Extracorporeal Isolated Ultrafiltration for Management of Congestion in Heart Failure and Cardiorenal Syndrome

Publication date: September 2018Source: Advances in Chronic Kidney Disease, Volume 25, Issue 5Author(s): Amir Kazory, Maria Rosa CostanzoAcute decompensated heart failure has the highest rate of hospital readmission among all medical conditions and portends a significant financial burden on health care system. Congestion, the hallmark of acute decompensated heart failure, represents the primary reason for hospitalization and the driver of adverse outcomes in these patients. Although diuretic-based medical regimens remain the mainstay of management of acute decompensated heart failure, they often show suboptimal efficacy and safety profiles in this setting. Mechanical extraction of excess fluid through extracorporeal ultrafiltration therapy has been proposed as a mechanistically relevant option in this setting. The advent of simplified, portable, and user-friendly devices that are dedicated to ultrafiltration therapy for these patients has renewed the interest in this therapeutic modality. In this article, we provide a brief overview of the initial mechanistic studies followed by the key clinical findings of the most recent landmark trials. The shortcomings of these studies are discussed in detail because not only do they provide the appropriate context in which the results are to be interpreted, but more importantly they also highlight the existing knowledge gaps that need to be addressed in future studies. Finally, selected practical and conceptual considerations and controv...
Source: Advances in Chronic Kidney Disease - Category: Urology & Nephrology Source Type: research

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ConclusionsDiabetes carries a significant health burden, and results vary across states. Efforts to prevent or delay diabetes or to improve diabetes management could reduce the health burden because of diabetes.
Source: American Journal of Preventive Medicine - Category: International Medicine & Public Health Source Type: research
Condition:   CKD Intervention:   Drug: LCZ 696 Sponsor:   The Second Affiliated Hospital of Harbin Medical University Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
ConclusionThis study demonstrates that the Surprise Question can identify heart failure patients within the last year of life. Despite over ‐classification of patients into the ‘not surprised’ category, the Surprise Question identified nearly all patients who were within the last year of life, whilst also accurately identifying those unlikely to die.
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
AimsTo examine sex differences in clinical characteristics, echocardiographic features, quality of life and 1 ‐year death or heart failure (HF) hospitalization outcomes in patients with/without diabetes mellitus (DM).Methods and resultsUtilizing the Asian Sudden Cardiac Death in HF (ASIAN ‐HF) registry, 5255 patients (mean age 59.6 ± 13.1, 78% men) with symptomatic HF with reduced ejection fraction (HFrEF) were stratified by DM status to address the research aims. Despite similar prevalence of DM between Asian men (43%) and women (42%), the odds of DM increased at lower body m ass index in women vs...
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
AbstractPurposeComparisons of the efficacy of dual- vs. single-chamber implantable cardioverter defibrillators (ICDs) in preventing inappropriate shocks have had contradictory results. We investigated whether dual-chamber devices have a lower risk of inappropriate shocks and the specific role of supraventricular tachycardia (SVT) discriminators.MethodsAll heart failure (HF) patients without an indication for pacing and implanted with a prophylactic ICD were recruited from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.ResultsAmong 7...
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
This article examines the effect of the anion that accompanies sodium delivered with these therapies. Do the negative effects on blood pressure (BP) and sodium retention, as measured by an increase in edema, weight gain, and congestive heart failure, observed with oral administration of sodium chloride (NaCl) differ when a similar amount of sodium is given with bicarbonate or citrate in this patient population? A review of the literature suggests that NaHCO3 does not increase BP or sodium retention when administered to patients with CKD during a concurrent severe NaCl dietary restriction (∼10 mEq/d). However, this degr...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
Conclusion: Patients with CKD had more often permanent type of AF. Percutaneous interventions of the left main coronary artery, the only elective procedures influencing patients ’ prognosis, were done more frequently in CKD patients with AF. In-hospital mortality was significantly higher in patients with severe renal impairment. Despite the higher risk of ischaemic stroke in CKD group the use of oral anticoagulation therapy was significantly less frequent and the patients were deprived of the confirmed benefits of such treatment.Kidney Blood Press Res 2018;43:1796 –1805
Source: Kidney and Blood Pressure Research - Category: Urology & Nephrology Source Type: research
Purpose of review Cachexia is a disease-related multifactorial syndrome characterized by inflammation, massive muscle protein catabolism and carbohydrate and lipid metabolism disorder. Several studies tried to define the impact of either nutrition or physical exercise (single approach strategy) or their combination (multimodal approach strategy) on prevention and/or treatment of muscle wasting in cachectic patients. Recent findings Single approach strategies (i.e. nutrition or physical exercise) have the potential of preventing and improving features of the cachexia syndrome possibly with a differential impact accord...
Source: Current Opinion in Clinical Nutrition and Metabolic Care - Category: Nutrition Tags: PROTEIN, AMINO ACID METABOLISM AND THERAPY: Edited by Rajavel Elango and Alessandro Laviano Source Type: research
Conclusions: Renal disease proved to be associated with early and subclinical impairment of LV systolic function, which persists after starting dialysis and even in spite of successful kidney transplantation. An increased E/e ’ resulted to be the most powerful independent predictor of abnormal GLS.Cardiorenal Med 2019;9:61 –68
Source: Cardiorenal Medicine - Category: Urology & Nephrology Source Type: research
We learn from basic physiology  lessons that human body is made up of 60 % water. What about heart ? There is no reason for the heart should behave differently from rest of the body . If my  assumptions are correct when the normal heart weighs 300g  , 180g of which should be  be water. The same thing could be applicable for LV mass( * Reference requested) Is there myocardial congestion in cardiac failure ? Genesis of edema in any tissue depends on local hydrostatic pressures, tissue resistive forces, osmotic balance, and cell membrane permeability. In the myocardium individual contri...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: cardiac failure Cardiac MRI Cardio Nephrology effect of dialysis on myocardial water content lv amss and myocardial edema myocardial edema and ckd chronic kidney failure myocardial interstitial edema myocardial water imaging water logging Source Type: blogs
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