Effect of Adding Nitroglycerin to Early Diuretic Therapy on the Morbidity and Mortality of Patients with Chronic Kidney Disease Presenting with 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.

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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

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

ESC Heart Failure ◽

10.1002/ehf2.12190 ◽

2017 ◽

Vol 4 (4) ◽

pp. 614-622 ◽

Cited By ~ 7

Author(s):

Shuntaro Ikeda ◽

Kiyotaka Ohshima ◽

Shigehiro Miyazaki ◽

Hisaki Kadota ◽

Hideaki Shimizu ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Diuretic Response

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ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2019.v12i12.35574 ◽

2019 ◽

pp. 61-63

Author(s):

PRUDENCE A RODRIGUES ◽

SOUMYA GK ◽

NADIA GRACE BUNSHAW ◽

SARANYA N ◽

SUJITH K ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Renal Injury ◽

Loop Diuretic ◽

Acute Decompensated Heart Failure ◽

Diuretic Therapy ◽

Decompensated Heart Failure ◽

Loop Diuretics ◽

Contributing Factors ◽

The Impact

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function.

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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

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Approach to decongestion therapy in patients with acute decompensated heart failure: the echocardiography guided strategy

Kardiologiia ◽

10.18087/cardio.2021.2.n1472 ◽

2021 ◽

Vol 61 (2) ◽

pp. 76-82

Author(s):

Alper Karakus ◽

Berat Uguz

Keyword(s):

Heart Failure ◽

Acute Decompensated Heart Failure ◽

Diuretic Therapy ◽

Body Weight Loss ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Electrolyte Imbalance ◽

Cross Sectional ◽

Reduced Ejection Fraction ◽

Dyspnea Assessment

Goal The E / (Ea×Sa) index is an echocardiographic parameter to determine a patient’s left ventricular filling pressure. This study aims to determine the safety and efficacy of the echocardiographic E / (Ea×Sa) index guided diuretic therapy compared to urine output (conventional) guided diuretic treatment.Material and Methods In this cross-sectional study, patients with heart failure with reduced ejection fraction (HFrEF) who were hospitalized due to acute decompensation episode were consecutively allocated in a 1:1 ratio to monitoring arms. The diuretic dose, which provided 20 % reduction in the E / (Ea×Sa) index value compared to initial value, was determined as adequate dose in echocardiography guided monitoring group. The estimated glomerular filtration rate (eGFR), change in weight, NT pro-BNP level and dyspnea assessment on visual analogue scale (VAS) were analyzed at the end of the monitoring.Results Although the similar doses of diuretics were used in both groups, the patients with E / (Ea×Sa) index guided strategy had the substantial lower NT pro-BNP level within 72 hours after diuretic administration (2172 vs.2514 pg / mL, p= 0.036). VAS score on dyspnea assessment was significantly better in the patients with E / (Ea×Sa) index guided strategy (52 vs. 65; p= 0.04). And, in term of body weight loss (4.93 vs.5.21 kg, p=0.87) and e-GFR (54.58±8.6 vs. 52.65±9.1 mL / min / 1.73 m2p=0.74) in both groups are associated with similar outcomes. In both groups, there was no worsening renal function and electrolyte imbalance that required stopping or decreasing loop diuretic dosing.Conclusions The E / (Ea×Sa) index guidance might be a safe strategy for more effective diuretic response that deserves consideration for selected a subgroup of acute decomposed HFrEF patients.

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Aggressive Versus Conservative Initial Diuretic Dosing in the Emergency Department for Acute Decompensated Heart Failure

Annals of Pharmacotherapy ◽

10.1177/1060028017725763 ◽

2017 ◽

Vol 52 (1) ◽

pp. 26-31 ◽

Cited By ~ 3

Author(s):

James R. Catlin ◽

Christopher B. Adams ◽

Daniel J. Louie ◽

Machelle D. Wilson ◽

Erin N. Louie

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Body Weight ◽

Urine Output ◽

Acute Decompensated Heart Failure ◽

Academic Medical Center ◽

Diuretic Therapy ◽

Decompensated Heart Failure ◽

Hospital Length Of Stay ◽

Conservative Group

Background:Intravenous (IV) loop diuretics are recommended to relieve vascular congestion in patients with acute decompensated heart failure (ADHF); however, initial dosing is often empirical. Strong evidence supporting individualized diuretic dosing in the emergency department (ED) is lacking. Objective: The purpose of this study was to compare the efficacy and safety of aggressive (≥2 daily home doses) and conservative (<2 daily home doses) initial doses of loop diuretic. Methods: This was a retrospective cohort study in adult patients presenting to the ED with ADHF at an academic medical center from Apri 2015 to September 2015. The primary outcome was time to transition from IV to oral diuretics. Results: A total of 91 patients were included (aggressive dosing, n = 44; conservative dosing, n = 47). Mean time to transition from IV to oral diuretics was 67.9 hours in the aggressive group compared with 88.1 hours in the conservative group ( P = 0.049). Mean hospital length of stay (LOS) was 119.5 hours in the aggressive group versus 123.0 hours in the conservative group ( P = 0.799). No differences were observed between the mean urine output ( P = 0.829), change in body weight ( P = 0.528), or serum creatinine ( P = 0.135). Conclusion: Patients who received an aggressive initial diuretic dose in the ED had a significantly faster time to oral diuretic therapy without any significant differences in hospital LOS, urine output, change in body weight, and renal function when compared with conservative dosing.

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