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Loop diuretic, heart failure

Leo F Buckley, Enrique Seoane-Vazquez, Judy W M Cheng, Ahmed Aldemerdash, Irene M Cooper, Lina Matta, Danika S Medina, Mandeep R Mehra, Kristina Navarro-Velez, Elaine L Shea, Joanne R Weintraub, Lynne W Stevenson, Akshay S Desai
Innovative treatment strategies for decompensated heart failure (HF) are required to achieve cost savings and improvements in outcomes. We developed a decision analytic model from a hospital perspective to compare 2 strategies for the treatment of decompensated HF, ambulatory diuretic infusion therapy, and hospitalization (standard care), with respect to total HF hospitalizations and costs. The ambulatory diuretic therapy strategy included outpatient treatment with high doses of intravenous loop diuretics in a specialized HF unit whereas standard care included hospitalization for intravenous loop diuretic therapy...
November 1, 2016: American Journal of Cardiology
Matthew Weir, Martha Mayo, Dahlia Garza, Susan Arthur, Lance Berman, David Bushinsky, Daniel Wilson, Murray Epstein
OBJECTIVE: Diuretics, alone or in combination, are frequently prescribed in chronic kidney disease (CKD) and heart failure (HF) patients to reduce volume, blood pressure, and/or for symptom control. Clinicians may also use them to reduce the risk of hyperkalemia, but high doses of diuretics may lead to adverse events from intravascular volume depletion or gout. Patiromer is a non-absorbed K-binding polymer recently approved by the FDA for the treatment of hyperkalemia (HK). We compared patiromer's effects in RAASi-treated CKD patients with HK on different types of diuretics to patients not receiving diuretics in the treatment phase of OPAL-HK...
September 2016: Journal of Hypertension
Carolina López, Andrés José Alcaraz, Blanca Toledo, Lucía Cortejoso, Maite Augusta Gil-Ruiz
OBJECTIVE: Patients in PICUs frequently present hypochloremic metabolic alkalosis secondary to loop diuretic treatment, especially those undergoing cardiac surgery. This study evaluates the effectiveness of acetazolamide therapy for metabolic alkalosis in PICU patients. DESIGN: Retrospective, observational study. SETTING: A tertiary care children's hospital PICU. PATIENTS: Children receiving at least a 2-day course of enteral acetazolamide...
September 29, 2016: Pediatric Critical Care Medicine
Sarah Hoss, Yair Elizur, David Luria, Andre Keren, Chaim Lotan, Israel Gotsman
Potassium levels are often abnormal in patients with heart failure (HF) and have a detrimental effect on clinical outcome. We evaluated potassium levels in a real-world cohort of patients with HF and its effect on mortality. All patients with a diagnosis of HF at a health maintenance organization were evaluated and followed for cardiac-related hospitalizations and death. The cohort consisted of 6,073 patients with HF. Mean potassium levels were 4.57 ± 0.53 mmol/L. Most patients (68%) had potassium levels in the normal range (4...
September 15, 2016: American Journal of Cardiology
Saul Blecker, Stuart D Katz, Leora I Horwitz, Gilad Kuperman, Hannah Park, Alex Gold, David Sontag
Importance: Accurate, real-time case identification is needed to target interventions to improve quality and outcomes for hospitalized patients with heart failure. Problem lists may be useful for case identification but are often inaccurate or incomplete. Machine-learning approaches may improve accuracy of identification but can be limited by complexity of implementation. Objective: To develop algorithms that use readily available clinical data to identify patients with heart failure while in the hospital...
October 5, 2016: JAMA Cardiology
Renato De Vecchis, Claudio Cantatrione, Damiana Mazzei, Cesare Baldi
In the congestive heart failure (CHF) setting, chronic hyponatremia is very common. The present review aims at addressing topics relevant to the pathophysiology of hyponatremia in the course of CHF as well as its optimal treatment, including the main advantages and the limitations resulting from the use of the available dietary and pharmacological measures approved for the treatment of this electrolytic trouble. A narrative review is carried out in order to represent the main modalities of therapy for chronic hyponatremia that frequently complicates CHF...
October 2, 2016: Journal of Clinical Medicine
Anca Simioniuc, Erberto Carluccio, Stefano Ghio, Andrea Rossi, Paolo Biagioli, Gianpaolo Reboldi, Gian Giacomo Galeotti, Fei Lu, Cornelia Zara, Gillian Whalley, Pier Luigi Temporelli, Frank Lloyd Dini
BACKGROUND: B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. METHODS AND RESULTS: In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF=30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF=33%)...
September 18, 2016: International Journal of Cardiology
Mayank K Mittal, Natraj Katta, Martin A Alpert
Chronic congestive heart failure (CHF) and acute decompensated heart failure (ADHF) refractory to medical therapy represent therapeutic challenges. In such patients, attempts to reduce pulmonary and systemic congestion frequently produce deterioration of renal function. In studies of patients with chronic severe CHF refractory to medical therapy (including loop diuretics), isolated ultrafiltration was frequently able to relieve congestive symptoms by precise removal of extracellular water and sodium, and in some cases was able to restore responsiveness to loop diuretics...
