Impact of chronic kidney disease on the diuretic response of tolvaptan in acute decompensated heart failure

Background: Congestive heart failure is responsible for repeated hospital admissions. It is classified into three types: (1) Heart Failure with reduced ejection fraction, (2) Heart failure with mid-range ejection fraction, and (3) Heart failure with preserved ejection fraction (HFpEF). It is essential to describe the risk factors of HFpEF patients' profiles as targeting them is crucial for management. Aim: Our retrospective study aims to identify the clinical and echocardiographic characteristics associated with HFpEF and its mortality among hospitalized patients with acute decompensated heart failure. Methods: 390 patients of all age groups presenting with acute heart failure decompensation at Mount Lebanon Hospital (MLH) and Middle East Institute of Health (MEIH, Bsalim) were recruited retrospectively between January 2014 and December 2016. We included 133 cases of HFpEF and collected data on each case including: baseline characteristics and comorbidities, electrocardiograms, laboratory studies, and echocardiographic parameters. Results: The 133 Lebanese patients having HFpEF were elderly (76 ± 10 years), with predominantly female gender (56%). Hypertension (87.96%) and diabetes (53.38%) were the most frequently reported comorbidities. The overall in-hospital mortality was 4.5%. Data was compared between living and deceased patients and the frequency of valvular heart disease (p=0.005) and chronic kidney disease (p=0.018) was significantly higher among deceased patients. Right ventricular (RV) dilation on echocardiography was significantly correlated with mortality. Elevated troponin, increased creatinine, hypochloremia, hyponatremia, and anemia were all lab markers associated with increased mortality (p<0.05). Conclusion: Patients with HFpEF represent 43.5% of all decompensated HF cases, with chronic kidney disease, valvular heart diseases, anemia and troponinemia, being the predominant risk factors for adverse clinical outcomes. HFpEF remains an enormous burden on cardiologists for appropriate evaluation, triage, and management.

Download Full-text

PREDICTORS OF ACUTE KIDNEY INJURY IN PATIENTS RECEIVING ULTRA-HIGH DOSE INFUSIONS OF LOOP DIURETICS FOR ACUTE DECOMPENSATED HEART FAILURE WITH CHRONIC KIDNEY DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)31586-2 ◽

2020 ◽

Vol 75 (11) ◽

pp. 959

Author(s):

Bipin Sunkara ◽

Michael Dorsch ◽

Rachel Perlman ◽

J. Matthew Nicklas ◽

John Nicklas

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Acute Decompensated Heart Failure ◽

Kidney Injury ◽

Decompensated Heart Failure ◽

Loop Diuretics ◽

High Dose

Download Full-text

Usefulness of the Combination of In-Hospital Poor Diuretic Response and Systemic Congestion to Predict Future Cardiac Events in Patients With Acute Decompensated Heart Failure

The American Journal of Cardiology ◽

10.1016/j.amjcard.2017.03.030 ◽

2017 ◽

Vol 119 (12) ◽

pp. 2010-2016 ◽

Cited By ~ 6

Author(s):

Soichiro Aoki ◽

Takahiro Okumura ◽

Akinori Sawamura ◽

Katsuhide Kitagawa ◽

Ryota Morimoto ◽

...

Keyword(s):

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Cardiac Events ◽

Diuretic Response

Download Full-text

Effects of early diuretic response to carperitide in acute decompensated heart failure treatment: A single-center retrospective study

PLoS ONE ◽

10.1371/journal.pone.0199263 ◽

2018 ◽

Vol 13 (6) ◽

pp. e0199263 ◽

Cited By ~ 1

Author(s):

Yoshitaka Okuhara ◽

Masanori Asakura ◽

Kohei Azuma ◽

Yoshiyuki Orihara ◽

Koichi Nishimura ◽

...

Keyword(s):

Heart Failure ◽

Retrospective Study ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Single Center ◽

Heart Failure Treatment ◽

Failure Treatment ◽

Diuretic Response

Download Full-text

Acute kidney disease after acute decompensated heart failure

Kidney International Reports ◽

10.1016/j.ekir.2021.12.033 ◽

2022 ◽

Author(s):

Jia-Jin Chen ◽

Tao-Han Lee ◽

George Kuo ◽

Chieh-Li Yen ◽

Shao-Wei Chen ◽

...

Keyword(s):

Heart Failure ◽

Kidney Disease ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Acute Kidney Disease

Download Full-text

Effects of Metolazone Administration on Congestion, Diuretic Response and Renal Function in Patients with Advanced Heart Failure

Journal of Clinical Medicine ◽

10.3390/jcm10184207 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4207

Author(s):

Alberto Palazzuoli ◽

Gaetano Ruocco ◽

Paolo Severino ◽

Luigi Gennari ◽

Filippo Pirrotta ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Acute Decompensated Heart Failure ◽

Nyha Class ◽

Decompensated Heart Failure ◽

Advanced Heart Failure ◽

Loop Diuretics ◽

Reduced Ejection Fraction ◽

Diuretic Response

Background: Advanced heart failure (HF) is a condition often requiring elevated doses of loop diuretics. Therefore, these patients often experience poor diuretic response. Both conditions have a detrimental impact on prognosis and hospitalization. Aims: This retrospective, multicenter study evaluates the effect of the addition of oral metolazone on diuretic response (DR), clinical congestion, NTproBNP values, and renal function over hospitalization phase. Follow-up analysis for a 6-month follow-up period was performed. Methods: We enrolled 132 patients with acute decompensated heart failure (ADHF) in advanced NYHA class with reduced ejection fraction (EF < 40%) taking a mean furosemide amount of 250 ± 120 mg/day. Sixty-five patients received traditional loop diuretic treatment plus metolazone (Group M). The mean dose ranged from 7.5 to 15 mg for one week. Sixty-seven patients continued the furosemide (Group F). Congestion score was evaluated according to the ESC recommendations. DR was assessed by the formula diuresis/40 mg of furosemide. Results: Patients in Group M and patients in Group F showed a similar prevalence of baseline clinical congestion (3.1 ± 0.7 in Group F vs. 3 ± 0.8 in Group M) and chronic kidney disease (CKD) (51% in Group M vs. 57% in Group F; p = 0.38). Patients in Group M experienced a better congestion score at discharge compared to patients in Group F (C score: 1 ± 1 in Group M vs. 3 ± 1 in Group F p > 0.05). Clinical congestion resolution was also associated with weight reduction (−6 ± 2 in Group M vs. −3 ± 1 kg in Group F, p < 0.05). Better DR response was observed in Group M compared to F (940 ± 149 mL/40 mgFUROSEMIDE/die vs. 541 ± 314 mL/40 mgFUROSEMIDE/die; p < 0.01), whereas median ΔNTproBNP remained similar between the two groups (−4819 ± 8718 in Group M vs. −3954 ± 5560 pg/mL in Group F NS). These data were associated with better daily diuresis during hospitalization in Group M (2820 ± 900 vs. 2050 ± 1120 mL p < 0.05). No differences were found in terms of WRF development and electrolyte unbalance at discharge, although Group M had a significant saline solution administration during hospitalization. Follow-up analysis did not differ between the group but a reduced trend for recurrent hospitalization was observed in the M group (26% vs. 38%). Conclusions: Metolazone administration could be helpful in patients taking an elevated loop diuretics dose. Use of thiazide therapy is associated with better decongestion and DR. Current findings could suggest positive insights due to the reduced amount of loop diuretics in patients with advanced HF.

Download Full-text