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

Publication ,  Journal Article
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 ...
Published in: J Card Fail
January 2016

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.

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Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

January 2016

Volume

22

Issue

1

Start / End Page

26 / 32

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Ultrafiltration
  • Randomized Controlled Trials as Topic
  • Middle Aged
  • Male
  • Injections, Intravenous
  • Humans
  • Female
  • Diuretics
  • Diuresis
 

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Grodin, J. L., Stevens, S. R., de Las Fuentes, L., Kiernan, M., Birati, E. Y., Gupta, D., … Tang, W. H. W. (2016). Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure. J Card Fail, 22(1), 26–32. https://doi.org/10.1016/j.cardfail.2015.07.007
Grodin, Justin L., Susanna R. Stevens, Lisa de Las Fuentes, Michael Kiernan, Edo Y. Birati, Divya Gupta, Bradley A. Bart, et al. “Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure.J Card Fail 22, no. 1 (January 2016): 26–32. https://doi.org/10.1016/j.cardfail.2015.07.007.
Grodin JL, Stevens SR, de Las Fuentes L, Kiernan M, Birati EY, Gupta D, et al. Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure. J Card Fail. 2016 Jan;22(1):26–32.
Grodin, Justin L., et al. “Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure.J Card Fail, vol. 22, no. 1, Jan. 2016, pp. 26–32. Pubmed, doi:10.1016/j.cardfail.2015.07.007.
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. Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure. J Card Fail. 2016 Jan;22(1):26–32.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

January 2016

Volume

22

Issue

1

Start / End Page

26 / 32

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Ultrafiltration
  • Randomized Controlled Trials as Topic
  • Middle Aged
  • Male
  • Injections, Intravenous
  • Humans
  • Female
  • Diuretics
  • Diuresis