Spironolactone to increase natriuresis in congestive heart failure with cardiorenal syndrome

Aims. To evaluate the effectiveness and safety of peritoneal dialysis (PD) in treating refractory congestive heart failure (RCHF) with cardiorenal syndrome (CRS).Methods. A total of 36 patients with RCHF were divided into type 2 CRS group (group A) and non-type 2 CRS group (group B) according to the patients’ clinical presentations and the ratio of serum urea to creatinine and urinary analyses in this prospective study. All patients were followed up till death or discontinuation of PD. Data were collected for analysis, including patient survival time on PD, technique failure, changes of heart function, and complications associated with PD treatment and hospitalization.Results. There were 27 deaths and 9 patients quitting PD program after a follow-up for 73 months with an average PD time of22.8±18.2months. A significant longer PD time was found in group B as compared with that in group A (29.0±19.4versus13.1±10.6months,p=0.003). Kaplan–Meier curves showed a higher survival probability in group B than that in group A (p<0.001). Multivariate regression demonstrated that type 2 CRS was an independent risk factor for short survival time on PD. The benefit of PD on the improvement of survival and LVEF was limited to group B patients, but absent from group A patients. The impairment of exercise tolerance indicated by NYHA classification was markedly improved by PD for both groups. The technique survival was high, and the hospital readmission was evidently decreased for both group A and group B patients.Conclusions. Our data suggest that PD is a safe and feasible palliative treatment for RCHF with type 2 CRS, though the long-term survival could not be expected for patients with the type 2 CRS. Registration ID Number isChiCTR1800015910.

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P0200KEEP ON (KEEPING RAAS INHIBITION TREATMENT WITH OPTIMAL POTASSIUM CONTROL). DESIGN OF A CLINICAL TRIAL OF USING SODIUM ZIRCONIUM CYCLOSILICATE FOR KEEPING RAAS INHIBITION AND/OR MRAS IN PATIENTS WITH CKD AND CONGESTIVE HEART FAILURE HISTORY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0200 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Maria Jesãºs Puchades Montesa ◽

Nayara Panizo Gonzalez ◽

Luis D'Marco ◽

Miguel Gonzalez-Rico ◽

Patricia Tomas ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cardiorenal Syndrome ◽

Serum Electrolytes ◽

Sodium Zirconium ◽

Multifrequency Bioimpedance ◽

Threatening Condition ◽

Life Threatening ◽

Sodium Zirconium Cyclosilicate ◽

Nephroprotective Effect

Abstract Background and Aims Hyperkalemia (HK) is a potentially life-threatening condition, in patients with chronic kidney disease (CKD) and congestive heart failure (CHF). The majority of patients affected with CKD or CHF, must be treated with inhibitors of renin angiotensin aldosterone system (RAASi) and mineralocorticoid receptor antagonists (MRAs). However, the treatments previously mentioned, increase the risk of HK episodes, which is the main cause of RAASi and MRAs downtitration or discontinuation, representing an undesirable clinical scenario, given that the patients are at high risk of be deprived of their nephroprotective effect and cardio-renal benefits The aim of the study is: to analyze if, in patients with HK, CKD and CHF treated with RAASi and/or MRA, serum potassium (sK) reduction by Sodium zirconium cyclosilicate (SZC) treatment is non-inferior to RAASi and/or MRAs discontinuation or downtitration. Method Results The study will demonstrate results on serum electrolytes, renal function, albuminuria, KDQoL questionnaire and changes in relative overhydration (multifrequency bioimpedance -BCM Fresenius-) Conclusion The KEEP ON study will define the ability of SZC to facilitate the use of RAAS-I and / or MRA in patients with HK and cardiorenal syndrome allowing the maintenance of the medications recommended by international guidelines for the treatment of CHF at different degrees of CKD while maintaining the potential cardio-renal and nephroprotective benefit.

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Traditional and Novel Invasive Hemodynamic Indices in the Evaluation of Congestive Heart Failure in Cardiorenal Syndrome

Kidney Disease in the Cardiac Catheterization Laboratory ◽

10.1007/978-3-030-45414-2_23 ◽

2020 ◽

pp. 379-395

Author(s):

Mahek Shah ◽

Brijesh Patel ◽

Sahil Agrawal ◽

Ulrich P. Jorde

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cardiorenal Syndrome

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Renal Replacement Therapy in Congestive Heart Failure Requiring Left Ventricular Assist Device Augmentation

Peritoneal Dialysis International ◽

10.3747/pdi.2011.00076 ◽

2012 ◽

Vol 32 (4) ◽

pp. 386-392 ◽

Cited By ~ 18

Author(s):

Bernadette A. Thomas ◽

Christine M. Logar ◽

Arthur E. Anderson

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Systemic Infection ◽

Cardiorenal Syndrome ◽

Left Ventricular ◽

Dialysis Access ◽

Ventricular Assist

“Cardiorenal syndrome” is a term used to describe a dysregulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner ( 1 , 2 ). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy ( 2 ). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a unique challenge with respect to receiving dialysis, because they experience higher rates of morbidity and mortality from infection in the post-LVAD period ( 3 - 7 ). Acute dialysis access can pose an increased infection risk. In this article, we present a patient who required renal replacement therapy and a LVAD for management of acute-on-chronic cardiorenal syndrome while awaiting heart transplantation. A literature review to determine whether peritoneal dialysis or hemodialysis is superior for patients with profound hemodynamic dysfunction and the need to minimize risk of infection did not offer clear guidance about which modality is superior in patients with advanced congestive heart failure. However, there is clear evidence of the superiority of peritoneal dialysis in reducing the risk of systemic infection secondary to acute dialysis access. Given the high risk of LVAD infection, we therefore conclude that, to decrease mortality secondary to systemic infection, peritoneal dialysis should strongly be considered in patients who require renal replacement therapy before or after LVAD placement.

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Nonuremic Indication for Peritoneal Dialysis for Refractory Heart Failure in Cardiorenal Syndrome Type II: Review and Perspective

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00014 ◽

2013 ◽

Vol 33 (1) ◽

pp. 8-14 ◽

Cited By ~ 15

Author(s):

Masaaki Nakayama

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Peritoneal Dialysis ◽

Maintenance Therapy ◽

Supportive Therapy ◽

Cardiorenal Syndrome ◽

Syndrome Type ◽

Type Ii ◽

Kidney Dysfunction ◽

Refractory Heart Failure

Cardiorenal syndrome (CRS) type II is a serious condition in which chronic cardiac abnormalities cause worsening kidney function, leading to permanent chronic kidney damage. Management of CRS type II coupled with diuretic-resistant congestive heart failure (CHF) has been an issue of dispute. However, since the early 1990s, reports indicating the clinical usefulness of peritoneal dialysis (PD) as maintenance therapy for intractable CHF in this population have been accumulating. The present manuscript reviews the mechanisms by which kidney dysfunction develops within CHF, and then examines recent experiences of PD as chronic supportive therapy for intractable CRS type II, reviews the contributing mechanisms, and discusses the rationale for using PD as a new therapeutic approach in the nonuremic setting of CHF.

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