October 2016: Hemodialysis International
Chan Joon Kim, Ik-Jun Choi, Hun-Jun Park, Tae Hoon Kim, Pum-Joon Kim, Kiyuk Chang, Sang Hong Baek, Wook Sung Chung, Ki-Bae Seung
BACKGROUND: Dysfunctional interplay between the heart and kidneys may lead to the development of anemia. The aim of this study was to evaluate the impact of cardiorenal anemia syndrome (CRAS) on short- and long-term outcomes among patients hospitalized with heart failure (HF). METHODS: We enrolled 303 patients hospitalized with HF. We divided the patients into two groups: a CRAS group (n = 64) and a non-CRAS group (n = 239). We defined CRAS as HF accompanied by (1) an estimated glomerular filtration rate <60 ml/min/1...
August 2016: Cardiorenal Medicine
Matthew Weir, Martha Mayo, Dahlia Garza, Susan Arthur, Lance Berman, David Bushinsky, Daniel Wilson, Murray Epstein
OBJECTIVE: Diuretics, alone or in combination, are frequently prescribed in chronic kidney disease (CKD) and heart failure (HF) patients to reduce volume, blood pressure, and/or for symptom control. Clinicians may also use them to reduce the risk of hyperkalemia, but high doses of diuretics may lead to adverse events from intravascular volume depletion or gout. Patiromer is a non-absorbed K-binding polymer recently approved by the FDA for the treatment of hyperkalemia (HK). We compared patiromer's effects in RAASi-treated CKD patients with HK on different types of diuretics to patients not receiving diuretics in the treatment phase of OPAL-HK...
September 2016: Journal of Hypertension
Genjiro Kimura
Primarily, the sodium-glucose cotransporter 2 (SGLT2) inhibitors suppress the cotransport of glucose and sodium from the tubular lumen of the proximal tubules to the blood, and excrete glucose into the urine. Therefore, glucose and caloric balances become negative, reducing both the blood glucose level and insulin secretion. On the other hand, the proximal tubular fluid, constituted with low chloride concentration because of SGLT2 inhibition, is transferred to the loop of Henle. Under low chloride conditions, the reabsorption mechanisms in the loop of Henle do not work, similar to when loop diuretics are given...
September 7, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Javed Butler, Adrian F Hernandez, Kevin J Anstrom, Andreas Kalogeropoulos, Margaret M Redfield, Marvin A Konstam, W H Wilson Tang, G Michael Felker, Monica R Shah, Eugene Braunwald
Although therapy with mineralocorticoid receptor antagonists (MRAs) is recommended for patients with chronic heart failure (HF) with reduced ejection fraction and in post-infarction HF, it has not been studied well in acute HF (AHF) despite being commonly used in this setting. At high doses, MRA therapy in AHF may relieve congestion through its natriuretic properties and mitigate the effects of adverse neurohormonal activation associated with intravenous loop diuretics. The ATHENA-HF (Aldosterone Targeted Neurohormonal Combined with Natriuresis Therapy in Heart Failure) trial is a randomized, double-blind, placebo-controlled study of the safety and efficacy of 100 mg/day spironolactone versus placebo (or continued low-dose spironolactone use in participants who are already receiving spironolactone at baseline) in 360 patients hospitalized for AHF...
September 2016: JACC. Heart Failure
Julio Núñez, Pau Llàcer, Vicente Bertomeu-González, Maria José Bosch, Pilar Merlos, Sergio García-Blas, Vicente Montagud, Vicent Bodí, Vicente Bertomeu-Martínez, Valle Pedrosa, Andrea Mendizábal, Alberto Cordero, Jorge Gallego, Patricia Palau, Gema Miñana, Enrique Santas, Salvador Morell, Angel Llàcer, Francisco J Chorro, Juan Sanchis, Lorenzo Fácila
OBJECTIVES: The study sought to evaluate the prognostic effect of carbohydrate antigen 125 (CA125)-guided therapy (CA125 strategy) versus standard of care (SOC) after a hospitalization for acute heart failure (AHF). BACKGROUND: CA125 has emerged as a surrogate of fluid overload and inflammatory status in AHF. After an episode of AHF admission, elevated values of this marker at baseline as well as its longitudinal profile relate to adverse outcomes, making it a potential tool for treatment guiding...
August 1, 2016: JACC. Heart Failure
T Deborde, L Amar, G Bobrie, A Burgun, G Chatellier, P-F Plouin, M Azizi, A Jannot
OBJECTIVE: Patients attending for the first time to a tertiary hypertension unit represent a sample of the general population of hypertensive patients from a region. Even though it is a biased sample, the longitudinal analysis with time of the data of these patients represents in part real life data and may show trends in adherence to guidelines by their primary care physicians and by patients themselves. Our tertiary hypertension unit has a computerized medical record with more than hundred structured items recorded at each visit...
