scholarly journals One-Year Survival and Renal Function Recovery of Acute Kidney Injury Patients with Chronic Heart Failure

2014 ◽  
Vol 5 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Wen Zhang ◽  
Dan Wen ◽  
Yan-Fang Zou ◽  
Ping-Yan Shen ◽  
Yao-Wen Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Clinical Characteristics ◽  
Nyha Class ◽  
Kidney Injury ◽  
Class Iii ◽  
Kidney Dysfunction ◽  
Nyha Classification

Objective: To describe and analyze the clinical characteristics of acute kidney injury (AKI) patients with preexisting chronic heart failure (CHF) and to identify the prognostic factors of the 1-year outcome. Methods: A total of 120 patients with preexisting CHF who developed AKI between January 2005 and December 2010 were enrolled. CHF was diagnosed according to the European Society of Cardiology guidelines, and AKI was diagnosed using the RIFLE criteria. Clinical characteristics were recorded, and nonrecovery from kidney dysfunction as well as mortality were analyzed. Results: The median age of the patients was 70 years, and 58.33% were male. 60% of the patients had an advanced AKI stage (‘failure') and 90% were classified as NYHA class III/IV. The 1-year mortality rate was 35%. 25.83% of the patients progressed to end-stage renal disease after 1 year. Hypertension, anemia, coronary atherosclerotic heart disease and chronic kidney disease were common comorbidities. Multiple organ dysfunction syndrome (MODS; OR, 35.950; 95% CI, 4.972-259.952), arrhythmia (OR, 13.461; 95% CI, 2.379-76.161), anemia (OR, 6.176; 95% CI, 1.172-32.544) and RIFLE category (OR, 5.353; 95% CI, 1.436-19.952) were identified as risk factors of 1-year mortality. For 1-year nonrecovery from kidney dysfunction, MODS (OR, 8.884; 95% CI, 2.535-31.135) and acute heart failure (OR, 3.281; 95% CI, 1.026-10.491) were independent risk factors. Conclusion: AKI patients with preexisting CHF were mainly elderly patients who had an advanced AKI stage and NYHA classification. Their 1-year mortality and nonrecovery from kidney dysfunction rates were high. Identifying risk factors may help to improve their outcome.

scholarly journals The Management of Heart Failure in Kidney and Urinary Tract Syndromes

2017 ◽  
Vol 10 ◽  
Author(s):  
Yuri Lopatin ◽  
Andrew JS Coats
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Urinary Tract ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Kidney Dysfunction ◽  
Co Morbidity ◽  
The Common

Kidney dysfunction and other related abnormalities are extremely common in all HF syndromes, both because of the similarity of risk factors and the similarity of demography of the two types of patients but also because of the common renal effects of agents used for the treatment of HF. Important renal syndromes for the HF patient include including chronic kidney disease, acute kidney injury, cardio-renal syndrome, and prostatic obstruction. In HF (all types including  HFrEF, HFmrEF and especially HFpEF) chronic kidney disease (CKD) frequently co-exists and almost as frequently complicates the HF management. The two groups of syndromes share many risk factors (diabetes, hypertension, hyperlipidaemia) and often interact to worsen the prognosis of each other in a way that makes the patient with combined HF and renal disease at extremely high risk. This article reviews this common co-morbidity and how to manage it.

Association between self-care and prognosis in 1123 patients with chronic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Calero ◽  
E Hidalgo ◽  
R Marin ◽  
L Rosenfeld ◽  
I Fernandez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Acute Heart Failure ◽  
Nyha Class ◽  
Self Care ◽  
P Value ◽  
Funding Source ◽  
Class Iii ◽  
Cox Models ◽  
Lower Tertile

Abstract Background Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF. Aims and methods The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF. We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline. Results We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour. Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception. Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028] Conclusion Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure. These results highlight the importance of assessing self-care and provide measures to improve them. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

Abstract 3143: Reverse Hemodynamic Remodelling May Be Possible Over Time

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lynne W Stevenson ◽  
Yong K Cho ◽  
J. T Heywood ◽  
Robert C Bourge ◽  
William T Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Nyha Class ◽  
Systolic Pressure ◽  
Filling Pressure ◽  
Class Iii ◽  
One Year ◽  
Over Time

