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A retrospective characterization of worsening renal function in patients with acute decompensated heart failure receiving nesiritide
A. Starr,Jessica; M. Nappi,Jean;
Pharmacy Practice (Internet) , 2009, DOI: 10.4321/S1886-36552009000300008
Abstract: nesiritide is approved by food and drug administration (fda) for the treatment of patients with acute decompensated heart failure (adhf) due its ability to rapidly reduce cardiac filling pressures and improve dyspnea. numerous studies have shown that renal dysfunction is associated with unfavorable outcomes in patients with heart failure. in addition, there have been reports suggesting that nesiritide may adversely affect renal function and mortality. objective: the purpose of this retrospective analysis was to assess the effect of dose and duration of nesiritide use and the dose and duration of diuretic therapy on worsening renal function and increased in-hospital mortality in this patient population. methods: seventy-five patients who were hospitalized for adhf and who were treated with nesiritide for at least 12 hours were reviewed retrospectively. results: the mean increase in scr was 0.5 mg/dl (range 0 - 4.4 mg/dl). thirty-six percent of patients (27/75) met the primary endpoint with an increase in scr>0.5 mg/dl. treatment dose and duration of nesiritide did not differ between those patients who had an increase in scr>0.5 mg/dl and those who did not (p=0.44 and 0.61). concomitant intravenous diuretics were used in 85% of patients with an increase in scr >0.5 mg/dl compared to 90% of patients without an increase in scr>0.5 mg/dl (p=0.57). the in-hospital mortality rate was also higher at 35% in those patients with an increase in creatinine >0.5 mg/dl compared to 11% in those without (p=0.01). conclusion: nesiritide was associated with an increase in scr > 0.5 mg/dl in approximately one-third of patients. the increase occurred independently of dose, duration of nesiritide therapy, blood pressure changes, and concomitant intravenous diuretic use. however, the increase in scr was associated with an increase in hospital stay and in hospital mortality consistent with previous reports in the literature.
A retrospective characterization of worsening renal function in patients with acute decompensated heart failure receiving nesiritide  [cached]
Starr JA,Nappi JM
Pharmacy Practice (Granada) , 2009,
Abstract: Nesiritide is approved by Food and Drug Administration (FDA) for the treatment of patients with acute decompensated heart failure (ADHF) due its ability to rapidly reduce cardiac filling pressures and improve dyspnea. Numerous studies have shown that renal dysfunction is associated with unfavorable outcomes in patients with heart failure. In addition, there have been reports suggesting that nesiritide may adversely affect renal function and mortality. Objective: The purpose of this retrospective analysis was to assess the effect of dose and duration of nesiritide use and the dose and duration of diuretic therapy on worsening renal function and increased in-hospital mortality in this patient population.Methods: Seventy-five patients who were hospitalized for ADHF and who were treated with nesiritide for at least 12 hours were reviewed retrospectively. Results: The mean increase in SCr was 0.5 mg/dL (range 0 – 4.4 mg/dL). Thirty-six percent of patients (27/75) met the primary endpoint with an increase in SCr>0.5 mg/dL. Treatment dose and duration of nesiritide did not differ between those patients who had an increase in SCr>0.5 mg/dL and those who did not (p=0.44 and 0.61). Concomitant intravenous diuretics were used in 85% of patients with an increase in SCr >0.5 mg/dL compared to 90% of patients without an increase in SCr>0.5 mg/dL (p=0.57). The in-hospital mortality rate was also higher at 35% in those patients with an increase in creatinine >0.5 mg/dL compared to 11% in those without (p=0.01). Conclusion: Nesiritide was associated with an increase in SCr > 0.5 mg/dL in approximately one-third of patients. The increase occurred independently of dose, duration of nesiritide therapy, blood pressure changes, and concomitant intravenous diuretic use. However, the increase in SCr was associated with an increase in hospital stay and in hospital mortality consistent with previous reports in the literature.
Worsening Renal Function in Patients Hospitalized with Acute Heart Failure: Risk Factors and Prognostic Significances
Valerio Verdiani,Vieri Lastrucci,Carlo Nozzoli
International Journal of Nephrology , 2011, DOI: 10.4061/2011/785974
Abstract: Objectives. To determine the prevalence, the clinical predictors, and the prognostic significances of Worsening Renal Function (WRF) in hospitalized patients with Acute Heart Failure (AHF). Methods. 394 consecutively hospitalized patients with AHF were evaluated. WRF was defined as an increase in serum creatinine of ≥0.3 mg/dL from baseline to discharge. Results. Nearly 11% of patients developed WRF. The independent predictors of WRF analyzed with a multivariable logistic regression were history of chronic kidney disease (=.047), age >75 years (=.049), and admission heart rates ≥100 bpm (=.004). Mortality or rehospitalization rates at 1 month, 6 months, and 1year were not significantly different between patients with WRF and those without WRF. Conclusion. Different clinical predictors at hospital admission can be used to identify patients at increased risk for developing WRF. Patients with WRF compared with those without WRF experienced no significant differences in hospital length of stay, mortality, or rehospitalization rates.
