scholarly journals Extracorporeal Ultrafiltration for Acute Heart Failure: Lost Battle or Lasting Opportunity?

2016 ◽  
Vol 43 (1-3) ◽  
pp. 1-10 ◽  
Author(s):  
Abhilash Koratala ◽  
Amir Kazory
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Prognostic Impact ◽  
Efficacy And Safety ◽  
Fluid Removal ◽  
Beneficial Effects ◽  
Sodium Removal

The negative prognostic impact of congestion and worsening renal function in patients with decompensated heart failure (HF) has been widely recognized. As diuretics are thought to provide suboptimal results and are associated with a number of adverse effects, a number of diuretic-sparing therapeutic strategies have been explored. Extracorporeal ultrafiltration (UF) represents an intriguing option that presumably lacks many of the untoward effects of diuretic-based regimens while portending several advantages. However, conflicting data have recently emerged in relation to some of its previously proposed beneficial effects possibly due to counterbalance of the underexplored mechanisms. Herein, the existing literature on the role of UF therapy for management of acute decompensated HF is briefly reviewed with special emphasis on its impact on surrogates of efficacy and safety such as excess fluid removal and renal function. A number of topics relevant to cardiorenal syndrome such as congestion and sodium removal are also discussed.

scholarly journals Therapeutic Options for the Management of the Cardiorenal Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Katerina Koniari ◽  
Marinos Nikolaou ◽  
Ioannis Paraskevaidis ◽  
John Parissis
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Acute Decompensated Heart Failure ◽  
Clinical Success ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Patients With Heart Failure ◽  
Adenosine A1 ◽  
A1 Receptor

Patients with heart failure often present with impaired renal function, which is a predictor of poor outcome. The cardiorenal syndrome is the worsening of renal function, which is accelerated by worsening of heart failure or acute decompensated heart failure. Although it is a frequent clinical entity due to the improved survival of heart failure patients, still its pathophysiology is not well understood, and thus its therapeutic approach remains controversial and sometimes ineffective. Established therapeutic strategies, such as diuretics and inotropes, are often associated with resistance and limited clinical success. That leads to an increasing concern about novel options, such as the use of vasopressin antagonists, adenosine A1 receptor antagonists, and renal-protective dopamine. Initial clinical trials have shown quite encouraging results in some heart failure subpopulations but have failed to demonstrate a clear beneficial role of these agents. On the other hand, ultrafiltration appears to be a more promising therapeutic procedure that will improve volume regulation, while preserving renal and cardiac function. Further clinical studies are required in order to determine their net effect on renal function and potential cardiovascular outcomes. Until then, management of the cardiorenal syndrome remains quite empirical.

scholarly journals The Role of Ultrafiltration in Patients with Decompensated Heart Failure

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Sandeep A. Kamath
Keyword(s):  
Heart Failure ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Loop Diuretics ◽  
Inpatient Setting ◽  
Effective Volume ◽  
Primary Driver ◽  
High Doses

Congestion, due in large part to hypervolemia, is the primary driver of heart failure (HF) admissions. Relief of congestion has been traditionally achieved through the use of loop diuretics, but there is increasing concern that these agents, particularly at high doses, may be deleterious in the inpatient setting. In addition, patients with HF and the cardiorenal syndrome (CRS) have diminished response to loop diuretics, making these agents less effective at relieving congestion. Ultrafiltration, a mechanical volume removal strategy, has demonstrated promise in achieving safe and effective volume removal in patients with cardiorenal syndrome and diuretic refractoriness. This paper outlines the rationale for ultrafiltration in CRS and the available evidence regarding its use in patients with HF. At present, the utility of ultrafiltration is restricted to selected populations, but a greater understanding of how this technology impacts HF and CRS may expand its use.

