scholarly journals Interactive and potentially independent roles of renin-angiotensin-aldosterone system blockade and the development of cardiorenal syndrome, type 1 on in-hospital mortality among elderly patients admitted with acute decompensated congestive heart failure

2019 ◽  
Vol Volume 12 ◽  
pp. 33-48
Author(s):  
Jose Iglesias ◽  
Savan Ghetiya ◽  
Kandria J Ledesma ◽  
Chirag S Patel ◽  
Jerrold S. Levine
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin

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.

Pathophysiology of congestive heart failure: role of atrial natriuretic factor and therapeutic implications

1991 ◽  
Vol 69 (10) ◽  
pp. 1576-1581 ◽  
Author(s):  
Mark A. Perrella ◽  
Kenneth B. Margulies ◽  
John C. Burnett Jr.
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Atrial Natriuretic Factor ◽  
Neutral Endopeptidase ◽  
Cyclic Guanosine Monophosphate ◽  
Guanosine Monophosphate ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Natriuretic Factor ◽  
Atrial Natriuretic

Endogenous atrial natriuretic factor (ANF) serves a functional role to maintain sodium homeostasis and inhibit activation of the renin–angiotensin–aldosterone system in acute congestive heart failure despite arterial hypotension. However, as heart failure progresses, maximal synthesis and release of ANF from both the atrial and ventricular myocardium may occur resulting in relative ANF deficiency. This relative deficiency of ANF results in a progressive inability to excrete sodium and antagonize the renin–angiotensin–aldosterone system. Consequently, agents that increase circulating ANF and (or) enhance its local action have potential therapeutic efficacy. Recent studies suggest that inhibitors of neutral endopeptidase 24.11, which block ANF degradation, potentiate the natriuretic action of endogenous ANF independent of systemic or renal hemodynamics. This action does not parallel increases in plasma ANF and is associated with marked increases in urinary ANF and cyclic guanosine monophosphate consistent with enhanced local action of the peptide. In addition, agents that selectively bind to biologically inactive ANF clearance receptors increase endogenous plasma ANF and promote increases in renal sodium excretion. These studies suggest a therapeutic role for neutral endopeptidase inhibition and clearance receptor blockade, while advancing our understanding of the pathophysiology of ANF in congestive heart failure.Key words: congestive heart failure, atrial natriuretic factor, cyclic guanosine monophosphate, natriuresis, renin–angiotensin–aldosterone system.

scholarly journals Outcomes after Acute Peritoneal Dialysis for Critical Cardiorenal Syndrome Type 1

2021 ◽  
pp. 1-9
Author(s):  
Watanyu Parapiboon ◽  
Tanit Kingjun ◽  
Laddaporn Wongluechai ◽  
Waraporn Leawnoraset
Keyword(s):  
Peritoneal Dialysis ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Fluid Balance ◽  
Multivariable Analysis ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Resource Limited ◽  
Limited Setting

<b><i>Introduction:</i></b> The aim of the study was to demonstrate the outcomes of peritoneal dialysis (PD) in critically ill cardiorenal syndrome type 1 (CRS1). <b><i>Methods:</i></b> A cohort of 147 patients with CRS1 who received PD from 2011 to 2019 in a referral hospital in Thailand was analyzed. The primary outcome was 30-day in-hospital mortality. Ultrafiltration and net fluid balance among survivors and nonsurvivors in the first 5 PD sessions were compared. <b><i>Results:</i></b> The 30-day mortality rate was 73.4%. Most patients were critically ill CRS1 (all patients had a respiratory failure of which 68% had cardiogenic shock). Blood urea nitrogen and creatinine at the commencement of PD were 60.1 and 4.05 mg/dL. In multivariable analysis, increasing age, unstable hemodynamics, and positive fluid balance in the first 5 PD sessions were associated with the risk of in-hospital mortality. The change of fluid balance per day during the first 5 dialysis days was significantly different among survivor and nonsurvivor groups (−353 vs. 175 mL per day, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> PD is a viable dialysis option in CRS1, especially in a resource-limited setting. PD can save up to 27% of lives among patients with critically ill CRS1.

scholarly journals Nonuremic Indication for Peritoneal Dialysis for Refractory Heart Failure in Cardiorenal Syndrome Type II: Review and Perspective

2013 ◽  
Vol 33 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Masaaki Nakayama
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Peritoneal Dialysis ◽  
Maintenance Therapy ◽  
Supportive Therapy ◽  
Cardiorenal Syndrome ◽  
Syndrome Type ◽  
Type Ii ◽  
Kidney Dysfunction ◽  
Refractory Heart Failure

Cardiorenal syndrome (CRS) type II is a serious condition in which chronic cardiac abnormalities cause worsening kidney function, leading to permanent chronic kidney damage. Management of CRS type II coupled with diuretic-resistant congestive heart failure (CHF) has been an issue of dispute. However, since the early 1990s, reports indicating the clinical usefulness of peritoneal dialysis (PD) as maintenance therapy for intractable CHF in this population have been accumulating. The present manuscript reviews the mechanisms by which kidney dysfunction develops within CHF, and then examines recent experiences of PD as chronic supportive therapy for intractable CRS type II, reviews the contributing mechanisms, and discusses the rationale for using PD as a new therapeutic approach in the nonuremic setting of CHF.

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