Impact of renal dysfunction on the management and outcome of acute heart failure: results from the French prospective, multicentre, DeFSSICA survey

Abstract

ObjectivesCardiorenal syndrome (CRS) is the combination of acute heart failure syndrome (AHF) and renal dysfunction (creatinine clearance (CrCl) ≤60 mL/min). Real-life data were used to compare the management and outcome of AHF with and without renal dysfunction.DesignProspective, multicentre.SettingTwenty-six academic, community and regional hospitals in France.Participants507 patients with AHF were assessed in two groups according to renal function: group 1 (patients with CRS (CrCl ≤60 mL/min): n=335) and group 2 (patients with AHF with normal renal function (CrCl >60 mL/min): n=172).ResultsDifferences were observed (group 1 vs group 2) at admission for the incidence of chronic heart failure (56.42% vs 47.67%), use of furosemide (60.9% vs 52.91%), insulin (15.52% vs 9.3%) and amiodarone (14.33% vs 4.65%); additionally, more patients in group 1 carried a defibrillator (4.78% vs 0%), had ≥2 hospitalisations in the last year (15.52% vs 5.81%) and were under the care of a cardiologist (72.24% vs 61.63%). Clinical signs were broadly similar in each group. Brain-type natriuretic peptide (BNP) and BNP prohormone were higher in group 1 than group 2 (1157.5 vs 534 ng/L and 5120 vs 2513 ng/mL), and more patients in group 1 were positive for troponin (58.2% vs 44.19%), had cardiomegaly (51.04% vs 37.21%) and interstitial opacities (60.3% vs 47.67%). The only difference in emergency treatment was the use of nitrates, (higher in group 1 (21.9% vs 12.21%)). In-hospital mortality and the percentage of patients still hospitalised after 30 days were similar between groups, but the median stay was longer in group 1 (8 days vs 6 days).ConclusionsRenal impairment in AHF should not limit the use of loop diuretics and/or vasodilators, but early assessment of pulmonary congestion and close monitoring of the efficacy of conventional therapies is encouraged to allow rapid and appropriate implementation of alternative therapies if necessary.

Natriuretic Peptides in the Cardiovascular System: Multifaceted Roles in Physiology, Pathology and Therapeutics

“…Thus, by promoting diuresis, natriuresis, and vasorelaxation, it counteracts not only HF but also chronic kidney disease (CKD) development. In fact, BNP and NT-proBNP levels are higher in acute HF patients with renal dysfunction as compared to patients with normal renal function [39]. Importantly, it has been shown that BNP infusion may contribute to prevent development of CKD in HF [40].…”

Fatores preditivos para o desenvolvimento da síndrome cardiorrenal em pacientes com insuficiência cardíaca

“…Os níveis dos biomarcadores BNP e pro-BNP foram maiores em pacientes com síndrome cardiorrenal do que em pacientes com insuficiência cardíaca aguda com função renal preservada, além de uma maior porcentagem de troponina positiva no mesmo grupo. Esses biomarcadores são importantes para analisar o status de congestão venosa dos pacientes e são recomendados para o manejo de pacientes admitidos com esse tipo de quadro, sendo fundamentais para auxiliar na tomada de decisão clínica e valor prognóstico (Reis et al, 2019).…”

“…Assim, o manejo adequado da congestão venosa na emergência parece ter importante valor prognóstico para preservar as funções cardíaca e renal (Reis et al, 2019).…”

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

“…Hence different viewpoints of rational diuretics use have been concluded in different clinical researches. The Description de la Filière de Soins dans les Syndromes d'Insuffisance Cardiaque Aigue (DeFSSICA) study indicated no limitation of loop diuretics in patients with AHF with renal insufficiency for the reason that the prognosis of patients with acute CRS on diuretics therapy was indiscriminate compared with that of patients with AHF ( 98 ). Conversely, the Randomized Evaluation of Heart Failure with Preserved Ejection Fraction Patients with Acute Heart Failure and Dopamine (ROPA-DOP) study and the DOSE-AHF study clarified the association between the utilization of diuretics and WRF in patients with AHF ( 99 , 100 ).…”