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By Erica Yama Nephrologist
Yasushi Ohashi, Akinobu Saito, Keisuke Yamazaki, Reibin Tai, Tatsuru Matsukiyo, Atsushi Aikawa, Ken Sakai
BACKGROUND/AIM: Fluid volume overload occurs in chronic kidney disease (CKD), leading to the compensatory release of natriuretic peptides. However, the elevated cardiac peptides may also be associated with malnutrition as well as volume overload. METHODS: Body fluid composition was measured in 147 patients with CKD between 2009 and 2015, and its relationship to brain natriuretic peptide (BNP) levels was examined. Body fluid composition was separated into three components: (a) a water-free mass consisting of muscle, fat, and minerals; (b) intracellular water (ICW) content, and (c) extracellular water (ECW) content...
August 2016: Cardiorenal Medicine
U Janssens, M Joannidis
Heart and kidney are closely interacting organs which function interdependently. Organ crosstalk between these two organs is based on humoral regulation and by inflammatory mediators, which are similar to those dominating systemic inflammation syndrome. The close interaction between heart and kidney results in organ dysfunction following both chronic and acute functional impairment of the respective counterpart. These changes are summarized under the term cardiorenal syndrome (CRS) which is subdivided into 5 types...
May 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Francisca Caetano, Paula Mota, Inês Almeida, Andreia Fernandes, Ana Botelho, António Leitão Marques
INTRODUCTION AND OBJECTIVES: Intravenous loop diuretics are an essential part of acute heart failure management; however, data to guide their use is sparse. Our aim was to compare continuous intravenous infusion of loop diuretics with intravenous bolus administration in terms of efficacy and adverse events in patients admitted with severe acute heart failure. METHODS: Over a period of three years, 110 patients were admitted to our cardiac intensive care unit with acute heart failure...
February 2015: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
Kurt W Prins, Keith M Wille, Jose A Tallaj, Ashita J Tolwani
BACKGROUND: Patients with acute decompensated heart failure (ADHF) and cardiorenal syndrome (CRS) 1 have poor outcomes. Ultrafiltration (UF) is used to mechanically remove salt and water in ADHF patients with diuretic resistance. However, little is known about the outcomes of ADHF patients on inotropes and/or vasopressors who require continuous renal replacement therapy (CRRT) for both UF and solute clearance in severe acute kidney injury. METHODS: We retrospectively analyzed 37 consecutive critically ill patients who were admitted for ADHF from 2005-13 and were on inotropes and/or vasopressors at the time of CRRT initiation...
February 2015: Clinical Kidney Journal
Bertram Pitt, Marc A Pfeffer, Susan F Assmann, Robin Boineau, Inder S Anand, Brian Claggett, Nadine Clausell, Akshay S Desai, Rafael Diaz, Jerome L Fleg, Ivan Gordeev, Brian Harty, John F Heitner, Christopher T Kenwood, Eldrin F Lewis, Eileen O'Meara, Jeffrey L Probstfield, Tamaz Shaburishvili, Sanjiv J Shah, Scott D Solomon, Nancy K Sweitzer, Song Yang, Sonja M McKinlay
BACKGROUND: Mineralocorticoid-receptor antagonists improve the prognosis for patients with heart failure and a reduced left ventricular ejection fraction. We evaluated the effects of spironolactone in patients with heart failure and a preserved left ventricular ejection fraction. METHODS: In this randomized, double-blind trial, we assigned 3445 patients with symptomatic heart failure and a left ventricular ejection fraction of 45% or more to receive either spironolactone (15 to 45 mg daily) or placebo...
April 10, 2014: New England Journal of Medicine
Anna Clementi, Grazia Maria Virzì, Alessandra Brocca, Massimo de Cal, Giorgio Vescovo, Antonio Granata, Claudio Ronco
Cardiorenal syndrome (CRS) type 4, or chronic renocardiac syndrome, has been defined as 'chronic abnormalities in renal function leading to cardiac disease' and recognizes the extreme burden of cardiovascular (CV) disease (CVD) risk in patients with chronic kidney disease (CKD). CKD is common and increasingly recognized as a risk factor for CVD. Although during the past 10 years CV morbidity and mortality have decreased markedly in the general population, their rates still remain high among CKD patients. For this reason, CKD patients should be evaluated thoroughly for CV risk factors which require an aggressive management, given the significant implications of CRS type 4 at both individual and societal level...
2013: Blood Purification
Adrian F Hernandez, Xiaojuan Mi, Bradley G Hammill, Stephen C Hammill, Paul A Heidenreich, Frederick A Masoudi, Laura G Qualls, Eric D Peterson, Gregg C Fonarow, Lesley H Curtis
CONTEXT: Aldosterone antagonist therapy for heart failure and reduced ejection fraction has been highly efficacious in randomized trials. However, questions remain regarding the effectiveness and safety of the therapy in clinical practice. OBJECTIVE: To examine the clinical effectiveness of newly initiated aldosterone antagonist therapy among older patients hospitalized with heart failure and reduced ejection fraction. DESIGN, SETTING, AND PARTICIPANTS: Using clinical registry data linked to Medicare claims from 2005 through 2010, we examined outcomes of eligible patients hospitalized with heart failure and reduced ejection fraction...
November 28, 2012: JAMA: the Journal of the American Medical Association
Bradley A Bart, Steven R Goldsmith, Kerry L Lee, Michael M Givertz, Christopher M O'Connor, David A Bull, Margaret M Redfield, Anita Deswal, Jean L Rouleau, Martin M LeWinter, Elizabeth O Ofili, Lynne W Stevenson, Marc J Semigran, G Michael Felker, Horng H Chen, Adrian F Hernandez, Kevin J Anstrom, Steven E McNulty, Eric J Velazquez, Jenny C Ibarra, Alice M Mascette, Eugene Braunwald
BACKGROUND: Ultrafiltration is an alternative strategy to diuretic therapy for the treatment of patients with acute decompensated heart failure. Little is known about the efficacy and safety of ultrafiltration in patients with acute decompensated heart failure complicated by persistent congestion and worsened renal function. METHODS: We randomly assigned a total of 188 patients with acute decompensated heart failure, worsened renal function, and persistent congestion to a strategy of stepped pharmacologic therapy (94 patients) or ultrafiltration (94 patients)...
December 13, 2012: New England Journal of Medicine
G Michael Felker, Kerry L Lee, David A Bull, Margaret M Redfield, Lynne W Stevenson, Steven R Goldsmith, Martin M LeWinter, Anita Deswal, Jean L Rouleau, Elizabeth O Ofili, Kevin J Anstrom, Adrian F Hernandez, Steven E McNulty, Eric J Velazquez, Abdallah G Kfoury, Horng H Chen, Michael M Givertz, Marc J Semigran, Bradley A Bart, Alice M Mascette, Eugene Braunwald, Christopher M O'Connor
BACKGROUND: Loop diuretics are an essential component of therapy for patients with acute decompensated heart failure, but there are few prospective data to guide their use. METHODS: In a prospective, double-blind, randomized trial, we assigned 308 patients with acute decompensated heart failure to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2...
March 3, 2011: New England Journal of Medicine
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