Prompt Reduction in Intra-Abdominal Pressure Following Large-Volume Mechanical Fluid Removal Improves Renal Insufficiency in Refractory Decompensated Heart Failure

Mullens, Wilfried; Abrahams, Zuheir; Francis, Gary S.; Taylor, David O.; Starling, Randall C.; Tang, W.H. Wilson

doi:10.1016/j.cardfail.2008.02.010

Cited by 154 publications

(43 citation statements)

References 20 publications

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“…This is exacerbated by excessive crystalloid resuscitation. In the early stages of IAH, diuretic therapy can be considered to mobilise the oedema, but only if the patient is haemodynamically stable [8,9]. Many patients, however, will not respond to diuretics or even develop anuria as renal blood flow is reduced due to IAH [10].…”

Section: Introductionmentioning

confidence: 99%

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

Laet

Deeren

Schoonheydt

et al. 2012

Ann. Intensive Care

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BackgroundLittle is known about the effects of renal replacement therapy (RRT) with fluid removal on intra-abdominal pressure (IAP). The global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) can easily be measured bedside by transpulmonary thermodilution (TPTD). The aim of this study is to evaluate the changes in IAP, GEDVI and EVLWI in critically ill patients receiving slow extended daily dialysis (SLEDD) or continuous venovenous haemofiltration (CVVH) with the intention of net fluid removal.MethodsWe performed a retrospective cohort study in ICU patients who were treated with SLEDD or CVVH and in whom IAP was also measured, and RRT sessions were excluded when the dose of vasoactive medication needed to be changed between the pre- and post-dialysis TPTD measurements and when net fluid loss did not exceed 500 ml. The TPTD measurements were performed within 2 h before and after SLEDD; in case of CVVH, before and after an interval of 12 h.ResultsWe studied 25 consecutive dialysis sessions in nine patients with acute renal failure and cardiogenic or non-cardiogenic pulmonary oedema. The GEDVI and EVLWI values before dialysis were 877 ml/m² and 14 ml/kg, respectively. Average net ultrafiltration per session was 3.6 l, with a net fluid loss 1.9 l. The GEDVI decreased significantly during dialysis, but not more than 47.8 ml/m² (p = 0.008), as also did the EVLWI with 1 ml/kg (p = 0.03). The IAP decreased significantly from 12 to 10.5 mmHg (p < 0.0001).ConclusionsNet fluid removal by SLEDD or CVVH in the range observed in this study decreased IAP, GEDVI and EVLWI in critically ill patients although EVLWI reduction was modest.

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Section: Introductionmentioning

confidence: 99%

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

Laet

Deeren

Schoonheydt

et al. 2012

Ann. Intensive Care

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“…After fluid removal, the mean intrabdominal pressure fell to 7 mm Hg. All patients had an increase in serum creatinine after admission to the heart failure unit prior to fluid removal and had a significant fall in serum creatinine after fluid removal (mean SCr 3.4 mg/dl prior to fluid removal and 2.4 mg/dl after fluid removal p = 0.01) 24. While there is not a definitive link between the mechanical removal of fluid and the change in serum creatinine, the findings do suggest that intrabdominal pressure is the determinant of changes in renal function in the patients with ADHF and increased intrabdominal pressure.…”

Section: Epidemiology and Prognosismentioning

confidence: 97%

The Effects of Heart Failure on Renal Function

Udani¹,

Koyner²

2010

Cardiology Clinics

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SummaryHeart-kidney interactions have been increasingly recognized by clinicians and researchers involved in the study and treatment of heart failure and kidney disease. A classification system has been developed to categorize the different manifestations of cardiac and renal dysfunction. Recent work has highlighted the significant negative prognostic effect of worsening renal function on outcomes for individuals with heart failure. The etiology of the concomitant cardiac and renal dysfunction remains unclear; however, increasing evidence supports alternatives to the established theory of underfilling, including effects of venous congestion and changes in intra-abdominal pressure. Conventional therapy focuses on blockade of the renin-angiotensin-aldosterone system with expanding use of direct renin and aldosterone antagonists. Novel therapeutic interventions using extracorporeal therapy and antagonists of the adenosine pathway show promise and require further investigation.

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“…Hence, it is not known if ultrafiltration has any role in patients who are diuretic resistant. In patients with significant ascites, paracentesis might be useful to reduce intra-abdominal pressure and improve renal hemodynamics and function 49 .…”

Section: Managementmentioning

confidence: 99%

Cardio-renal syndrome

Gnanaraj

2016

F1000Res

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Cardio-renal syndrome is a commonly encountered problem in clinical practice. Its pathogenesis is not fully understood. The purpose of this article is to highlight the interaction between the cardiovascular system and the renal system and how their interaction results in the complex syndrome of cardio-renal dysfunction. Additionally, we outline the available therapeutic strategies to manage this complex syndrome.

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Prompt Reduction in Intra-Abdominal Pressure Following Large-Volume Mechanical Fluid Removal Improves Renal Insufficiency in Refractory Decompensated Heart Failure

Cited by 154 publications

References 20 publications

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

The Effects of Heart Failure on Renal Function

Cardio-renal syndrome

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