Chronic kidney disease and its worsening are recurring conditions in chronic heart failure(CHF) which are independently associated with poor patient outcome.The heart and kidney share many pathophysiological mechanism...Chronic kidney disease and its worsening are recurring conditions in chronic heart failure(CHF) which are independently associated with poor patient outcome.The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index(a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction.展开更多
The evidence base for the use of diuretics in acute heart failure is limited, with no large double-blind placebo-controlled randomized trials. However, their use as a first line treatment of acute heart failure is fir...The evidence base for the use of diuretics in acute heart failure is limited, with no large double-blind placebo-controlled randomized trials. However, their use as a first line treatment of acute heart failure is firmly established in clinical practice, and endorsed in clinical guidelines. Loop diuretics are typically the first line diuretic strategy for the treatment of acute heart failure. For patients with considerable fluid retention, there is some evidence that initial treatment with continuous infusion or boluses of high dose loop diuretic is superior to an initial lower dose strategy. In patients who are diuretic resistant, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. Intravenous low-dose dopamine has also been used to assist diuresis and preserve renal function in such circumstances, but trials are underway to confirm the clinical value of this agent. Mechanical ultrafiltration has been used to treat patients with heart failure and fluid retention, but the evidence base is not secure, and its place in clinical practice is yet to be established.展开更多
Heart failure and kidney disease share common pathophysiological pathways which can lead to mutual dysfunction,known as cardiorenal syndrome.In heart failure patients,renal impairment is related to hemodynamic and non...Heart failure and kidney disease share common pathophysiological pathways which can lead to mutual dysfunction,known as cardiorenal syndrome.In heart failure patients,renal impairment is related to hemodynamic and nonhemodynamic factors.Both decreased renal blood flow and renal venous congestion due to heart failure could lead to impaired renal function.Kidney disease and worsening renal function are independently associated with poor prognosis in heart failure patients,both in acute and chronic clinical settings.The aim of this review is to assess the role of renal imaging modalities in the evaluation and management of heart failure patients.Renal imaging techniques could complete laboratory data,as estimated glomerular filtration rate,exploring different pathophysiological factors involved in kidney disease and adding valuable information about renal structure and function.In particular,Doppler examination of arterial and venous hemodynamics is a feasible and non invasive technique,which has proven to be a reliable method for prognostic stratification in patients with cardiorenal syndrome.The renal resistance index,a measure related to renal hemodynamics,can be calculated from the Doppler evaluation of arterial flow.Moreover,the analysis of Doppler venous flow patterns can integrate information from the arterial study and evaluate renal congestion.Other imaging modalities are promising,but still confined to research purposes.展开更多
<strong>Background:</strong> Chronic kidney disease (CKD) is a worldwide public health alarming problem. Although both heart and kidneys are separated by a quite distance within the body and they perform v...<strong>Background:</strong> Chronic kidney disease (CKD) is a worldwide public health alarming problem. Although both heart and kidneys are separated by a quite distance within the body and they perform varied functions, there is a close physiological relationship between them. The diseases in the kidneys can trigger a disease in the heart and vice versa. High blood pressure is the most significant risk factor for the development and progression of chronic kidney disease (CKD). Lowering blood pressure is a goal to prevent CKD progress. Chronic abnormalities in cardiac function (e.g., chronic congestive heart failure) causing, chronic kidney disease and anemia appear to act together in a vicious circle in which each condition causes or exacerbates the other progressive chronic kidney disease. <strong>Objective:</strong> To assess the prevalence of chronic kidney disease in patients with cardiovascular disease at Shebin El-Kom Teaching Hospital and Menoufia University Hospital Cardiology Outpatient Clinic, Menoufia Governorate, Egypt. <strong>Methods:</strong> This is a cross-sectional study that was conducted in Shebin El-Kom Teaching Hospital Cardiology Outpatient Clinic, Menoufia University Cardiology Outpatient Clinic from April 2019 to July 2019. This study included 200 patients with cardiovascular disease or hypertension for more than 6 months. All patients were subjected to detailed history taking, clinical examination, laboratory investigation, echo and abdominal ultrasound. <strong>Results:</strong> This study included 200 patients with cardiovascular disease or hypertension for more than 6 months, which showed that: 63 (31.5%) were diagnosed as chronic kidney disease, 24 (38%) known to be CKD, 39 (62%) not known diagnosed in our study. Uncontrolled hypertension, congestive heart failure, diuretics and ACEI or ARBS with diuretics together are significant risk factors for renal impairment;uncontrolled hypertension and diuretics are the most predictors for renal impairment. <strong>Conclusion:</strong> Uncontrolled hypertension is the most preventable cause of renal impairment;RAAS not cause renal impairment but lead to decreased GFR in CKD patients. We should be careful with ACEI or ARBS with diuretics or diuretics only and control congestive heart disease to avoid kidney injury and chronic cardiorenal.展开更多
