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Cardiorenal syndrome in decompensated heart failure: Prognostic and therapeutic implications

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Abstract

Various lines of evidence implicate impaired renal function as an important prognostic indicator in patients with congestive heart failure (CHF). Conventional diuretics may aggravate renal dysfunction and can result in neurohumoral activation. Evolving new therapeutic strategies that enhance renal function include administration of B-type natriuretic peptide, adenosine and vasopressin antagonists, and ultrafiltration methods. Prospective studies are needed to evaluate whether these new renal-enhancing strategies will improve patient outcome in CHF.

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References and Recommended Reading

  1. Hillege HL, Girbes AR, de Kam PJ, et al.: Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000, 102:203–210.

    PubMed  CAS  Google Scholar 

  2. Dries DL, Exner DV, Domanski MJ, et al.: The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2000, 35:681–689.

    Article  PubMed  CAS  Google Scholar 

  3. Forman DE, Butler J, Wang Y, et al.: Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004, 43:61–67. This study provides a score for patients at risk for developing worsening renal function. A higher score is associated with adverse outcomes.

    Article  PubMed  Google Scholar 

  4. Schrier RW, Abraham WT: Hormones and hemodynamics in heart failure. N Engl J Med 1999, 341:577–585.

    Article  PubMed  CAS  Google Scholar 

  5. Stevens TL, Burnett JC Jr, Kinoshita M, et al.: A functional role for endogenous atrial natriuretic peptide in a canine model of early left ventricular dysfunction. J Clin Invest 1995, 95:1101–1108.

    PubMed  CAS  Google Scholar 

  6. Reilly RF, Ellison DH: Mammalian distal tubule: physiology, pathophysiology, and molecular anatomy. Physiol Rev 2000, 80:277–313.

    PubMed  CAS  Google Scholar 

  7. Ellison DH: Diuretic therapy and resistance in congestive heart failure. Cardiology 2001, 96:132–143. This is an informative review of mechanisms and therapy of diuretic resistance.

    Article  PubMed  CAS  Google Scholar 

  8. Murray MD, Deer MM, Ferguson JA, et al.: Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure. Am J Med 2001, 111:513–520.

    Article  PubMed  CAS  Google Scholar 

  9. Colucci WS, Elkayam U, Horton DP, et al.: Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group. N Engl J Med 2000, 343:246–253.

    Article  PubMed  CAS  Google Scholar 

  10. Yamamoto K, Burnett JCJ, Redfield MM: Effect of endogenous natriuretic peptide system on ventricular and coronary function in failing heart. Am J Physiol 1997, 273:H2406-H2414.

    PubMed  CAS  Google Scholar 

  11. Brunner-La Rocca HP, Kaye DM, Woods RL, et al.: Effects of intravenous brain natriuretic peptide on regional sympathetic activity in patients with chronic heart failure as compared with healthy control subjects. J Am Coll Cardiol 2001, 37:1221–1227.

    Article  CAS  Google Scholar 

  12. Publication Committee for the VMAC Investigators (Vasodilation in the Management of Acute Heart CHF). Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA 2002, 287:1531–1540. This is the largest randomized clinical trial of nesiritide in patients hospitalized for decompensated heart failure.

    Article  Google Scholar 

  13. Butler J, Emerman C, Peacock WF, et al.: The efficacy and safety of B-type natriuretic peptide (nesiritide) in patients with renal insufficiency and acutely decompensated congestive heart failure. Nephrol Dial Transplant 2004, 19:391–399.

    Article  PubMed  CAS  Google Scholar 

  14. Cataliotti A, Boerrigter G, Costello-Boerrigter LC, et al.: Brain natriuretic peptide enhances renal actions of furosemide and suppresses furosemide-induced aldosterone activation in experimental heart failure. Circulation 2004, 109:1680–1685. This study reports that BNP in addition to furosemide enhances the diuretic and natriuretic effect of furosemide, preserves renal function, and inhibits the activation of aldosterone in experimental heart failure.