Introduction : Elevated filling pressures are a hallmark of chronic heart failure. They can be reduced acutely during HF hospitalization but the hemodynamic impact of ongoing therapy to maintain optivolemia has not been established. Methods and Results : After recent HF hospitalization, 274 NYHA Class III or IV HF patients were enrolled in the COMPASS-HF study at 28 experienced HF centers and received intense HF management (average 24.7 staff contacts/ 6 months) ± access to filling pressure information to adjust diuretics to maintain optivolemia, usually defined as estimated pulmonary artery diastolic (PAD) pressure of 12±4 mmHg. Filling pressure information was available for half the patients during the first 6 months (the Chronicle group, <Access), and for all patients during the next 6 months. Diuretics were adjusted 12.7 times per patient in the Chronicle group and 8.2 times per patient in the Control (-Access) group during the first 6 months (p = 0.0001). Compared to baseline, decreases in RV systolic pressure (RVSP) and ePAD were significant for the +Access patients by one year (p=0.0012 and p =.04, respectively). The Control patients exhibited a similar trend 6 months after crossing to +Access (figure ). Conclusions: Targeted therapeutic adjustments, based on continuous filling pressures along with intensification of HF management contacts, are associated with a reduction in chronic left-sided filling pressures and right ventricular load.

Clinical Significance of Acute Kidney Injury in Patients Admitted for Worsening Chronic Heart Failure

2011 ◽  
Vol 17 (9) ◽  
pp. S163
Author(s):  
Shigeru Matsui ◽  
Junnichi Ishii ◽  
Kousuke Hattori ◽  
Tousei Hashimoto ◽  
Hiroyuki Naruse ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Clinical Significance ◽  
Kidney Injury

Stability and feasibility of measurement of lung-to-finger circulation time by simple breath holdings in heart failure patients

2021 ◽  
Author(s):  
Tomoyuki Tobushi ◽  
Kasai Takatoshi ◽  
Masayuki Hirose ◽  
Kazuhiro Sakai ◽  
Manabu Akamatsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Intraclass Correlation ◽  
Circulation Time ◽  
Infrared Light ◽  
Breath Hold ◽  
Laser Sensor ◽  
Class Iii ◽  
Heart Failure Patients ◽  
Nyha Classification

Abstract Lung to finger circulation time (LFCT) has been used to estimate cardiac function. We developed a new LFCT measurement device using a laser sensor at fingertip. We measured LFCT by measuring time from re-breathing after 20 seconds of breath hold to the nadir of the difference of transmitted red light and infrared light, which corresponds to percutaneous oxygen saturation. Fifty patients with heart failure were enrolled. The intrasubject stability of the measurement was assessed by the intraclass correlation coefficient (ICC). The ICC calculated from 44 cases was 0.85 (95% confidence interval:0.77-0.91), which means to have “Excellent reliability.” By measuring twice, at least one clear LFCT value was obtained in 89.1% of patients and the overall measurability was 95.7%. We conducted all LFCT measurements safely. High ICCs were obtained even after dividing patients according to age, cardiac index (CI), and New York Heart Association (NYHA) classification; 0.85 and 0.84 (≥ 75 or < 75 years group, respectively), 0.81 and 0.84 (N=28, ≥ or < 2.2 L/min/M2), 0.82 and 0.94 (NYHA Class I-II or Class III). These results show that our new method to measure LFCT is highly stable and feasible for any type of heart failure patients.

Pd Treatment for Severe Congestive Heart Failure

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 231-235 ◽  
Author(s):  
Bernd G. Stegmayr ◽  
Ravi Banga ◽  
Lennart Lundberg ◽  
Ann Marie Wikdahl ◽  
Marianne Plum-Wirell
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Nyha Class ◽  
Fatal Outcome ◽  
Severe Congestive Heart Failure ◽  
Class Iii ◽  
Refractory Heart Failure ◽  
Nyha Classification ◽  
Heart Size ◽  
Angiotension Converting Enzyme