Practical approach to acute heart failure with algorithms  [cached]
Mehdi Zoghi,Yüksel ?avu?o?lu,Mehmet Birhan Y?lmaz,Sanem Nalbantgil
Anadolu Kardiyoloji Dergisi , 2009,
Abstract: Acute heart failure syndrome is a heterogeneous group, which requires distinct therapeutic approaches. Diuretics and/or vasodilators for patients with high blood pressure and inotropic agents for patients with low left ventricular ejection fraction and evidence of hypoperfusion are kept in the forefront. Early initiation of therapy along with accurate and early diagnosis in acute heart failure reduces mortality and morbidity significantly. Therefore, it is critically important to develop algorithms, which could easily be followed by all physicians.In this paper, in parallelism with heart failure guidelines and utilizing data of the clinical studies, performed by colleagues of our country in this area, therapeutic algorithms compatible with the conditions of our country are suggested for distinct clinical presentations of acute heart failure.
Newer treatments for decompensated heart failure: focus on levosimendan  [cached]
Ferenc Follath
Drug Design, Development and Therapy , 2009,
Abstract: Ferenc FollathUniversity Hospital Zürich, Steering Group Drug Therapy, Zürich, SwitzerlandAbstract: Acute heart failure (AHF) is a major cause of hospitalizations. Severe dyspnea, pulmonary congestion and low cardiac output with peripheral vasoconstriction and renal hypoperfusion is a main form of clinical presentation. Most patients with acute worsening have a pre-existing decompensated chronic heart failure (ADCHF), but AHF may also occur as a first manifestation of a previously unknown heart disease. Myocardial ischemia, cardiac arrhythmias, non-compliance with medication and infections are frequent precipitating factors. Management of AHF depends on the underlying heart disease and cause of decompensation. In patients with ADCHF vasodilators and iv diuretics are first-line drugs for rapid reduction of dyspnea and congestion. In patients with signs of low cardiac output and oliguria, inotropic agents are also often administered to prevent further deterioration. Beta-adrenergic agents and phosphodiesterase inhibitors correct the hemodynamic disturbance, but may also induce arrhythmias and worsen myocardial ischemia. Inotropic therapy therefore remains controversial. A novel class of drugs, the calcium sensitizers, represent a new therapeutic option. Levosimendan was shown to improve myocardial contractility without increasing oxygen requirements and to produce peripheral and coronary vasodilation. Its therapeutic effects and tolerance have been tested in several trials. The present review focuses on the clinical pharmacology and therapeutic utility of levosimendan in patients with ADCHF.Keywords: acute heart failure, inotropic agents, calcium sensitizers, levosimendan
Newer treatments for decompensated heart failure: focus on levosimendan
Ferenc Follath
Drug Design, Development and Therapy , 2009, DOI: http://dx.doi.org/10.2147/DDDT.S3097
Abstract: treatments for decompensated heart failure: focus on levosimendan Review (6179) Total Article Views Authors: Ferenc Follath Published Date March 2009 Volume 2009:3 Pages 73 - 78 DOI: http://dx.doi.org/10.2147/DDDT.S3097 Ferenc Follath University Hospital Zürich, Steering Group Drug Therapy, Zürich, Switzerland Abstract: Acute heart failure (AHF) is a major cause of hospitalizations. Severe dyspnea, pulmonary congestion and low cardiac output with peripheral vasoconstriction and renal hypoperfusion is a main form of clinical presentation. Most patients with acute worsening have a pre-existing decompensated chronic heart failure (ADCHF), but AHF may also occur as a first manifestation of a previously unknown heart disease. Myocardial ischemia, cardiac arrhythmias, non-compliance with medication and infections are frequent precipitating factors. Management of AHF depends on the underlying heart disease and cause of decompensation. In patients with ADCHF vasodilators and iv diuretics are first-line drugs for rapid reduction of dyspnea and congestion. In patients with signs of low cardiac output and oliguria, inotropic agents are also often administered to prevent further deterioration. Beta-adrenergic agents and phosphodiesterase inhibitors correct the hemodynamic disturbance, but may also induce arrhythmias and worsen myocardial ischemia. Inotropic therapy therefore remains controversial. A novel class of drugs, the calcium sensitizers, represent a new therapeutic option. Levosimendan was shown to improve myocardial contractility without increasing oxygen requirements and to produce peripheral and coronary vasodilation. Its therapeutic effects and tolerance have been tested in several trials. The present review focuses on the clinical pharmacology and therapeutic utility of levosimendan in patients with ADCHF.