    Article  PubMed  CAS  Google Scholar 

  15. Natrecor (nesiritide). http://www.natrecor.com/pdf/ natrecor_pi.pdf. Accessed April 14, 2004.

  16. Hilleman D, Lenz T, Malesker M, et al.: Pharmacoeconomic analysis of nesiritide in decompensated heart failure: a multi-center study. Circulation 2003, 108:IV-556:2535.

    Google Scholar 

  17. Colonna P, Sorino M, D’Agostino C, et al.: Nonpharmacologic care of heart failure: counseling, dietary restriction, rehabilitation, treatment of sleep apnea, and ultrafiltration. Am J Cardiol 2003, 91:41F-50F. This is an informative review of nonpharmacologic care of patients with heart failure.

    Article  PubMed  Google Scholar 

  18. Jaski BE, Ha J, Denys BG, et al.: Peripherally inserted venovenous ultrafiltration for rapid treatment of volume overloaded patients. J Card Fail 2003, 9:227–231.

    Article  PubMed  Google Scholar 

  19. Agostoni PG, Marenzi GC: Sustained benefit from ultrafiltration in moderate congestive heart failure. Cardiology 2001, 96:183–189.

    Article  PubMed  CAS  Google Scholar 

  20. Krumholz HM, Chen YT, Vaccarino V, et al.: Correlates and impact on outcomes of worsening renal function in patients > or =65 years of age with heart failure. Am J Cardiol 2000, 85:1110–1113.

    Article  PubMed  CAS  Google Scholar 

  21. Gottlieb SS, Abraham W, Butler J, et al.: The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 2002, 8:136–141.

    Article  PubMed  Google Scholar 

  22. Lee SC, Stevens TL, Sandberg SM, et al.: The potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heart failure. J Card Fail 2002, 8:149–154.

    Article  PubMed  CAS  Google Scholar 

  23. Maisel A: B-type natriuretic peptide levels: a potential novel "white count" for congestive heart failure. J Card Fail 2001, 7:183–193.

    Article  PubMed  CAS  Google Scholar 

  24. Troughton RW, Frampton CM, Yandle TG, et al.: Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000, 355:1126–1130.

    Article  PubMed  CAS  Google Scholar 

  25. Amabile CM, Spencer AP: Keeping your patient with heart failure safe (a review of potentially dangerous medications). Arch Intern Med 2004, 164:709–720.

    Article  PubMed  Google Scholar 

  26. Chen HH, Redfield MM, Nordstrom LJ, et al.: Angiotensin II AT1 receptor antagonism prevents detrimental renal actions of acute diuretic therapy in human heart failure. Am J Physiol Renal Physiol 2003, 284:F1115-F1119.

    PubMed  CAS  Google Scholar 

  27. Mangrum AJ, Bakris GL: Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in chronic renal disease: safety issues. Semin Nephrol 2004, 24:168–175.

    Article  PubMed  CAS  Google Scholar 

  28. Domanski M, Norman J, Pitt B, et al.: Diuretic use, progressive heart failure, and death in patients in the Studies Of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 2003, 42:705–708. This retrospective analysis suggests that the use of potassium-sparing diuretics alone or in combination with nonpotassium-sparing diuretics is associated with decreased mortality and less hospitalizations compared with the use of nonpotassium-sparing diuretics alone in patients with heart failure.

    Article  PubMed  CAS  Google Scholar 

  29. Hernandez AF, O’Connor CM: Sparing a little may save a lot: lessons from the Studies of Left Ventricular Dysfunction (SOLVD). J Am Coll Cardiol 2003, 42:709–711.

    Article  PubMed  Google Scholar 

  30. Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999, 341:709–717.

    Article  PubMed  CAS  Google Scholar 

  31. Pitt B, Remme W, Zannad F, et al.: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003, 348:1309–1321.

    Article  PubMed  CAS  Google Scholar 

  32. Abdallah JG, Schrier RW, Edelstein C, et al.: Loop diuretic infusion increases thiazide-sensitive Na(+)/Cl(-)-cotransporter abundance: role of aldosterone. J Am Soc Nephrol 2001, 12:1335–1341.