OBJECTIVE:To test the effects of Zhuling decoction(猪苓汤)on patients with diuretic resistance in heart failure compared with a group of patients undergoing conventional treatment alone.METHODS:This research was a pro...OBJECTIVE:To test the effects of Zhuling decoction(猪苓汤)on patients with diuretic resistance in heart failure compared with a group of patients undergoing conventional treatment alone.METHODS:This research was a prospective,randomized,controlled study.From July 2018 to August 2020,96 diuretic resistance patients from the Cardiovascular Research Center of Taicang Hospital affiliated with Nanjing University of Traditional Chinese Medicine(GradeⅢHospital of Traditional Chinese Medicine)were enrolled in the study.The subjects were randomly divided into an observation group(48 cases)and a control group(48 cases).Patients in both groups received conventional treatment.In addition,observation group patients received Traditional Chinese Medicine Zhuling decoction.The primary endpoint was the urine output mean difference between Day 1 and Day 7 after treatment.Secondary endpoints were the changes over time in the N-terminal pro-B type natriuretic peptide(NTproBNP),New York Heart Association(NYHA)functional classification,and Minnesota Living with Heart Failure Questionnaire(MLHFQ).The safety and tolerability of the drug were comprehensively evaluated based on adverse drug reactions,as well as laboratory-assisted tests for liver and kidney function and electrolytes.RESULTS:Significant improvements were demonstrated for urine output in the two groups at Day 7,with a 1325 vs 1045 mL difference in favor of the observation group(P=0.018).The observation group also had greater improvements in NT-proBNP and NYHA functional classification changes than the control group.At the 30 th day of follow-up,a significant reduction in negative findings on the MLHFQ from baseline was observed in both groups,but the observation group demonstrated a significantly greater reduction than the control group(P<0.001).CONCLUSIONS:Zhuling decoction could be used in combination therapy for patients with diuretic resistance in heart failure in addition to standard treatment.展开更多
Background Studies have shown that increased levels of serum uric acid （SUA） are associated with atrial fibrillation （AF）. However, less is known about the prognostic value of SUA levels for AF in patients with ch...Background Studies have shown that increased levels of serum uric acid （SUA） are associated with atrial fibrillation （AF）. However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure （CHF）. The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF. Methods Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients＇ medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic （ROC） curves. Results The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level （HR, 1.084; 95% CI, 1.017-1.144; P 〈0.001）, diuretics （HR, 1.549; 95% CI, 1.246-1.854; P 〈0.001）, and New York Heart Association （NYHA） （HR, 1.237; 95% CI, 1.168-1.306; P 〈0.001） function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant （Wald Z2, 1494.88; P 〈0.001 for AF）; 58.8% （95% CI, 57.7%-60.0%） of the observed results were concordant with the separate model. Conclusion Higher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.展开更多
文摘Chronic kidney disease and its worsening are recurring conditions in chronic heart failure(CHF) which are independently associated with poor patient outcome.The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index(a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction.
文摘The evidence base for the use of diuretics in acute heart failure is limited, with no large double-blind placebo-controlled randomized trials. However, their use as a first line treatment of acute heart failure is firmly established in clinical practice, and endorsed in clinical guidelines. Loop diuretics are typically the first line diuretic strategy for the treatment of acute heart failure. For patients with considerable fluid retention, there is some evidence that initial treatment with continuous infusion or boluses of high dose loop diuretic is superior to an initial lower dose strategy. In patients who are diuretic resistant, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. Intravenous low-dose dopamine has also been used to assist diuresis and preserve renal function in such circumstances, but trials are underway to confirm the clinical value of this agent. Mechanical ultrafiltration has been used to treat patients with heart failure and fluid retention, but the evidence base is not secure, and its place in clinical practice is yet to be established.
文摘Heart failure and kidney disease share common pathophysiological pathways which can lead to mutual dysfunction,known as cardiorenal syndrome.In heart failure patients,renal impairment is related to hemodynamic and nonhemodynamic factors.Both decreased renal blood flow and renal venous congestion due to heart failure could lead to impaired renal function.Kidney disease and worsening renal function are independently associated with poor prognosis in heart failure patients,both in acute and chronic clinical settings.The aim of this review is to assess the role of renal imaging modalities in the evaluation and management of heart failure patients.Renal imaging techniques could complete laboratory data,as estimated glomerular filtration rate,exploring different pathophysiological factors involved in kidney disease and adding valuable information about renal structure and function.In particular,Doppler examination of arterial and venous hemodynamics is a feasible and non invasive technique,which has proven to be a reliable method for prognostic stratification in patients with cardiorenal syndrome.The renal resistance index,a measure related to renal hemodynamics,can be calculated from the Doppler evaluation of arterial flow.Moreover,the analysis of Doppler venous flow patterns can integrate information from the arterial study and evaluate renal congestion.Other imaging modalities are promising,but still confined to research purposes.