Cardiorenal biomarkers in acute heart failure
Rajiv Choudhary,Dipika Gopal,Ben A. Kipper,Alejandro De La Parra Landa
老年心脏病学杂志(英文版) , 2012,
Abstract: Managing patients with heart failure (HF) is a challenging task within itself, but the presence of associated worsening renal function can greatly increase mortality and morbidity. Early diagnosis and treatment is the key to prevent re-hospitalizations and reduce healthcare costs. Biomarkers have long been established as highly sensitive and specific tools in diagnosing and prognosticating patients with HF. Reflecting distinct pathophysiological events and ongoing cellular insult, biomarkers have been proven superior to conventional laboratory tests. Availability of better assays and rapid analysis has allowed the use of biomarkers as point-of-care tests in the emergency department and at the patient’s bed-side. Acute HF patients often go on to develop worsening renal function, termed as acute cardiorenal syndrome. The growing breadth of studies has shown the implications of combining multiple biomarkers to better chart outcomes and produce desirable results in such patients.
ACUTE RENAL FAILURE
QURBAN ALI SHAIKH
The Professional Medical Journal , 2008,
Abstract: Objective: To find out the various causes of acute renal failure (ARF) and its out come in our settingof tertiary Care Hospital in rural areas. Design: A retrospective Study. Setting: Nephro-urology department ChandkaMedical College teaching hospital Larkana. Period: From March 1998 to March 2005. Patients & Methods: Reviewof 294 patients of acute renal failure admitted in Nephro-urology department Chandka Medical College teachinghospital Larkana. Detailed history, physical examination and laboratory data of 294 consecutive patients of acute renalfailure were analyzed. Result: 294 patients were included in this study. Among them 149 (51.7%) were in the youngerage group (less than 40 years) with dominance of males (1.61 to 1.00 male to female ratio). Major cause of ARF waspre renal, seen in 172 (66.6%) patients, 70 (23.8%) of all cases of acute renal failure had gynecological and obstetricalback ground. Other causes C.V.A in 24 (9.3%), HHD in 14(4.5%). Glomerulonephritis in 22(8.5%),and obstructiveuropathy in 16(6.2%). 92 Patients (31.3%) improved on conservative treatment,166(56.5%) needed dialysis and36(12.2%) left against medical advice. Conclusion: This data reveals that pre renal element is the single mostimportant cause of acute renal failure, in which commonest cause was pregnancy related ARF followed by C.V.A,HHD,glomerulonephrits and obstructive urophathy. Early indentification, referral treatment of pre renal factors, good perinatal care and good therapeutic measures substantially bring down the incidence of acute renal failure. 12.2% patientsleft against medical advice due to heavy expenses on the treatment and needs NGOs and Government support fortreatment of poor patients.
Nutrition in acute renal failure
Guimar?es, Sérgio Mussi;Cipullo, José Paulo;Lobo, Suzana Margareth Ajeje;Burdmann, Emmanuel de Almeida;
Sao Paulo Medical Journal , 2005, DOI: 10.1590/S1516-31802005000300011
Abstract: nutritional status has been considered to be one of the possible determinants of mortality rates in cases of acute renal failure (arf). however, most studies evaluating possible mortality indicators in arf cases have not focused on the nutritional status, possibly because of the difficulties involved in assessing the nutritional status of critically ill patients. although the traditional methods for assessing nutritional status are used for arf patients, they are not the best choice in this population. the use of nutritional support for these patients has produced conflicting results regarding morbidity and mortality. this review covers the mechanisms and indicators of malnutrition in arf cases and the types of nutritional support that may be used.
ACUTE RENAL FAILURE
Tufail Muhammad
The Professional Medical Journal , 1995,
Abstract: Acute renal failure (ARF) is defined as any rapid decline in glomerular filtration rate. It is the most commonform of renal disease after urinary tract infections and stones affecting all age groups and bothsexes. Etiology is variable. Originally it was described as a complication of military casualties. Thedisease has become equally common from non traumatic sources. Low urine output (oliguria) is the mostcommon clinical presentation.Hyperkalemia, acidosis, salt and water retention, tendency towards infections, G.I. bleeding and uremiaare serious complications. Disease is to some extent preventable, largely treatable and potentiallyreversible depending upon the underlying disease process. Unless there is indication of spontaneousrecovery, dialysis, hemo or peritoneal must be started without too much delay.
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