Our objective was to evaluate if peritoneal dialysis (PD) could improve survival of patients with progressive severe congestive heart failure resistant to drug therapy. The patients were selected by the cardiologist in cooperation with a nephrologist, including patients not responding to conventional medication with an expected fatal outcome within the next months. The study included 16 consecutive patients with a chronic progressive severe refractory heart failure (sHF) of NYHA class III (n = 6) or IV (n = 10) who did not respond to diuretics and angiotension converting enzyme (ACE) inhibitors. They had a mean age of 60 years (±14, range 30 -75, median 62 years). Nine of the patients had sHF as the only reason for initiating PD (all NYHA IV), while 7 also needed dialysis due to uremia. Five of 7 had been on hemodialysis but switched to PD due to a progressive congestive sHF. ln 2 patients, PD was decided already at start of dialysis therapy due to the severity of their heart failure. The reason for sHF was: valvular dysfunction (n = 5) with defect prosthesis (n = 3); in the course of a myocardial infarction (n = 4); and cardiomyopathy (n = 4). Tenckhoff catheters were inserted under local anesthesia and ultrafiltration was started and maintained until discharge. The survival time and change in heart size by x ray was used for analyses. All patients improved their stage of congestive heart failure by NYHA classification already during the first month. Six patients died during the follow-up period due to cardiac reasons (sudden death, relapse of sHF) after a mean of 10.7 months (±3.7, range 1 24 months). Ten were alive after a median observation period of 10 months (±12.5, range 1–36 months). Heart size was reduced in 15 of the patients. Three of the patients with sHF but without uremia could stop the PD. The results showed that ultrafiltration by PD was easy to perform despite low initial blood pressure. The sHF was reduced and life span was prolonged with improved quality of life.

scholarly journals CARDIORENAL SYNDROME IN PATIENTS WITH CHRONIC HEART FAILURE AS A STAGE OF THE CARDIORENAL CONTINUUM (PART I): DEFINITION, CLASSIFICATION, PATHOGENESIS, DIAGNOSIS, EPIDEMIOLOGY

2019 ◽  
Vol 9 (1) ◽  
pp. 5-22 ◽  
Author(s):  
E. V. Reznik ◽  
I. G. Nikitin
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Impaired Renal Function ◽  
Prognostic Value ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Patients With Heart Failure

The combination of heart failure and renal failure is called cardiorenal syndrome. It is a stage of the cardiorenal continuum and, possibly, a small link of the cardiorenal-cerebral-metabolic axis. Despite the fact that the phrase “cardiorenal syndrome” and its five types have become a part of the medical lexicon, many aspects of this problem are still not clear. Cardiorenal syndrome can be diagnosed in 32-90.3% of patients with heart failure. Cardiorenal syndrome type 1 or 2 develops in most cases of heart failure: cardiorenal syndrome presents with the development ofchronic kidney disease in patients with chronic heart failure and acute kidney injury in patients with acute heart failure. Impaired renal function has an unfavorable prognostic value. It leads to an increase in the mortality of patients with heart failure. It is necessary to timely diagnose the presence of cardiorenal syndrome and take into account its presence when managing patients with heart failure. Further researches are needed on ways toprevent the development and prevent the progression of kidney damage in patients with heart failure, to which the efforts of the multidisciplinary team should be directed. The first part of this review examines the currently definition, classification, pathogenesis, epidemiology and prognosis of cardiorenal syndrome in patients with heart failure.

scholarly journals A Case of Acute Kidney Injury in a Patient with Renal Hypouricemia without Intense Exercise

2020 ◽  
Vol 10 (1) ◽  
pp. 26-34
Author(s):  
Daiki Aomura ◽  
Kosuke Sonoda ◽  
Makoto Harada ◽  
Koji Hashimoto ◽  
Yuji Kamijo
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Risk Factor ◽  
Conservative Treatment ◽  
Kidney Injury ◽  
Intense Exercise ◽  
Kidney Dysfunction ◽  
Renal Hypouricemia ◽  
Orthostatic Dysregulation ◽  
Exercise Induced

Exercise-induced acute kidney injury (EIAKI) frequently develops in patients with renal hypouricemia (RHUC). However, several cases of RHUC with acute kidney injury (AKI) but without intense exercise have been reported. We encountered a 15-year-old male with RHUC who experienced AKI. He reported no episodes of intense exercise and displayed no other representative risk factors of EIAKI, although a vasopressor had been administered for orthostatic dysregulation before AKI onset. His kidney dysfunction improved with discontinuation of the vasopressor and conservative treatment. Thus, AKI can develop in patients with RHUC in the absence of intense exercise, for which vasopressors may be a risk factor.