文摘<strong>Background:</strong> Chronic kidney disease (CKD) is a worldwide public health alarming problem. Although both heart and kidneys are separated by a quite distance within the body and they perform varied functions, there is a close physiological relationship between them. The diseases in the kidneys can trigger a disease in the heart and vice versa. High blood pressure is the most significant risk factor for the development and progression of chronic kidney disease (CKD). Lowering blood pressure is a goal to prevent CKD progress. Chronic abnormalities in cardiac function (e.g., chronic congestive heart failure) causing, chronic kidney disease and anemia appear to act together in a vicious circle in which each condition causes or exacerbates the other progressive chronic kidney disease. <strong>Objective:</strong> To assess the prevalence of chronic kidney disease in patients with cardiovascular disease at Shebin El-Kom Teaching Hospital and Menoufia University Hospital Cardiology Outpatient Clinic, Menoufia Governorate, Egypt. <strong>Methods:</strong> This is a cross-sectional study that was conducted in Shebin El-Kom Teaching Hospital Cardiology Outpatient Clinic, Menoufia University Cardiology Outpatient Clinic from April 2019 to July 2019. This study included 200 patients with cardiovascular disease or hypertension for more than 6 months. All patients were subjected to detailed history taking, clinical examination, laboratory investigation, echo and abdominal ultrasound. <strong>Results:</strong> This study included 200 patients with cardiovascular disease or hypertension for more than 6 months, which showed that: 63 (31.5%) were diagnosed as chronic kidney disease, 24 (38%) known to be CKD, 39 (62%) not known diagnosed in our study. Uncontrolled hypertension, congestive heart failure, diuretics and ACEI or ARBS with diuretics together are significant risk factors for renal impairment;uncontrolled hypertension and diuretics are the most predictors for renal impairment. <strong>Conclusion:</strong> Uncontrolled hypertension is the most preventable cause of renal impairment;RAAS not cause renal impairment but lead to decreased GFR in CKD patients. We should be careful with ACEI or ARBS with diuretics or diuretics only and control congestive heart disease to avoid kidney injury and chronic cardiorenal.
基金Supported by the 2019 Suzhou(Taicang)Science and Technology Development Plan(the fourth batch of basic research on people’s livelihood,science and technology,and medical and health applications).Project name:Applied research on diuretic resistance of Zhuling decoction.Project number:SYSD2019201,TC2019JCYL13
文摘OBJECTIVE:To test the effects of Zhuling decoction(猪苓汤)on patients with diuretic resistance in heart failure compared with a group of patients undergoing conventional treatment alone.METHODS:This research was a prospective,randomized,controlled study.From July 2018 to August 2020,96 diuretic resistance patients from the Cardiovascular Research Center of Taicang Hospital affiliated with Nanjing University of Traditional Chinese Medicine(GradeⅢHospital of Traditional Chinese Medicine)were enrolled in the study.The subjects were randomly divided into an observation group(48 cases)and a control group(48 cases).Patients in both groups received conventional treatment.In addition,observation group patients received Traditional Chinese Medicine Zhuling decoction.The primary endpoint was the urine output mean difference between Day 1 and Day 7 after treatment.Secondary endpoints were the changes over time in the N-terminal pro-B type natriuretic peptide(NTproBNP),New York Heart Association(NYHA)functional classification,and Minnesota Living with Heart Failure Questionnaire(MLHFQ).The safety and tolerability of the drug were comprehensively evaluated based on adverse drug reactions,as well as laboratory-assisted tests for liver and kidney function and electrolytes.RESULTS:Significant improvements were demonstrated for urine output in the two groups at Day 7,with a 1325 vs 1045 mL difference in favor of the observation group(P=0.018).The observation group also had greater improvements in NT-proBNP and NYHA functional classification changes than the control group.At the 30 th day of follow-up,a significant reduction in negative findings on the MLHFQ from baseline was observed in both groups,but the observation group demonstrated a significantly greater reduction than the control group(P<0.001).CONCLUSIONS:Zhuling decoction could be used in combination therapy for patients with diuretic resistance in heart failure in addition to standard treatment.
文摘Background Studies have shown that increased levels of serum uric acid （SUA） are associated with atrial fibrillation （AF）. However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure （CHF）. The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF. Methods Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients＇ medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic （ROC） curves. Results The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level （HR, 1.084; 95% CI, 1.017-1.144; P 〈0.001）, diuretics （HR, 1.549; 95% CI, 1.246-1.854; P 〈0.001）, and New York Heart Association （NYHA） （HR, 1.237; 95% CI, 1.168-1.306; P 〈0.001） function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant （Wald Z2, 1494.88; P 〈0.001 for AF）; 58.8% （95% CI, 57.7%-60.0%） of the observed results were concordant with the separate model. Conclusion Higher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.
