Safety of add-on tolvaptan in patients with furosemide-resistant congestive heart failure complicated by advanced chronic kidney disease: a sub-analysis of a pharmacokinetics/ pharmacodynamics study

2015 ◽  
Vol 84 (2015) (07) ◽  
pp. 29-38 ◽  
Author(s):  
Naoto Tominaga ◽  
Keisuke Kida ◽  
Naoki Matsumoto ◽  
Yoshihiro J. Akashi ◽  
Fumihiko Miyake ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Kidney Disease ◽  
Advanced Chronic Kidney Disease

scholarly journals The association of beta-blocker use with mortality in elderly patients with congestive heart failure and advanced chronic kidney disease

2019 ◽  
Vol 35 (5) ◽  
pp. 782-789 ◽  
Author(s):  
Amber O Molnar ◽  
William Petrcich ◽  
Matthew A Weir ◽  
Amit X Garg ◽  
Michael Walsh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Randomized Trials ◽  
Advanced Chronic Kidney Disease ◽  
All Cause Mortality ◽  
Β Blocker ◽  
Β Blockers

Abstract Background Whether the survival benefit of β-blockers in congestive heart failure (CHF) from randomized trials extends to patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 but not receiving dialysis] is uncertain. Methods This was a retrospective cohort study using administrative datasets. Older adults from Ontario, Canada, with incident CHF (median age 79 years) from April 2002 to March 2014 were included. We matched new users of β-blockers to nonusers on age, sex, eGFR categories (>60, 30–60, <30), CHF diagnosis date and a high-dimensional propensity score. Using Cox proportional hazards models, we examined the association of β-blocker use versus nonuse with all-cause mortality. Results We matched 5862 incident β-blocker users (eGFR >60, n = 3136; eGFR 30–60, n = 2368; eGFR <30, n = 358). There were 2361 mortality events during follow-up. β-Blocker use was associated with reduced all-cause mortality [adjusted hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.54–0.64]. This result was consistent across all eGFR categories (>60: adjusted HR 0.55, 95% CI 0.49–0.62; 30–60: adjusted HR 0.63, 95% CI 0.55–0.71; <30: adjusted HR 0.55, 95% CI 0.41–0.73; interaction term, P = 0.30). The results were consistent in an intention-to-treat analysis and with β-blocker use treated as a time-varying exposure. Conclusions β-Blocker use is associated with reduced all-cause mortality in elderly patients with CHF and CKD, including those with an eGFR <30. Randomized trials that examine β-blockers in patients with CHF and advanced CKD are needed.

O210 Risk factors for congestive heart failure in patients with chronic kidney disease: the CRIC study

Global Heart ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. e58
Author(s):  
Jiang He ◽  
Wei Yang ◽  
Amanda Anderson ◽  
Harold Feldman ◽  
John Kusek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Kidney Disease

Diuretics in critical illness

2016 ◽  
Author(s):  
Marlies Ostermann ◽  
Ruth Y. Y. Wan
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Renal Function ◽  
Liver Disease ◽  
Kidney Disease ◽  
Chronic Liver Disease ◽  
Fluid Overload ◽  
Chronic Liver ◽  
Risk Of Death

Fluid overload and chronic hypertension are the most common indications for diuretics. The diuretic response varies between different types and depends on underlying renal function. In patients with congestive heart failure, diuretics appear to reduce the risk of death and worsening heart failure compared with placebo, but their use in acute decompensated heart failure is questionable. Diuretics are also widely used in chronic kidney disease to prevent or control fluid overload, and treat hypertension. In acute kidney injury, there is no evidence that they improve renal function, speed up recovery, or change mortality. In patients with chronic liver disease and large volume ascites, paracentesis is more effective and associated with fewer adverse events than diuretic therapy, but maintenance treatment with diuretics is indicated to prevent recurrence of ascites. Mannitol has a role in liver patients with cerebral oedema and normal renal function. The use of diuretics in rhabdomyolysis is controversial and restricted to patients who are not fluid deplete. In conditions associated with resistant oedema (chronic kidney disease, congestive heart failure, chronic liver disease), combinations of diuretics with different modes of action may be necessary. Diuresis is easier to achieve with a continuous furosemide infusion compared with intermittent boluses, but there is no evidence of better outcomes. The role of combination therapy with albumin in patients with fluid overload and severe hypoalbuminaemia is uncertain with conflicting data.