Enhanced TNFα and oxidative stress in patients with heart failure: effect of TNFα on platelet O2 - production

2003 ◽  
Vol 90 (08) ◽  
pp. 317-325 ◽  
Author(s):  
Luciano Biase ◽  
Pasquale Pignatelli ◽  
Luisa Lenti ◽  
Giuliano Tocci ◽  
Fabiana Piccioni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nadph Oxidase ◽  
Nyha Class ◽  
Experimental Studies ◽  
Specific Inhibitor ◽  
Class Iii ◽  
Nyha Classification ◽  
Patients With Heart Failure ◽  
O2 Production

SummaryExperimental studies have suggested that TNFα, a pro-inflammatory cytokine, may contribute to the deterioration of cardiovascular function through various mechanisms, including the generation of reactive oxygen species. It has not yet been demonstrated whether TNFα has prooxidant activity in patients with heart failure, and what the mechanism eventually resulting in this effect are.We analyzed 42 patients (38 men and 4 women, aged 26 to 74 years) with heart failure, secondary to idiopathic dilated car-diomyopathy (n=21), coronary artery disease (n=15), and valve disease (n=6), and 20 controls (18 men and 2 women, aged 49 to 67 years). Ten patients were in class I,9 in class II,15 in class III and 8 in class IV according to NYHA Classification. Blood samples were obtained from each patient to evaluate basal and collagen-induced platelet O2 - production, and plasma TNFα. In vivo results showed increased platelet O2 - production and plasma TNFα levels in NYHA class III-IV compared with that in controls or in NYHA I-II (p<0,001); platelet O2 - production correlated significantly (R=0,6; p<0,01) with TNFα plasma levels. In vitro studies showed TNFα dose-dependently (5-40 pg/ml) induced platelet O2 - production, and that this effect was significantly inhibited by its specific inhibitor, WP9QY (1 μM); aspirin (100 μM), AACOCF3, a specific PLA2 inhibitor (14 μM), and DPI, an inhibitor of NADPH oxidase, significantly inhibited TNFα-mediated platelet O2 - production.This study suggests that in patients with heart failure, enhanced platelet O2 - production is mediated by TNFα via activation of arachidonic acid and NADPH oxidase pathways.

Abstract 18738: Use of Antithrombotic Therapies and Outcomes in Patients with Atrial Fibrillation and Heart Failure: Insights from the GARFIELD Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ramon Corbalan ◽  
Antonio C Pereira Barretto ◽  
Giuseppe Ambrosio ◽  
Wael Al Mahmeed ◽  
Jean-Yves Le Heuzey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Stroke Risk ◽  
Nyha Class ◽  
Heart Association ◽  
Class Iii ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors

Background: Atrial fibrillation (AF) is commonly associated with heart failure (HF) and this combination is associated with a worse prognosis than either alone. However, it is unclear if these patients receive appropriate antithrombotic therapies and if they have a higher incidence of stroke or systemic embolism (SE). Methods: We compared clinical characteristics, antithrombotic therapies, and outcomes in patients with and without HF in the GARFIELD Registry, an ongoing, international, observational registry of consecutively recruited patients with newly diagnosed non-valvular AF and ≥1 additional stroke risk factor. A total of 12,458 prospective patients were enrolled in 30 countries between March 2010 and January 2013. Results are reported at 1-year follow-up. HF was defined at baseline as New York Heart Association (NYHA) I-II or III-IV. Antithrombotic therapy use and 1-year outcomes in patients with and without HF were analysed. Results: In total, 20% of patients had HF; they were older and had higher CHA2DS2-VASc and HAS-BLED scores compared with patients without HF. A higher proportion of patients with HF received antithrombotic therapies. The incidence of all-cause death was higher in HF patients than non-HF patients. Patients with NYHA class III-IV HF had a higher unadjusted incidence of all-cause death and stroke/SE compared with non-HF patients: 10.5 (95% confidence interval 8.8 to 12.7) vs 2.9 (2.7 to 3.2) per 100 person-years and 1.9 (1.2 to 3.0) vs 1.0 (0.8 to 1.2) per 100 person-years, respectively. Event rates slightly changed after adjustment for stroke risk factors. Conclusion: More AF patients with HF received antithrombotic therapies compared with those without HF. They also showed a higher incidence of all-cause death with increasing HF severity compared with AF patients without HF. After adjustment for stroke risk factors, this association was slightly attenuated.

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