Cardiorenal Syndrome In Patients Research Articles

Cardiorenal syndrome in patients with chronic kidney disease and diabetes mellitus

AIM: Combination of cardiovascular and renal disease is currently viewed as a unified cardiorenal syndrome (CRS). The aim of our study was to assess the CRS prevalence and risk factors associated with left ventricular hypertrophy (LVH) in patients with pre-dialysis stages of chronic kidney disease (CKD) of various etiology.
 MATERIALS AND METHODS: We enrolled 172 patients with CKD to participate in this study. First group consisted of 83 patients with nondiabetic CKD at 2nd through 4th stage (mean age 46-15 years, 51% male and 29% female). Mean glomerular filtration rate (GFR) was 37.2 ml/min (33.9-41.4 with 95% CI); creatinine plasma clearance was 2.9 mg/dl (2.6-3.2). Second group consisted of 89 patients with type 2 diabetes mellitus (T2DM) and CKD at 1st?2nd stage (40% male and 60% female) with albuminuria (mean age 57.3-7.1 years). Duration of diabetes in this sampling was 10.4-7.1 years. All patients underwent standard clinical examination, supplemented with echocardiography to evaluate the influence of general and CKD-related risk factors for LVH.
 RESULTS: LVH was diagnosed in 37.3% of non-diabetic patients with CKD at 2nd through 4th stage. Aside from classic cardiovascular riskfactors (including age, gender, arterial hypertension, family history of cardiovascular diseases, hypercholesterolemia), we observed theimpact of kidney-related factors (anemia, plasma creatinine, disturbance of calcium-phosphorus metabolism). CKD progression wasassociated with elevation in the incidence of concentric and eccentric LVH). Patients with T2DM were diagnosed with LVH in 36% ofcases. Increased myocardial mass correlated with plasma levels of uric acid, HbA1c, obesity and albuminuria. There was also a firmassociation between diabetic nephropathy, left ventricular myocardial remodelling and a history of cardiovascular events.
 CONCLUSION: In patients with diabetes mellitus and CKD cardiorenal syndrome develops at pre-dialysis stages due to both classic and kidney-related cardiovascular risk factors.

Ultrafiltration for ADHF Underperforms in Patients with Cardiorenal Syndrome

Managing cardiorenal syndrome in patients with acute decompensated heart failure (ADHF) is a considerable challenge. Diuretics — the mainstay of

Plasma Adrenomedullin and Subclinical Cardiorenal Syndrome in Patients with Type 2 Diabetes Mellitus

To evaluate whether plasma adrenomedullin is involved in the previously reported significant inverse correlation between left ventricular (LV) end-diastolic pressure (peak velocity of early transmitral flow/peak velocity of early diastolic mitral annular motion ratio [E/E' ]) and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus, mild-to-moderate renal function impairment and LV relaxation impairment (E'≤7.1 cm/s). Plasma adrenomedullin concentration, E/E' and eGFR were assessed in 82 patients with type 2 diabetes. Plasma adrenomedullin concentration was positively correlated with eGFR in patients with or without LV relaxation impairment, and inversely correlated with E/E' in patients with LV relaxation impairment. Multivariate linear regression analysis supported a role for plasma adrenomedullin in the association between E/E' and eGFR. These results support the hypothesis that adrenomedullin modulates the interaction between the heart and kidneys in early subclinical cardiorenal syndrome in patients with type 2 diabetes mellitus.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Cardio-renal syndrome type 2: Etiopathogenesis, diagnosis and therapy

Congestive heart failure, as a consequence, has decreased cardiac work, decreased effective arterial volume, tissue hypoperfusion and neurohormonal system activation. The study aimed at finding risk factors, pathogenetic mechanisms for progression of cardiorenal syndrome and highlighting clinical importance of early findings, prevention and timely treatment of cardiorenal syndrome in patients with acute decompensation of chronic congestive heart failure. Expert papers and clinical studies that deal with etiopathogenesis, diagnosis and treatment of cardiorenal syndrome were analyzed. Due to overfilling of pulmonary cappilaries patients is dispnoic, pleural effusion, ascites, periferal and generalized swellings are present. Decreased effective arterial volume decreases kidney perfusion which causes acute kidney damage. Increased neurohormonal systems activity, resistency to diuretics, retention of sodium and water in the organism overload volume and worsen heart failure. Controlled liquid disposal by ultrafiltration improves clinical status in patients with increased preload and cappilaries overfilling. Equillibrium maintenance between extracellular volume disposal and effective arterial extracellular volume, which enables kidney perfusion, plays key role in prevention of acute kidney damage contributing importantly in morbidity and mortality decrease as well as better quality of life for these patients.

