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The Association Between Intra-abdominal Pressure and Diuretic Response in Heart Failure

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Abstract

Purpose of the Review

An efficient diuretic response is vital during cardiac decompensation in heart failure (HF) patients. The increase in intra-abdominal pressure (IAP) could be one of the keys for understanding cardiorenal syndrome and guiding diuretic treatment during hospitalization. In this review, we analyze the relationship between IAP and diuretic response in HF patients.

Recent Findings

Increased IAP is associated with worsening renal function (WRF) in patients with advanced HF. Furthermore, the persistence of a rise in IAP after the first 72 h of intravenous diuretic treatment has been correlated with a worse diuretic response, a higher degree of congestion, and an impaired prognosis.

Summary

The rise in IAP in HF patients has been associated with impaired renal function and a lower diuretic response. Nonetheless, more studies are needed to elucidate the actual role of IAP in congestive nephropathy and whether it may help guide diuretic therapy during acute decompensations.

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Abbreviations

ADHF :

acute decompensated heart failure

AKI :

acute kidney injury

CVP :

central venous pressure

CKD :

chronic kidney disease

eGRF :

estimated glomerular filtration rate

GDMT :

guideline-directed medical therapy

HF :

heart failure

HFrEF :

heart failure with reduced ejection fraction

HFpEF :

heart failure with preserved ejection fraction

IAH :

intra-abdominal hypertension

IAP :

intra-abdominal pressure

IVC :

inferior vena cava

LVEF :

left ventricular ejection fraction

NGAL :

neutrophil gelatinase-associated lipocalin

NYHA :

New York Heart Association

RAAS :

renin-angiotensin-aldosterone system

SNS :

sympathetic nervous system

VExUS :

venous excess ultrasound grading system

WRF :

worsening of renal function

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Authors and Affiliations

  1. Internal Medicine Department, Hospital Clínico Universitario “Lozano Blesa”, Avda. San Juan Bosco N° 15, 50009, Zaragoza, Spain

    S. Crespo-Aznarez, A. Campos-Sáenz de Santamaría, M. Sánchez-Marteles, V. Garcés-Horna, C. Josa-Laorden, J. I. Pérez-Calvo & J. Rubio-Gracia

  2. Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain

    S. Crespo-Aznarez, A. Campos-Sáenz de Santamaría, M. Sánchez-Marteles, V. Garcés-Horna, C. Josa-Laorden, I. Giménez-López, J. I. Pérez-Calvo & J. Rubio-Gracia

  3. University of Zaragoza, Zaragoza, Spain

    I. Giménez-López, J. I. Pérez-Calvo & J. Rubio-Gracia

  4. Aragonese Institute of Health Sciences, Zaragoza, Spain

    I. Giménez-López

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Crespo-Aznarez, S., Campos-Sáenz de Santamaría, A., Sánchez-Marteles, M. et al. The Association Between Intra-abdominal Pressure and Diuretic Response in Heart Failure. Curr Heart Fail Rep 20, 390–400 (2023). https://doi.org/10.1007/s11897-023-00617-x

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