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.

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 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 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 DURATION OF ORAL LOOP DIURETICS AND 30-DAY READMISSION IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

2017 ◽  
Vol 69 (11) ◽  
pp. 671
Author(s):  
Benjamin Laliberte ◽  
Brent Reed ◽  
Sandeep Devabhakthuni ◽  
Kristin Watson ◽  
Vijay Ivaturi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Loop Diuretics

Refractory oedema in congestive heart failure: a contributory role of loop diuretics?

1995 ◽  
Vol 237 (2) ◽  
pp. 211-214 ◽  
Author(s):  
C. HALLER ◽  
P. SALBACH ◽  
H. KATUS ◽  
W. KÜBLER
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Loop Diuretics
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