Intensive hemodialysis for cardiomyopathy associated with end-stage renal disease

Heart and kidney dysfunction often coexist, and increasing evidence supports the interaction of these two organs, as demonstrated by the clinical condition known as cardiorenal syndrome (CRS). We report a pediatric patient with end-stage renal disease (ESRD) who developed a dilated cardiomyopathy and decompensated heart failure after undergoing unilateral nephrectomy and while on maintenance peritoneal dialysis. He showed marked improvement in his cardiac function with the addition of intensive hemodialysis. We discuss the pathophysiology of cardiorenal syndrome in patients with ESRD and suggest that intensive dialysis may be an effective therapy for this condition.

Neutrophil gelatinase-associated lipocalin in the diagnosis of type 1 cardio-renal syndrome in the general ward.

The early identification of acute heart failure (HF) patients with type 1 cardio-renal syndrome should be the first step for developing prevention and treatment strategies for these patients. This study aimed to assess the performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C in the early detection of type 1 cardio-renal syndrome in patients with acute HF. One-hundred nineteen patients admitted with acute HF were studied. NGAL and creatinine were measured in the first hospitalization morning; creatinine was also measured at least after 48 to 72 hours. Physicians were blinded to NGAL and cystatin C levels. Type 1 cardio-renal syndrome was defined as an increase in the creatinine level of at least 0.3 mg/dl or 50% of basal creatinine. Type 1 cardio-renal syndrome developed within 48 to 72 hours in 14 patients (11.8%). Admission NGAL levels were higher in these patients: 212 versus 83 ng/dl. At a cutoff value of 170 ng/L, NGAL determined type 1 cardio-renal syndrome with a sensitivity of 100% and a specificity of 86.7%. The area under the receiver-operating characteristic curve of NGAL was 0.93 and that of cystatin C was 0.68. Above a cutoff value of 170 ng/L, NGAL predicts 48- to 72-hour development of type 1 cardio-renal syndrome with a negative predictive value of 100% and a positive predictive value of 50%. NGAL independently associates with type 1 cardio-renal syndrome and might be a useful biomarker in the early recognition of these patients.

Echocardiographic Features of Acute Cardiorenal Syndrome in Patients With Advanced Heart Failure

Echocardiographic Features of Acute Cardiorenal Syndrome in Patients With Advanced Heart Failure

Abstract 5120: Cardiac Sympathetic Nerve Activity is Associated With the Progression of Cardiorenal Syndrome in Patients With Chronic Heart Failure: 10-Year Follow up Study

Background : Chronic heart failure (CHF) and renal dysfunction (RD) frequently coexist. Cardiac sympathetic nerve activity (CSNA) influences the clinical outcomes in CHF patients (pts), but there is no information available on the relation between CSNA and RD in CHF pts, so-called cardiorenal syndrome (CRS). Methods : We studied 101 CHF patients with left ventricular ejection fraction (LVEF) &lt; 40%. At the entry, I-123 MIBG imaging was performed, and washout rate (WR) was calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. Every year, estimated Glomerular Filtration Rate (GFR) by the MDRD equation was obtained in each patient. Results : GFR at the entry was significantly lower in pts with (n=49) than without abnormal WR (n=52) (more than 27%: the mean control WR +2SD) (59±18 vs 67±19 ml/min/1.73m 2 , p=0.029). With a mean follow-up of 7.3±3.5 yrs, GFR decreased from 64±19 to 50±21 ml/min/1.73m 2 , the median value of GFR depression rate (GFRdep) was 3.5%/year, and 31 of 101 pts died of cardiac death. GFRdep was also significantly greater in pts with than without abnormal WR (8.2 vs 2.5%/year, p&lt;0.01). There were no significant differences in gender, age, NYHA class, LVEF, or the content of anti-heart failure therapy between pts with and without WR≥27%. Cardiac death was significantly more frequently observed in pts with than without GFRdep≥3.5%/year (44 vs 16%, p&lt;0.01). The odds ratio of greater GFRdep for cardiac death was 3.8 (95%CI 1.7 to 8.5). Conclusion: In CHF pts, CSNA would be associated with the progression of RD. Furthermore, progression of RD had poor clinical outcome. Thus, CSNA might play an important role in the progression of CRS in CHF pts.

Loop Diuretics in Acute Decompensated Heart Failure

Acute decompensated heart failure (ADHF) is a common and highly morbid cardiovascular disorder. Most hospitalizations for ADHF are related to symptoms of congestion, and the vast majority of ADHF patients are treated with intravenous loop diuretics. Despite this nearly ubiquitous use, data supporting the safety and efficacy of loop diuretics in ADHF are limited, and controversy exists about the best way to use loop diuretics with regard to both dosing and means of administration (continuous infusion vs. intermittent boluses). We reviewed the data supporting the safety and efficacy of loop diuretics in patients with ADHF. A large body of observational literature suggests that loop diuretics, especially at higher doses, may be associated with increased mortality in patients with heart failure even after detailed adjustment for other measures of disease severity. Additionally, multiple small underpowered trials suggest that continuous infusion may be equivalent or superior to intermittent bolus dosing. In summary, there is a critical need to develop more robust data on the use of loop diuretics in ADHF. In that context, the NIH Heart Failure Clinical Research Network has begun the Diuretics Optimization Strategies Evaluation (DOSE) study, a multi-center, double-blind, randomized controlled trial that will enroll 300 patients with ADHF. The DOSE study will randomize patients using a 2 × 2 factorial design to low dose vs. high dose furosemide, and intermittent bolus vs. continuous infusion. Successful completion of the DOSE study will provide important data on the optimal clinical use of loop diuretics in ADHF.

