Decompensated Heart Failure and Renal Failure: What Is the Current Evidence?
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Purpose of Review
Acute decompensated heart failure (ADHF) is one of the biggest challenges in the management of chronic heart failure. Despite several advances in medical and device therapy, high readmission and mortality rates continue to be a burden on healthcare systems worldwide. The aim of the current review is to provide an overview on current as well as future approaches in cardiorenal interactions in patients with ADHF.
One of the strongest predictors of adverse outcomes in ADHF is renal dysfunction, referred to as cardiorenal syndromes (CRS) or cardiorenal interactions. Patients with ADHF frequently develop worsening of renal function (WRF) and/or acute kidney injury (AKI). Recent studies brought new information about biomarkers in diagnosing and predicting prognosis of CRS. Among others, dry weight at hospital discharge is considered a surrogate marker of successful treatment in ADHF patients with/without renal dysfunction.
The etiology of WRF appears to be an important factor for determining risk related to WRF as well as clinical management. The hypertonic saline used as adjunctive therapy for intravenous loop diuretics and/or induction of aquaresis (e.g., using tolvaptan) may be promising and efficient approaches in the future.
KeywordsAcute decompensated heart failure Cardiorenal syndrome Cardiorenal interactions Tolvaptan Hypertonic saline solution Biomarkers
Compliance with Ethical Standards
Conflict of Interest
Agata Bielecka-Dabrowa, Breno Godoy, Joerg C. Schefold, Maciej Banach, and Stephan von Haehling each declare no potential conflicts of interest. Michael Koziolek reports a grant and personal fees from Novartis Pharma and personal fees from CVRx.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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