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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/18181

Title: Management of the Cardiorenal Syndrome in Decompensated Heart Failure
Authors: VERBRUGGE, Frederik
MULLENS, Wilfried
Issue Date: 2014
Publisher: KARGER
Citation: CARDIORENAL MEDICINE, 4 (3-4), p. 176-188
Abstract: Background: The management of the cardiorenal syndrome (CRS) in decompensated heart failure (HF) is challenging, with high-quality evidence lacking. Summary: The pathophysiology of CRS in decompensated HF is complex, with glomerular filtration rate (GFR) and urine output representing different aspects of kidney function. GFR depends on structural factors (number of functional nephrons and integrity of the glomerular membrane) versus hemodynamic alterations (volume status, renal perfusion, arterial blood pressure, central venous pressure or intra-abdominal pressure) and neurohumoral activation. In contrast, urine output and volume homeostasis are mainly a function of the renal tubules. Treatment of CRS in decompensated HF patients should be individualized based on the underlying pathophysiological processes. Key Messages: Congestion, defined as elevated cardiac filling pressures, is not a surrogate for volume overload. Transient decreases in GFR might be accepted during decongestion, but hypotension must be avoided. Paracentesis and compression therapy are essential to remove fluid overload from third spaces. Increasing the effective circulatory volume improves renal function when cardiac output is depressed. As mechanical support is invasive and inotropes are related to increased mortality, afterload reduction through vasodilator therapy remains the preferred strategy in patients who are normo- or hypertensive. Specific therapies to augment renal perfusion (rolofylline, dopamine or nesiritide) have rendered disappointing results, but recently, serelaxin has been shown to improve renal function, even with a trend towards reduced all-cause mortality in selected patients. Diuretic resistance is associated with worse outcomes, independent of the underlying GFR. Combinational diuretic therapy, with ultrafiltration as a bail-out strategy, is indicated in case of diuretic resistance.
Notes: [Verbrugge, Frederik Hendrik; Grieten, Lars; Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, BE-3600 Genk, Belgium. [Verbrugge, Frederik Hendrik] Hasselt Univ, Fac Med & Life Sci, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Grieten, Lars; Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium.
URI: http://hdl.handle.net/1942/18181
DOI: 10.1159/000366168
ISI #: 000346886700005
ISSN: 1664-3828
Category: A1
Type: Journal Contribution
Validation: ecoom, 2016
Appears in Collections: Research publications

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