Renal Dysfunction in Heart Failure Is Due to Congestion but Not Low Output

Guglin, Maya; Rivero, Abel; Matar, Fadi; Garcia, Marcos

doi:10.1002/clc.20831

Cited by 77 publications

(65 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, high central venous pressure correlated with low estimated GFR in a study by Damman et al [16], and could predict mortality, independent of the cardiac index. These findings were confirmed by Guglin et al [17] who found that low estimated GFR was associated with elevated central venous pressure, but not cardiac index or left ventricular ejection fraction. It has been challenging to reconcile these findings with the existing literature supporting a primary role for cardiac output in maintaining renal perfusion and function.…”

Section: Emerging Concepts In Cardiorenal Pathophysiology: Renal Venosupporting

confidence: 70%

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

Ross

Kazory

2012

Blood Purif

View full text Add to dashboard Cite

Background: Heart failure (HF) has a high readmission rate in part due to conventional and recently developed therapeutic options having suboptimal results. Extracorporeal and peritoneal ultrafiltration have been advocated as more beneficial methods for fluid removal in decompensated or refractory HF, respectively. Methods: Traditional and emerging concepts explaining the pathophysiology of HF and the cardiorenal syndrome are reviewed. Extracorporeal and peritoneal ultrafiltration clinical trials are then discussed in terms of potential physiologic benefits, feasibility and their effects on both cardiac and renal function. Results: Ultrafiltration therapy can efficiently correct volume overload in the acute setting, improve cardiac functional and quality of life parameters, and is associated with long-lasting benefits such as reduced HF-related readmissions. Although excessive fluid removal can adversely affect the kidneys, there is evidence that careful protocols can restore diuretic sensitivity and maintain stable renal function; crafting safe parameters has yet to be studied. Conclusion: While extracorporeal ultrafiltration is an appealing therapeutic option for patients with acute decompensated HF, determining the optimal fluid removal rate and the impact on renal function need further investigation. Peritoneal dialysis may be an appropriate alternative in the setting of chronic refractory HF, but controlled studies are needed. Further trials are warranted to determine the long-term outcomes from both ultrafiltration modalities in HF.

show abstract

Section: Emerging Concepts In Cardiorenal Pathophysiology: Renal Venosupporting

confidence: 70%

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

Ross

Kazory

2012

Blood Purif

View full text Add to dashboard Cite

show abstract

“…However, it is often not feasible to serially repeat invasive catherization. We therefore chose to follow the majority of the literature and pursue a cross-sectional study where the utilization of a large number of data points taken from patients at different phases in heart failure can elicit these trends [9, 10, 15]. …”

Section: Discussionmentioning

confidence: 99%

“…Those that do are often small in size. Some analyses from the ESCAPE trial have suggested no association between renal failure and any pulmonary artery catherization hemodynamic value [8, 13], whilst other observational series suggest weak associations between renal failure and cardiac congestion [7, 9, 10, 14, 15]. Damman et al [15] demonstrated in the largest series on this topic by far ( n = 2,557 patients) an inverse relationship in terms of cardiac filling pressures, predominantly renal artery pressure, with renal function.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Catherization Data Correlate Poorly with Renal Function in Heart Failure

Masha

Stone

et al. 2018

Cardiorenal Med

View full text Add to dashboard Cite

Background: The mechanisms of renal dysfunction in heart failure are poorly understood. We chose to explore the relationship of cardiac filling pressures and cardiac index (CI) in relation to renal dysfunction in advanced heart failure. Objectives: To determine the relationship between renal function and cardiac filling pressures using the United Network of Organ Sharing (UNOS) pulmonary artery catherization registry. Methods: Patients over the age of 18 years who were listed for single-organ heart transplantation were included. Exclusion criteria included a history of mechanical circulatory support, previous transplantation, any use of renal replacement therapy, prior history of malignancy, and cardiac surgery, amongst others. Correlations between serum creatinine (SCr) and CI, pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic pressure (PASP), and pulmonary artery diastolic pressure (PADP) were assessed by Pearson correlation coefficients and simple linear regression coefficients. Results: Pearson correlation coefficients between SCr and PCWP, PASP, and PADP were near zero with values of 0.1, 0.07, and 0.08, respectively (p < 0.0001). A weak negative correlation coefficient between SCr and CI was found (correlation coefficient, –0.045, p = 0.027). In a subgroup of young patients unlikely to have noncardiac etiologies, no significant correlations between these values were identified. Conclusion: These findings suggest that, as assessed by pulmonary artery catherization, none of the factors – PCWP, PASP, PADP, or CI – play a prominent role in cardiorenal syndromes.

show abstract

“…Damman et al reported that high central venous pressure (CVP) correlated with low estimated GFR (eGFR) and could predict mortality independent of the cardiac index in HF patients (32). Similarly, Guglin et al found that low eGFR was associated with elevated CVP but not with cardiac index or left ventricular ejection fraction in these patients (33). A primary role of venous congestion in ADHF and cardiorenal syndrome is especially appealing because it could potentially be amenable to fluid removal by UF.…”

Section: Venous Decongestionmentioning

confidence: 99%

Cardiorenal Syndrome

Kazory

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryHeart failure remains the leading cause of hospitalization in older patients and is considered a growing public health problem with a significant financial burden on the health care system. The suboptimal efficacy and safety profile of diuretic-based therapeutic regimens coupled with unsatisfactory results of the studies on novel pharmacologic agents have positioned ultrafiltration on the forefront as an appealing therapeutic option for patients with acute decompensated heart failure (ADHF). In recent years, substantial interest in the use of ultrafiltration has been generated due to the advent of dedicated portable devices and promising results of trials focusing both on mechanistic and clinical aspects of this therapeutic modality. This article briefly reviews the proposed benefits of ultrafiltration therapy in the setting of ADHF and summarizes the major findings of the currently available studies in this field. The results of more recent trials on cardiorenal syndrome that present a counterpoint to previous observations and highlight certain limitations of ultrafiltration therapy are then discussed, followed by identification of major challenges and unanswered questions that could potentially hinder its more widespread use. Future studies are warranted to shed light on less well characterized aspects of ultrafiltration therapy and to further define its role in ADHF and cardiorenal syndrome.

show abstract

Renal Dysfunction in Heart Failure Is Due to Congestion but Not Low Output

Cited by 77 publications

References 10 publications

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

Ultrafiltration Therapy for Cardiorenal Syndrome: Physiologic Basis and Contemporary Options

Pulmonary Catherization Data Correlate Poorly with Renal Function in Heart Failure

Cardiorenal Syndrome

Contact Info

Product

Resources

About