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Acute cardiorenal syndrome in acute heart failure : focus on renal replacement therapy

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Abstract
Almost half of hospitalised patients with acute heart failure develop acute cardiorenal syndrome. Treatment consists of optimisation of fluid status and haemodynamics, targeted therapy for the underlying cardiac disease, optimisation of heart failure treatment and preventive measures such as avoidance of nephrotoxic agents. Renal replacement therapy may be temporarily needed to support kidney function, mostly in case of diuretic resistant fluid overload or severe metabolic derangement. The best timing to initiate renal replacement therapy and the best modality in acute heart failure are still under debate. Several modalities are available such as intermittent and continuous renal replacement therapy as well as hybrid techniques, based on two main principles: haemofiltration and haemodialysis. Although continuous techniques have been associated with less haemodynamic instability and a greater chance of renal recovery, cohort data are conflicting and randomised controlled trials have not shown a difference in recovery or mortality. In the presence of diuretic resistance, isolated ultrafiltration with individualisation of ultrafiltration rates is a valid option for decongestion in acute heart failure patients. Practical tools to optimise the use of renal replacement therapy in acute heart failure-related acute cardiorenal syndrome were discussed.
Keywords
Critical Care and Intensive Care Medicine, Cardiology and Cardiovascular Medicine, General Medicine, Acute heart failure, acute kidney injury, acute cardiorenal syndrome, renal replacement therapy, ultrafiltration, ACUTE KIDNEY INJURY, CRITICALLY-ILL PATIENTS, PERITONEAL-DIALYSIS, INTERMITTENT HEMODIALYSIS, INTRAVENOUS DIURETICS, VENOUS CONGESTION, ULTRAFILTRATION, ASSOCIATION, MODALITY, FLUID

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MLA
Schaubroeck, Hannah, et al. “Acute Cardiorenal Syndrome in Acute Heart Failure : Focus on Renal Replacement Therapy.” EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE, 2020, doi:10.1177/2048872620936371.
APA
Schaubroeck, H., Gevaert, S., Bagshaw, S. M., Kellum, J. A., & Hoste, E. (2020). Acute cardiorenal syndrome in acute heart failure : focus on renal replacement therapy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE. https://doi.org/10.1177/2048872620936371
Chicago author-date
Schaubroeck, Hannah, Sofie Gevaert, Sean M. Bagshaw, John A. Kellum, and Eric Hoste. 2020. “Acute Cardiorenal Syndrome in Acute Heart Failure : Focus on Renal Replacement Therapy.” EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE. https://doi.org/10.1177/2048872620936371.
Chicago author-date (all authors)
Schaubroeck, Hannah, Sofie Gevaert, Sean M. Bagshaw, John A. Kellum, and Eric Hoste. 2020. “Acute Cardiorenal Syndrome in Acute Heart Failure : Focus on Renal Replacement Therapy.” EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE. doi:10.1177/2048872620936371.
Vancouver
1.
Schaubroeck H, Gevaert S, Bagshaw SM, Kellum JA, Hoste E. Acute cardiorenal syndrome in acute heart failure : focus on renal replacement therapy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE. 2020;
IEEE
[1]
H. Schaubroeck, S. Gevaert, S. M. Bagshaw, J. A. Kellum, and E. Hoste, “Acute cardiorenal syndrome in acute heart failure : focus on renal replacement therapy,” EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE, 2020.
@article{8669879,
  abstract     = {Almost half of hospitalised patients with acute heart failure develop acute cardiorenal syndrome. Treatment consists of optimisation of fluid status and haemodynamics, targeted therapy for the underlying cardiac disease, optimisation of heart failure treatment and preventive measures such as avoidance of nephrotoxic agents. Renal replacement therapy may be temporarily needed to support kidney function, mostly in case of diuretic resistant fluid overload or severe metabolic derangement. The best timing to initiate renal replacement therapy and the best modality in acute heart failure are still under debate. Several modalities are available such as intermittent and continuous renal replacement therapy as well as hybrid techniques, based on two main principles: haemofiltration and haemodialysis. Although continuous techniques have been associated with less haemodynamic instability and a greater chance of renal recovery, cohort data are conflicting and randomised controlled trials have not shown a difference in recovery or mortality. In the presence of diuretic resistance, isolated ultrafiltration with individualisation of ultrafiltration rates is a valid option for decongestion in acute heart failure patients. Practical tools to optimise the use of renal replacement therapy in acute heart failure-related acute cardiorenal syndrome were discussed.},
  articleno    = {2048872620936371},
  author       = {Schaubroeck, Hannah and Gevaert, Sofie and Bagshaw, Sean M. and Kellum, John A. and Hoste, Eric},
  issn         = {2048-8726},
  journal      = {EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE},
  keywords     = {Critical Care and Intensive Care Medicine,Cardiology and Cardiovascular Medicine,General Medicine,Acute heart failure,acute kidney injury,acute cardiorenal syndrome,renal replacement therapy,ultrafiltration,ACUTE KIDNEY INJURY,CRITICALLY-ILL PATIENTS,PERITONEAL-DIALYSIS,INTERMITTENT HEMODIALYSIS,INTRAVENOUS DIURETICS,VENOUS CONGESTION,ULTRAFILTRATION,ASSOCIATION,MODALITY,FLUID},
  language     = {eng},
  title        = {Acute cardiorenal syndrome in acute heart failure : focus on renal replacement therapy},
  url          = {http://dx.doi.org/10.1177/2048872620936371},
  year         = {2020},
}

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