Heart Failure and Kidney Disease: Management in the Short-Stay Unit

Abstract

Heart failure and kidney disease are among the fastest-growing diagnoses in the United States. Recent data indicate that more than half of heart failure patients have underlying kidney dysfunction. The presentation of a patient with acute heart failure and concomitant kidney disease describes one of the most complex patients to manage. Unfortunately, there are no guidelines for managing this patient population. Current treatment options for managing acutely decompensated heart failure focus on improving cardiac function through reductions in preload and afterload. Medical therapy in patients with heart failure and CKD is similar but with a few important differences. This chapter explores diagnostic, therapeutic, and prognostic considerations that should be employed when dealing with this patient population. Although there are well-established guidelines for managing heart failure and kidney disease alone, the lack of significant randomized clinical trials guiding management of their copresentation in the emergency department and short-stay unit has slowed development of evidence-based treatments. This chapter will mainly focus on the additional management of patients with heart failure and concomitant kidney disease in the short-stay unit.