Hypotension is associated with diuretic resistance in severe chronic heart failure, independent of renal function

Abstract

Background: Diuretic resistance and systemic hypotension are common in chronic heart failure (CHF), however, the two have not been associated. Aims: Since blood pressure (BP) might be an important determinant of sodium excretion, we searched for an association between BP and diuretic dosage in severe CHF. Methods: Our heart failure database was retrospectively reviewed for patients with severe left ventricular systolic dysfunction. The 54-patient cohort was divided on the basis of frusemide dosage (high-dose z250 mg daily, n=26). Results: Patients taking high-dose frusemide had higher serum creatinine, and lower systolic and diastolic BP. On logistic regression analysis, increased serum creatinine and reduced diastolic BP were independent predictors of the use of high-dose frusemide. Grouping these variables into tertiles, the odds ratio for the use of high-dose frusemide was 4.0 as diastolic BP decreased ( pb0.01), and 6.8 as serum creatinine increased ( pb0.001). Conclusions: We have found an association between hypotension and the use of high-dose frusemide in severe CHF, which is independent of renal function, and which may be an important physiologic mechanism of diuretic resistance in severe CHF. Crown

Pre-clinical model of severe glutathione peroxidase-3 deficiency and chronic kidney disease results in coronary artery thrombosis and depressed left ventricular function

“…Similar to the lack of effect of GPx3 deficiency on cerebral blood flow in unstressed animals [13], we did not observe a baseline decrease in left ventricular systolic function in knockout animals or animals undergoing sham surgery. GPx3 À/À þ CKD rapidly developed a decline in FS over 4 weeks along with cardiac fibrosis, hypotension and a high mortality rate, pathological changes consistent with severe systolic heart failure [58][59][60]. It has been recognized by several groups that CKD-induced cardiac disease can be characterized by cardiac fibrosis in the absence of hypertension [11,[61][62][63].…”

The Effects of Nesiritide on Renal Function and Diuretic Responsiveness in Acutely Decompensated Heart Failure Patients With Renal Dysfunction

“…(32) Such effects may contribute to the preload reducing effects of nesiritide and may limit diuresis. Further, the reduction in blood pressure, and thus renal perfusion pressure associated with this dose of nesiritide, may also limit the diuretic effects of both furosemide (33) and nesiritide as mentioned above. Based on the potent hypotensive effect of this dose of nesiritide and the preliminary findings with lower dose nesiritide mentioned above, (16,26,27) we speculate that alternate natriuretic peptide/furosemide dosing strategies may optimize diuresis while minimizing renal dysfunction in HF.…”

İleri evre kalp yetersizliği rehberi

“…[261] Kalp yetersizliği hastalarında dopamin dışındaki vazoaktif ilaçlar ile (nesiritid, nitrogliserin, dobutamin) renal fonksiyonların korunabildiği gösterilememiş-tir. Düşük doz dopamin (4-5 μg kg -1 dk -1 ) infüzyo-nu ile dEFKY hastalarında renal kan akımı ve GFR artabilmektedir.…”