Relationship between Intra-Abdominal Pressure and Renal Function in Patients with Acute Decompensated Heart Failure: Pilot Observations

AbstractIn order to predict the occurrence of worsening renal function (WRF) and of WRF plus in-hospital death, 101 emergency department (ED) patients with acute decompensated heart failure (ADHF) were evaluated with testing for amino-terminal pro-B-type natriuretic peptide (NT-proBNP), BNP, sST2, and neutrophil gelatinase associated lipocalin (NGAL).In a prospective international study, biomarkers were collected at the time of admission; the occurrence of subsequent in hospital WRF was evaluated.In total 26% of patients developed WRF. Compared to patients without WRF, those with WRF had a longer in-hospital length of stay (LOS) (mean LOS 13.1±13.4 days vs. 4.8±3.7 days, p<0.001) and higher in-hospital mortality [6/26 (23%) vs. 2/75 (2.6%), p<0.001]. Among the biomarkers assessed, baseline NT-proBNP (4846 vs. 3024 pg/mL; p=0.04), BNP (609 vs. 435 pg/mL; p=0.05) and NGAL (234 vs. 174 pg/mL; p=0.05) were each higher in those who developed WRF. In logistic regression, the combination of elevated natriuretic peptide and NGAL were additively predictive for WRF (OR: In ED patients with ADHF, the combination of NT-proBNP or BNP plus NGAL at presentation may be useful to predict impending WRF (Clinicaltrials.gov NCT#0150153).

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4877Renal function and intensive blood pressure lowering in high-risk adults without diabetes: insights from the Systolic Blood Pressure Intervention Trial (SPRINT)

European Heart Journal ◽

10.1093/eurheartj/ehz746 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

M Pareek ◽

A M D Kristensen ◽

M Vaduganathan ◽

T Biering-Sorensen ◽

C Byrne ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Renal Function ◽

Acute Decompensated Heart Failure ◽

Kidney Injury ◽

Decompensated Heart Failure ◽

Primary Efficacy ◽

Primary Efficacy Endpoint ◽

The Relationship ◽

Intensive Blood Pressure

Abstract Background The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive blood pressure (BP) lowering reduced the rates of cardiovascular events and mortality but increased the risk of certain adverse events, in patients with and without chronic kidney disease at baseline. However, it is unclear whether intensive BP management is well-tolerated and modifies risk uniformly across the entire spectrum of renal function. Purpose To assess the relationship between renal function, treatment response to intensive BP lowering, and cardiovascular (CV) outcomes. Methods SPRINT was a randomized, controlled trial in which 9,361 individuals ≥50 years of age, at high CV risk but without diabetes who had a systolic BP (SBP) 130–180 mmHg, were randomized to intensive (target SBP <120mmHg) or standard antihypertensive treatment (target SBP <140mmHg). The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, acute decompensated heart failure, or death from CV causes. The primary safety endpoint was the composite of serious adverse events (SAE). Renal function was assessed using the estimated glomerular filtration rate (GFR), calculated with the Modification of Diet in Renal Disease equation. We first assessed whether a linear association was present between eGFR and clinical endpoints using restricted cubic splines. We then examined the prognostic implications of eGFR, unadjusted and adjusted for demographic, clinical, and laboratory variables. We further explored the effects of intensive BP lowering across the eGFR spectrum. Results Baseline eGFR was available for 9,324 (>99%) individuals. Mean eGFR was similar between the two groups (intensive group 71.8 ml/min/1.73m2 vs. standard group 71.7 ml/min/1.73m2; P=0.92). Median follow-up was 3.3 years (range 0–4.8), with 561 primary efficacy events (6%) and 3,522 SAE (38%) recorded during the study period. Baseline eGFR was non-linearly associated with the risk of the primary efficacy endpoint, death from CV causes, death from any cause, acute decompensated heart failure, SAE, electrolyte abnormality, and acute kidney injury (test for non-linearity, P<0.05; test for overall trend, P<0.001) and remained significantly associated with all tested endpoints upon multivariable adjustment (P<0.05). Baseline eGFR significantly modified the effects of intensive BP lowering on the primary efficacy endpoint (P=0.02), acute decompensated heart failure (P=0.01), SAE (P=0.01), and acute kidney injury (P=0.04). The Figure shows treatment effects (hazard ratios) across the spectrum of eGFR for these four endpoints. P-values are for the interaction between eGFR and treatment effect. Significant interactions were not detected for other endpoints. Figure 1 Conclusions In SPRINT, lower eGFR was associated with a greater risk of both CV events and SAE. Patients with higher eGFR appeared to derive more benefit from intensive BP lowering while the relationship with safety events was complex.

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New renal haemodynamic indices can predict worsening of renal function in acute decompensated heart failure

ESC Heart Failure ◽

10.1002/ehf2.12835 ◽

2020 ◽

Vol 7 (5) ◽

pp. 2581-2588

Author(s):

Amir Mostafa ◽

Karim Said ◽

Walid Ammar ◽

Ahmed Elsayed Eltawil ◽

Magdy Abdelhamid

Keyword(s):

Heart Failure ◽

Renal Function ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure

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Renal Function in Patients With Acute Decompensated Heart Failure Treated With Ultrafiltration

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2012.06.477 ◽

2012 ◽

Vol 18 (8) ◽

pp. S74

Author(s):

Nicholas Haglund ◽

Michael Johnston ◽

Ioana Dumitru ◽

Joan Mack ◽

Brian Lowes ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure

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IMPACT OF LEVOSIMENDAN ON RENAL FUNCTION IN COMPLEX TREATMENT OF ACUTE DECOMPENSATED HEART FAILURE

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2018-14-2-176-183 ◽

2018 ◽

Vol 14 (2) ◽

pp. 176-183

Author(s):

M. V. Lediakhova ◽

S. N. Nasonova ◽

I. V. Zhirov ◽

M. V. Andreevskaya ◽

R. M. Bogieva ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Complex Treatment

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ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2019.v12i12.35574 ◽

2019 ◽

pp. 61-63

Author(s):

PRUDENCE A RODRIGUES ◽

SOUMYA GK ◽

NADIA GRACE BUNSHAW ◽

SARANYA N ◽

SUJITH K ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Renal Injury ◽

Loop Diuretic ◽

Acute Decompensated Heart Failure ◽

Diuretic Therapy ◽

Decompensated Heart Failure ◽

Loop Diuretics ◽

Contributing Factors ◽

The Impact

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

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