September 2016: Journal of Hypertension
P Talarowska, A Segiet, M Rozanska, O Mozenska, D A Kosior
OBJECTIVE: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Individuals with OSA are at increased risk of cardiovascular diseases such as arterial hypertension (HTN), heart failure, stroke and pulmonary hypertension. Detailed data regarding hypotensive therapy and its effectiveness in patients with HTN and OSA are lacking. The aim of the study was to characterize in details hypotensive therapy in patients with HTN and OSA. DESIGN AND METHOD: We retrospectively analyzed 1270 patients who were treated in our outpatient sleep apnea clinic...
September 2016: Journal of Hypertension
Jennifer S Hanberg, Veena Rao, Jozine M Ter Maaten, Olga Laur, Meredith A Brisco, F Perry Wilson, Justin L Grodin, Mahlet Assefa, J Samuel Broughton, Noah J Planavsky, Tariq Ahmad, Lavanya Bellumkonda, W H Wilson Tang, Chirag R Parikh, Jeffrey M Testani
BACKGROUND: Recent epidemiological studies have implicated chloride, rather than sodium, as the driver of poor survival previously attributed to hyponatremia in heart failure. Accumulating basic science evidence has identified chloride as a critical factor in renal salt sensing. Our goal was to probe the physiology bridging this basic and epidemiological literature. METHODS AND RESULTS: Two heart failure cohorts were included: (1) observational: patients receiving loop diuretics at the Yale Transitional Care Center (N=162) and (2) interventional pilot: stable outpatients receiving ≥80 mg furosemide equivalents were studied before and after 3 days of 115 mmol/d supplemental lysine chloride (N=10)...
August 2016: Circulation. Heart Failure
Brandi N Bowman, James J Nawarskas, Joe R Anderson
Loop diuretics are central to the management of fluid overload in acute decompensated heart failure. However, a variance in the response to loop diuretics can alter a patient's clinical course and has an adverse effect on clinical outcomes. Thus, a diminished response to loop diuretics is an important clinical issue. Factors thought to contribute to diuretic resistance include erratic oral absorption in congested states and postdiuretic sodium retention. Further contributing to diuretic resistance in patients with advanced heart failure are decreases in renal perfusion and alterations in sodium handling that occur in an attempt to maintain circulatory homeostasis...
September 2016: Cardiology in Review
Jasper Tromp, Sven Meyer, Robert J Mentz, Christopher M O'Connor, Marco Metra, Howard C Dittrich, Piotr Ponikowski, John R Teerlink, Gad Cotter, Beth Davison, John G F Cleland, Michael M Givertz, Daniel M Bloomfield, Dirk J van Veldhuisen, Hans L Hillege, Adriaan A Voors, Peter van der Meer
BACKGROUND: Young patients (<50years) exhibit specific characteristics in chronic heart failure (HF), but their phenotype in acute heart failure (AHF) is not well described. METHODS AND RESULTS: 2033 patients of the PROTECT trial were divided into two groups: young patients (≤50years) and older patients (>50years). Biomarkers from different pathophysiological domains were available in 1266 patients. Patients were compared with regard to clinical characteristics, biomarker profiles, and in-hospital (worsening renal function [WRF] and decongestion) and post-discharge (180-day survival) outcome...
October 15, 2016: International Journal of Cardiology
Haifeng Tang, Yuping Zhu, Nardos Teumelsan, Shawn P Walsh, Aurash Shahripour, Birgit T Priest, Andrew M Swensen, John P Felix, Richard M Brochu, Timothy Bailey, Brande Thomas-Fowlkes, Lee-Yuh Pai, Caryn Hampton, Aaron Corona, Melba Hernandez, Joseph Metzger, Michael Forrest, Xiaoyan Zhou, Karen Owens, Vincent Tong, Emma Parmee, Sophie Roy, Gregory J Kaczorowski, Lihu Yang, Magdalena Alonso-Galicia, Maria L Garcia, Alexander Pasternak
ROMK, the renal outer medullary potassium channel, is involved in potassium recycling at the thick ascending loop of Henle and potassium secretion at the cortical collecting duct in the kidney nephron. Because of this dual site of action, selective inhibitors of ROMK are expected to represent a new class of diuretics/natriuretics with superior efficacy and reduced urinary loss of potassium compared to standard-of-care loop and thiazide diuretics. Following our earlier work, this communication will detail subsequent medicinal chemistry endeavors to further improve lead selectivity against the hERG channel and preclinical pharmacokinetic properties...
July 14, 2016: ACS Medicinal Chemistry Letters
Javier Díez, Luis M Ruilope
Acute heart failure (AHF) is a complex clinical syndrome characterized by fluid overload and haemodynamic abnormalities (short-term clinical consequences) and the development of end-organ damage (long-term consequences). Current therapies for the treatment of AHF, such as loop diuretics and vasodilators, help to relieve haemodynamic imbalance and congestion, but have not been shown to prevent (and may even contribute to) end-organ damage, or to provide long-term clinical benefit. Serelaxin is the recombinant form of human relaxin-2, a naturally occurring hormone involved in mediating haemodynamic changes during pregnancy...
April 2016: European Heart Journal. Cardiovascular Pharmacotherapy
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