GALECTIN-3 LEVELS IN PATIENTS WITH CONGESTIVE HEART FAILURE NYHA III-IV AND CHRONIC KIDNEY DISEASE

2019 ◽  
Vol 37 ◽  
pp. e200
Author(s):  
V. Podzolkov ◽  
N. Dragomiretskaya ◽  
A. Kazadaeva ◽  
S. Stolbova ◽  
E. Shtemplevskay ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Kidney Disease ◽  
Galectin 3

scholarly journals SO057BETA-BLOCKERS ARE ASSOCIATED WITH REDUCED MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION AND ADVANCED CHRONIC KIDNEY DISEASE: COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Edouard L Fu ◽  
Alicia Uijl ◽  
Friedo W Dekker ◽  
Lars H Lund ◽  
Gianluigi Savarese ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Advanced Chronic Kidney Disease ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Background and Aims Beta-blockers reduce mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, patients with advanced chronic kidney disease (CKD) were underrepresented in landmark trials. We evaluated if beta-blockers are associated with improved survival in patients with HFrEF and advanced CKD. Method We identified 3906 persons with an ejection fraction <40% and advanced CKD (eGFR <30 mL/min/1.73m2) enrolled in the Swedish Heart Failure Registry during 2001-2016. The associations between beta-blocker use, 5-year all-cause mortality, and the composite of time to cardiovascular (CV) mortality/first HF hospitalization were assessed by multivariable Cox regression. Analyses were adjusted for 36 variables, including demographics, laboratory measures, comorbidities, medication use, medical procedures, and socioeconomic status. To assess consistency, the same analyses were performed in a positive control cohort of 12,673 patients with moderate CKD (eGFR <60-30 mL/min/1.73m2). Results The majority (89%) of individuals with HFrEF and advanced CKD received treatment with beta-blockers. Median (IQR) age was 81 (74-86) years, 36% were women and median eGFR was 26 (20-28) mL/min/173m2. During 5 years of follow-up, 2086 (53.4%) individuals had a subsequent HF hospitalization, and 2954 (75.6%) individuals died, of which 2089 (70.1%) due to cardiovascular causes. Beta-blocker use was associated with a significant reduction in 5-year all-cause mortality [adjusted hazard ratio (HR) 0.86; 95% confidence interval (CI) 0.76-0.96)] and CV mortality/HF hospitalization (HR 0.87; 95% CI 0.77-0.98). The magnitude of the associations between beta-blocker use and outcomes was similar to that observed for HFrEF patients with mild/moderate CKD, with adjusted HRs for all-cause mortality and CV mortality/HF hospitalization of 0.85 (95% CI 0.78-0.91) and 0.88 (95% CI 0.82-0.96), respectively. Conclusion Despite lack of trial evidence, the use of beta-blockers in patients with HFrEF and advanced CKD was high in routine Swedish care, and was independently associated with reduced mortality to the same degree as HFrEF with moderate CKD.

Deep vein thrombosis in patients with chronic kidney disease

2008 ◽  
Vol 99 (06) ◽  
pp. 1035-1039 ◽  
Author(s):  
H. Daneschvar ◽  
Ali Seddighzadeh ◽  
Gregory Piazza ◽  
Samuel Goldhaber
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Congestive Heart Failure ◽  
Renal Function ◽  
Deep Vein Thrombosis ◽  
Kidney Disease ◽  
Special Population ◽  
Future Studies ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryDeep vein thrombosis (DVT) is a poorly understood complication of chronic kidney disease (CKD). The objective of our analysis was to profile DVT patients with and without CKD. We defined CKD as patients requiring dialysis or patients having nephrotic syndrome.We compared 268 patients with CKD (184 patients with dialysis-dependent renal disease and 84 with nephrotic syndrome) to 4,307 patients with preserved renal function from a prospective United States multicenter deep venous thrombosis (DVT) registry. Compared with non-CKD patients, CKD patients with DVT were younger (median age 62 vs. 69 years, p<0.0001), more often African- American (p<0.0001), and more often Hispanic (p=0.0003). CKD patients underwent surgery more frequently in the three months prior to developing DVT (48.9% vs. 39.0%, p=0.001) and more often had concomitant congestive heart failure (20.9% vs. 14.6%, p=0.005). CKD patients suffered upper extremity DVT more frequently (30.0% vs. 10.8%, p<0.0001). Patients with CKD presented less often with typical DVT symptoms of extremity discomfort (42.9% vs. 52.4%, p=0.003) and difficulty ambulating (5.4% vs. 10.1%, p=0.01). Prophylaxis rates prior to DVT were similarly low in CKD and non-CKD patients (44.2% vs. 38.0%, p=0.06). Future studies of DVT in CKD patients should explore novel strategies for improving prophylaxis utilization and the detection of DVT in this special population.

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