Role of endothelial dysfunction in the development of cardiorenal syndrome in patients with type 1 diabetes mellitus

We examined the role of endothelial dysfunction in the development and progression of cardiorenal syndrome in 93 patients with type 1 diabetes mellitus. Patients: According to the stage of renal insufficiency all patients were divided into equal groups: those with normal albumin excretion rate, with microalbuminuria, with proteinuria, and with chronic renal failure. We analyzed endothelial flow-mediated dilation of the brachial artery, levels of endothelin-1, von Willerbrand factor, C-reactive protein, renal:albumin and protein excretion rates, glomerular filtration rate (GFR), and cardiovascular (ECG, echocardiography, blood pressure monitoring) functions. Results: There were negative correlations between the GFR, BP level and endothelial dysfunction markers. At the same time GFR correlated positively with the coefficient of sensitivity of endothelium to shear stress. There were also positive correlations between BP, permeability of glomerular filter and endothelial dysfunction markers and negative correlation with the coefficient of sensitivity of endothelium to shear stress and GFR. Left ventricle mass correlated with markers of endothelial dysfunction and stage of renal disease. Patients with chronic renal failure had negative correlations between LVM and GFR, ILVM and GFR and a positive correlation between ejection fraction and GFR. Conclusions: There is a close relationship between endothelial dysfunction and development and progression of renal and cardiovascular pathology in patients with type 1 diabetes mellitus.

The prevalence of cardiorenal syndrome in patients hospitalized with heart failure - secular trends and referral bias

Background: Renal dysfunction (RD) and worsening renal function during heart failure (HF) therapy (cardiorenal syndrome, CRS) are important determinants of mortality and length of stay (LOS) among patients (pts) hospitalized with HF. Advances in HF diagnosis and therapy have altered the natural history of HF and the prevalence of CRS may be changing. Differences in the severity of RD and prevalence of CRS in referral (R) vs community based (C) HF populations are undefined. Objective: In pts admitted with HF, we sought to determine if the severity of RD and/or the prevalence of the CRS have changed over time (secular trends) and if there are differences in C vs R HF populations (referral bias). Methods: Electronic chart abstraction was performed on all pts discharged from Mayo Clinic hospitals (Rochester, MN) from 1/1/1990 to 12/31/2002 with a HF diagnosis code (DRG127). Pts were identified as C vs R based on county of residence (N=8,081 pts; 30% C). Creatinine (Crt) was examined on and for 14 days after admission. Results: Data from the first (90-94) and last (99-02) four study years are shown to demonstrate time and R vs C cohort effects (table). Height and Weight (wt) were available electronically for 99-02 only. Using ideal body wt in the Gault equation, average Crt clearance was 34.5±19.7 ml/min in C vs 37.7±22.0 ml/min in R (p=ns). Conclusions: Referral bias: C pts were older than R pts. While admit Crt was higher in R pts, more R pts were male and Crt clearance was not different although hemoglobin was lower in C. The prevalence of CRS was lower in R. Secular trends: Over the study period, mean age and the severity of RD and anemia increased in both R and C HF populations. However, the prevalence of the CRS remained stable. Despite evidence of increasing HF severity, LOS has decreased over time in R and C. We speculate that decreases in LOS reflect in part, institutional initiatives to improve fiscal outcomes for DRG 127.∗C 90–94 (n=734)C 99–02 (n=741)R 90–94 (n=1781)R 99–02 (n=1693)R vs C (p)Mean age (yrs)±SD77.0±13.077.8∗±12.172.5±13.273.1∗±13.1<0.001Male (%)42.448.360.358.5<0.001Mean admit Crt (mg/dl)±SD1.56±0.961.63∗±0.931.65±1.041.72∗±0.950.005% with Δ Crt ≥25%28.028.726.025.40.02% with Δ Crt>0.3 mg/dl25.625.923.926.70.02Mean Hb (g/dl)±SD12.0±2.111.8±1.9∗12.3±2.111.7±2.0∗0.01Mean LOS (days)±SD5.3±4.43.9±3.1∗5.8±4.04.6±4.4∗<0.001∗p<0.05 vs 90–94