Worsening renal function in children hospitalized with decompensated heart failure: Evidence for a pediatric cardiorenal syndrome?*

2008 ◽  
Vol 9 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Jack F. Price ◽  
Antonio R. Mott ◽  
Heather A. Dickerson ◽  
John Lynn Jefferies ◽  
David P. Nelson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Worsening Renal Function

Ultrafiltrazione peritoneale e sindrome cardiorenale: gestione del sovraccarico di fluidi e ruolo del sodio

2019 ◽  
Vol 31 (2) ◽  
pp. 100-105
Author(s):  
Luca Di Lullo ◽  
Claudio Ronco ◽  
Fulvio Floccari ◽  
Antonio De Pascalis ◽  
Rodolfo Rivera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peritoneal Dialysis ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Therapeutic Modality ◽  
Heart Failure Patients ◽  
Sodium Removal ◽  
Refractory Heart Failure ◽  
Home Based

Congestion represents a crucial clinical component of both heart failure and cardiorenal syndrome and it has been postulated to modulate heart and kidney cross-link. Diuretic therapy is a corner stone in the treatment patients with heart failure, and renal replacement therapies are mainly used for patients with refractory heart failure who have not reached the worst stages of renal disfunction. Peritoneal dialysis is a home-based therapeutic modality providing both solute clearance and ultrafiltration, together with relief from congestion in decompensated heart failure patients. The following review will focus on sodium removal in refractory decompensated heart failure patients undergoing peritoneal dialysis. (Cardionephrology)

Pathophysiology of cardiorenal syndrome in decompensated heart failure: Role of lung–right heart–kidney interaction

2013 ◽  
Vol 169 (6) ◽  
pp. 379-384 ◽  
Author(s):  
M. Guazzi ◽  
P. Gatto ◽  
G. Giusti ◽  
F. Pizzamiglio ◽  
I. Previtali ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Right Heart

scholarly journals Vasodilatory Responses of Renal Interlobular Arteries to Epoxyeicosatrienoic Acids Analog Are Not Enhanced in Ren-2 Transgenic Hypertensive Rats: Evidence Against a Role of Direct Vascular Effects of Epoxyeicosatrienoic Acids in Progression of Experimental Heart Failure

2017 ◽  
pp. 29-39 ◽  
Author(s):  
A. SPORKOVÁ ◽  
Z. HUSKOVÁ ◽  
P. ŠKAROUPKOVÁ ◽  
N. RAMI REDDY ◽  
J. R. FALCK ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Epoxyeicosatrienoic Acids ◽  
Sprague Dawley ◽  
Resistance Arteries ◽  
Vascular Effects ◽  
Beneficial Effects ◽  
Function Impairment

Pathophysiological mechanisms underlying the development of renal dysfunction and progression of congestive heart failure (CHF) remain poorly understood. Recent studies have revealed striking differences in the role of epoxyeicosatrienoic acids (EETs), active products of cytochrome P-450-dependent epoxygenase pathway of arachidonic acid, in the progression of aorto-caval fistula (ACF)-induced CHF between hypertensive Ren-2 renin transgenic rats (TGR) and transgene-negative normotensive Hannover Sprague-Dawley (HanSD) controls. Both ACF TGR and ACF HanSD strains exhibited marked intrarenal EETs deficiency and impairment of renal function, and in both strains chronic pharmacologic inhibition of soluble epoxide hydrolase (sEH) (which normally degrades EETs) normalized EETs levels. However, the treatment improved the survival rate and attenuated renal function impairment in ACF TGR only. Here we aimed to establish if the reported improved renal function and attenuation of progression of CHF in ACF TGR observed after sEH blockade depends on increased vasodilatory responsiveness of renal resistance arteries to EETs. Therefore, we examined the responses of interlobar arteries from kidneys of ACF TGR and ACF HanSD rats to EET-A, a new stable 14,15-EET analog. We found that the arteries from ACF HanSD kidneys rats exhibited greater vasodilator responses when compared to the ACF TGR arteries. Hence, reduced renal vasodilatory responsiveness cannot be responsible for the lack of beneficial effects of chronic sEH inhibition on the development of renal dysfunction and progression of CHF in ACF HanSD rats.

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