association between hemoconcentration and WRF was also analyzed.…”

Section: Pv Estimationmentioning

confidence: 99%

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Takei

Kohsaka

Shiraishi

et al. 2015

Circ: Heart Failure

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Background-The prognostic relevance of plasma volume reduction (PVR) in acute heart failure patients remains unclear because of the confounding hemodynamic effect of left ventricular ejection fraction impairment on kidney function. Methods and Results-Subjects enrolled in the West Tokyo Heart Failure Registry were examined. The PV at admission and discharge was estimated from the subjects' body weight and its deviation from the ideal body weight. Patients in the top tertile of estimated PVR were classified as PVR+. Of the 381 patients with acute heart failure, 181 (47.5%) had heart failure with preserved ejection fraction (HFpEF). Estimated PVR was associated with worsening renal function in the HFpEF (odds ratio, 3.28; 95% confidence interval, 1.55-6.96; P=0.002) but not in the heart failure with reduced ejection fraction cohort (odds ratio, 1.22; 95% confidence interval, 0.61-2.42; P=0.57). This association in the HFpEF cohort remained significant after adjusting for a history of hypertension and diabetes mellitus and the estimated glomerular filtration rate (odds ratio, 3.34; 95% confidence interval, 1.52-7.33; P=0.003). The use of intravenous diuretics was a significant predictor of PVR in the HFpEF and heart failure with reduced ejection fraction groups. Conclusions-The effect of estimated PVR differs by HF type, and the estimated PVR during hospitalization is a predictor of worsening renal function in patients with HFpEF but not in heart failure with reduced ejection fraction. Clinical Trial Registration

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Section: Pv Estimationmentioning

confidence: 99%

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Takei

Kohsaka

Shiraishi

et al. 2015

Circ: Heart Failure

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“…The reasons for the apparent disconnect between WRF and outcomes are beyond the scope of this article and have previously been discussed elsewhere (35). There have been proposals for revisiting the use of WRF as an end point in HF trials or changing its current definition (i.e., an increase in serum creatinine level of .0.3 mg/dl or a decrease of 20%-25% in eGFR) in the hope of achieving closer correlation with the outcomes (36)(37)(38).…”

Section: Renal Functionmentioning

confidence: 95%

Ultrafiltration Therapy for Heart Failure: Balancing Likely Benefits against Possible Risks

Kazory

2016

CJASN

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Heart failure remains a major public health concern because of its high prevalence, morbidity, mortality, and financial burden. The poor clinical outcomes associated with acute decompensated heart failure, suboptimal efficacy and safety profile of conventional treatment regimens, and unsatisfactory experiences with the newer classes of pharmacologic therapy underlie the interest in the use of extracorporeal isolated ultrafiltration in this setting. In this article, selected mechanistic aspects of ultrafiltration therapy are briefly reviewed followed by a critical overview of the largest trials in this field. I will discuss the clinical relevance of renal dysfunction and decongestion as two commonly used end points of safety and efficacy in the ultrafiltration trials, with emphasis on the emerging pertinent notions that could challenge our conventional thinking. Finally, a number of practical recommendations (e.g., customization of ultrafiltration rates) are provided for ultrafiltration therapy in the setting of acute decompensated heart failure. Because of a paucity of evidence, universally accepted consensus guidelines cannot yet be generated. As such, when considering ultrafiltration therapy for acute decompensated heart failure, the likely benefits should be carefully balanced against the potential risks for an individual patient. A conceivable implication of the ultrafiltration trials is that collaborative heart failure programs benefiting from nephrology expertise and resources could improve the outcomes and reduce the cost.

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“…патофизиологии процесса все больше набирают акту-альность и другие явления -такие, как гемодинами-ческие перегрузки, венозный застой, воспаление, эндотелиальная дисфункция, окислительный стресс и влияние последнего на ремоделирование сердца и сосудов [5].…”

Section: патофизиология острой сердечной недостаточности что нового?unclassified

Pathophysiology of Acute Heart Failure. What’s New?

Терещенко¹,

Жиров²,

Nasonova³

et al. 2016

Russ J Cardiol

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Cardiorenal Interactions in Acute Decompensated Heart Failure: Contemporary Concepts Facing Emerging Controversies

Cited by 40 publications

References 56 publications

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Ultrafiltration Therapy for Heart Failure: Balancing Likely Benefits against Possible Risks

Pathophysiology of Acute Heart Failure. What’s New?

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