Diuretics in the Management of Cardiorenal Syndrome

Chitturi, Chandrika; Novak, James E.

doi:10.1053/j.ackd.2018.08.008

Cited by 18 publications

(24 citation statements)

References 58 publications

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“…With only about a quarter of the individuals with hypertension aware of their diagnosis in SSA [ 37 , 38 ], patient self-report of hypertension is likely an indicator of engagement with the healthcare system and taking appropriate preventative therapies, which explains why self-reported hypertension appears to be protective against mortality among HF patients in our setting. Leg swelling is a marker of volume overload and is associated with severe symptoms and poor outcomes in HF, which may explain why leg swelling is a positive predictor of mortality in HF patients in Tanzania and elsewhere [ 39 , 40 ]. Other studies have found age and NYHA class to be predictors of mortality in HF patients in SSA, although they were not predictive of mortality in our cohort [ 41 – 43 ].…”

Section: Discussionmentioning

confidence: 99%

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

et al. 2021

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Background The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. Methods In a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality. Results Of 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21–0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35–5.56, p = 0.006). Conclusion In a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting.

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Section: Discussionmentioning

confidence: 99%

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

et al. 2021

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“…Los objetivos del tratamiento farmacológico del SCR consisten en lograr una mejoría de los signos de congestión vascular y asegurar presiones adecuadas para garantizar la perfusión tisular [19][20][21]. Los diuréticos son la piedra angular del manejo descongestivo, se prescriben en aproximadamente el 90 % de los pacientes con insu ciencia cardiaca descompensada con sobrecarga hídrica, por sus efectos en la disminución de la presión venosa central resultado de las pérdidas urinarias de sodio y agua [1,5].…”

Section: Terapias Descongestivasunclassified

“…En sus resultados no hubo diferencia signi cativa en la evaluación global de los síntomas o cambio en la creatinina sérica durante 72 h con administración diurética en bolo o infusión continua, o con una dosis baja versus una dosis alta; sin embargo, los pacientes asignados a la estrategia de dosis más altas experimentaron un incremento de creatinina transitoria [22]. El tratamiento con diuréticos, a diferencia de muchas otras terapias farmacológicas para la insu ciencia cardiaca, sigue siendo en gran medida empírico [1,19]. Las mejores prácticas clínicas basadas en la evidencia para el uso de diuréticos siguen siendo inciertas, ya que si bien proporcionan un rápido alivio de los síntomas, no han demostrado bene cio en desenlaces de mortalidad o de rehospitalización [1,19].…”

Section: Terapias Descongestivasunclassified

Estado del arte del síndrome cardiorrenal, ventajas y limitaciones de las terapias conocidas

Barbur

Mejía-Sanjuanelo

Anaya-Taboada

et al. 2021

Rev. Colomb. Nefrol.

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Las interacciones entre las enfermedades cardíacas y renales se han clasificado como síndromes cardiorenales. La clasificación actual incluye cinco subtipos, los cuales son: insuficiencia cardíaca aguda que conduce a insuficiencia renal aguda (tipo 1), insuficiencia cardíaca crónica que conduce a insuficiencia renal (tipo 2), lesión renal aguda que conduce a insuficiencia cardíaca (tipo 3), enfermedad renal crónica que conduce a insuficiencia cardíaca (tipo 4) y afecciones sistémicas que conducen a insuficiencia cardíaca y renal (tipo 5) (Tabla 1) (1,2). En esta revisión discutimos la definición, clasificación, fisiopatología del síndrome cardiorrenal, enfocándonos en el manejo en fases agudas y su recuperación, exponiendo la evidencia actualmente disponible de los diuréticos y la ultrafiltración con el objetivo de intervenir de manera oportuna a nuestros pacientes conociendo las ventajas y limitaciones de cada una de las estrategias de manejo en aras de reducir el riesgo de eventos clínicos, re- hospitalización y muerte.

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“…Кардиоваскулярный риск, обусловленный ухудшением функции почек, начинает возрастать на ранних стадиях почечной патологии, чем это ранее предполагалось [16], что определяет повышенное внимание к состоянию сердечно-сосудистой системы и влияет на тактику ведения больных ХБП [17]. Возможное развитие кардиоренального синдрома у пациентов с кардиоваскулярными заболеваниями подчеркивает актуальность вопроса оптимального выбора диуретических средств, поскольку проводимая симптоматическая терапия СН ограничена прогрессирующим снижением функции почек [1,6,10].…”

Section: хроническая боле знь почек: определениеunclassified

“…Сегодня диуретики являются одним из распространенных классов лекарственных препаратов, используемых в медицинской практике, включая внутренние болезни, неврологию, эндокринологию, урологию и другие медицинские специальности [1][2][3][4][5][6][7]. Такой широкий спектр их применения объясняется различными механизмами действия и клиническими эффектами.…”

Section: Introductionunclassified

Diuretics in chronic kidney disease

Diadyk

Тарадин

Сулиман

et al. 2020

Arhivʺ vnutrennej mediciny

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The issues of diuretic therapy in patients with chronic kidney disease, pharmacokinetics of diuretics, the problem of diuretic resistance, the tactics of using thiazides and loop diuretics in patients with various stages of chronic kidney disease, according to the recommendations of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative are discussed in the article. Particular attention is paid to the prescription of this group of drugs to patients with end stage renal disease, as well as those undergoing renal replacement therapy (hemodialysis).Diuretics play an important role in the management of patients with chronic kidney disease with the development of hypertension and an increased extracellular fluid volume. In case of impaired renal function leading place is given to loop diuretics. Their combination with thiazide diuretics can increase the diuretic effect. The results of clinical trials assessing the effectiveness of the use of diuretics during decline of residual renal function are provided. It is reported about the effect of potassium-sparing diuretics on the incidence of cardiovascular complications, the development of hyperkalemia in patients undergoing dialysis treatment. The importance of continuation of intensive study about the possibility of antagonists of mineralocorticoid receptors usage, in particular the spironolactone, eplerenone, and finerenone in order to reduce cardiovascular complications and mortality, is indicated.

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Diuretics in the Management of Cardiorenal Syndrome

Cited by 18 publications

References 58 publications

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

Estado del arte del síndrome cardiorrenal, ventajas y limitaciones de las terapias conocidas

Diuretics in chronic kidney disease

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