    PubMed  CAS  Google Scholar 

  33. Mizuno O, Onishi K, Dohi K, et al.: Effects of therapeutic doses of human atrial natriuretic peptide on load and myocardial performance in patients with congestive heart failure. Am J Cardiol 2001, 88:863–866.

    Article  PubMed  CAS  Google Scholar 

  34. Kikuchi M, Nakamura M, Suzuki T, et al.: Usefulness of carperitide for the treatment of refractory heart failure due to severe acute myocardial infarction. Jpn Heart J 2001, 42:271–280.

    Article  PubMed  CAS  Google Scholar 

  35. Chen HH, Redfield MM, Nordstrom LJ, et al.: Subcutaneous administration of the cardiac hormone BNP in symptomatic human heart failure. J Card Fail 2004, 10:115–119.

    Article  PubMed  CAS  Google Scholar 

  36. Scios announces FUSION 1 study shows natrecor to be safe for use in heart failure patients in outpatient setting. http:// www.sciosinc.com/scios/pr_1064336427. Accessed April 14, 2004.

  37. Rouleau JL, Pfeffer MA, Stewart DJ, et al.: Comparison of vasopeptidase inhibitor, omapatrilat, and lisinopril on exercise tolerance and morbidity in patients with heart failure: IMPRESS randomised trial. Lancet 2000, 356:615–620.

    Article  PubMed  CAS  Google Scholar 

  38. Packer M, Califf RM, Konstam MA, et al.: Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE). Circulation 2002, 106:920–926.

    Article  PubMed  CAS  Google Scholar 

  39. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. The SOLVD Investigators. N Engl J Med 1991, 325:293-302.

  40. Gheorghiade M, Niazi I, Ouyang J, et al.: Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: results from a double-blind, randomized trial. Circulation 2003, 107:2690–2696.

    Article  PubMed  CAS  Google Scholar 

  41. Udelson JE, Smith WB, Hendrix GH, et al.: Acute hemodynamic effects of conivaptan, a dual V(1A) and V(2) vasopressin receptor antagonist, in patients with advanced heart failure. Circulation 2001, 104:2417–2423.

    PubMed  CAS  Google Scholar 

  42. Burnett JC, Costello-Boerrigter LC, Smith WB, et al.: Tolvaptan (OPC-41061), a V2 vasopressin receptor antagonist, protects against the decline in renal function observed with loop diuretic therapy. Circulation 2003, 108:IV-398:1841A.

    Google Scholar 

  43. Gheorghiade M, Gattis WA, O’Connor CM, et al.: Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA 2004, 291:1963–1971.

    Article  PubMed  CAS  Google Scholar 

  44. Thomson S, Bao D, Deng A, Vallon V: Adenosine formed by 5’-nucleotidase mediates tubuloglomerular feedback. J Clin Invest 2000, 106:289–298.

    Article  PubMed  CAS  Google Scholar 

  45. Lucas DG Jr, Hendrick JW, Sample JA, et al.: Cardiorenal effects of adenosine subtype 1 (A1) receptor inhibition in an experimental model of heart failure. J Am Coll Surg 2002, 194:603–609.

    Article  PubMed  Google Scholar 

  46. Gottlieb SS, Brater DC, Thomas I, et al.: BG9719 (CVT-124), an A1 adenosine receptor antagonist, protects against the decline in renal function observed with diuretic therapy. Circulation 2002, 105:1348–1353.

    Article  PubMed  CAS  Google Scholar 

  47. Torre-Amione G, Young JB, Colucci WS, et al.: Hemodynamic and clinical effects of tezosentan, an intravenous dual endothelin receptor antagonist, in patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 2003, 42:140–147.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    John C. Burnett Jr MD

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  1. Guido Boerrigter MD
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  2. John C. Burnett Jr MD
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Boerrigter, G., Burnett, J.C. Cardiorenal syndrome in decompensated heart failure: Prognostic and therapeutic implications. Curr Heart Fail Rep 1, 113–120 (2004). https://doi.org/10.1007/s11897-004-0020-9

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  • DOI: https://doi.org/10.1007/s11897-004-0020-9

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