Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure.

Published

Journal Article

BACKGROUND: Worsening renal function in heart failure may be related to increased venous congestion, decreased cardiac output, or both. Diuretics are universally used in acute decompensated heart failure, but they may be ineffective and may lead to azotemia. We aimed to compare the decongestive properties of a urine output-guided diuretic adjustment and standard therapy for the management of cardiorenal syndrome in acute decompensated heart failure. METHODS AND RESULTS: Data were pooled from subjects randomized to the stepwise pharmacologic care algorithm (SPCA) in the CARRESS-HF trial and those who developed cardiorenal syndrome (rise in creatinine >0.3 mg/dL) in the DOSE-AHF and ROSE-AHF trials. Patients treated with SPCA (n = 94) were compared with patients treated with standard decongestive therapy (SDT) that included intravenous loop diuretic use (DOSE-AHF and ROSE-AHF; n = 107) at the time of cardiorenal syndrome and followed for net fluid balance, weight loss, and changing renal function. The SPCA group had higher degrees of jugular venous pressure (P < .0001) at the time of cardiorenal syndrome. The group that received SPCA had more weight change (-3.4 ± 5.2 lb) and more net fluid loss (1.705 ± 1.417 L) after 24 hours than the SDT group (-0.8 ± 3.4 lb and 0.892 ± 1.395 L, respectively; P < .001 for both) with a slight improvement in renal function (creatinine change -0.1 ± 0.3 vs 0.0 ± 0.3 mg/dL, respectively; P = .03). CONCLUSIONS: Compared with SDT, patients who received an intensification of medication therapy for treating persisting congestion had greater net fluid and weight loss without being associated with renal compromise.

Full Text

Duke Authors

Cited Authors

  • Grodin, JL; Stevens, SR; de Las Fuentes, L; Kiernan, M; Birati, EY; Gupta, D; Bart, BA; Felker, GM; Chen, HH; Butler, J; Dávila-Román, VG; Margulies, KB; Hernandez, AF; Anstrom, KJ; Tang, WHW

Published Date

  • January 2016

Published In

Volume / Issue

  • 22 / 1

Start / End Page

  • 26 - 32

PubMed ID

  • 26209004

Pubmed Central ID

  • 26209004

Electronic International Standard Serial Number (EISSN)

  • 1532-8414

Digital Object Identifier (DOI)

  • 10.1016/j.cardfail.2015.07.007

Language

  • eng

Conference Location

  • United States