Role of renal congestion in early diagnosis and treatment tactics of acute renal injury in patients with chronic heart failure acute decompensation
Abstract. Acute cardiorenal syndrome is a common complication of acute decompensation of chronic heart failure (ADCHF), which is associated with a high risk of acute renal injury (ARI), which worsens the prognosis and complicates therapy. The possibility of early detection of ARI and optimization of treatment using a comprehensive assessment of venous and renal congestion according to VExUS protocol and natriuresis is still remaining to be poorly understood.Andriamanueri R.T., Safarova A.F., Kobalava Zh.D.
The aim: to evaluate the clinical and prognostic role of total venous and renal congestion using the VExUS protocol in the development of AKI in patients with ADCHF, as well as their impact on diuretic-associated natriuresis.
Material and methods. The study included 155 patients with ADCHF (mean age 72 ± 12 years) hospitalized in the intensive care unit. The participants underwent Doppler ultrasonography estimation of venous congestion using VExUS protocol, and analysis of natriuresis in 2 hours after the first dose of furosemide.
Results. Venous congestion was found in all patients, from them severe grade 3 congestion – in 54.8%. ARI was diagnosed in 57% of participants, more often it was found in case of severe venous congestion (77.8 vs. 33.3 and 36.4% with mild and moderate congestion, respectively; p < 0.001). Monophasic renal blood flow was associated with the risk of ARI development (relative risk 3.61; 95% confidence interval: 1.82–7.14; p < 0.001). Urine sodium concentration < 70 mmol/L 2 h after furosemide administration was more often observed with severe venous congestion and monophasic renal blood flow. Patients with severe general and renal congestion had lower diuresis and the need for higher doses of furosemide.
Conclusion. In patients with ADCHF, severe venous congestion and significant renal blood flow impairment according to VExUS data are associated with an increased risk of ARI and reduced natriuretic response to the first dose of furosemide. A comprehensive assessment of these parameters can be used for early risk stratification and optimization of diuretic therapy.
Keywords
acute decompensation of chronic heart failure
acute kidney injury
acute cardiorenal syndrome
VExUS
natriuresis
venous congestion
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About the Authors
Robinson T. Andriamanuary, MD, postgraduate student of the Department of internal medicine with the course of cardiology and functional diagnostics named after academician V.S. Moiseyev of the Medical institute, RUDN University, cardiologist. Address: 117198, Moscow, 6 Mikloukho-Maklaya St.E-mail: robamhy@mail.ru
ORCID: http://orcid.org/0000-0003-1878-0001
Ayten F. Safarova, MD, Dr. Sci. (Medicine), professor, professor of the Department of internal medicine with the course of cardiology and functional diagnostics named after academician V.S. Moiseyev, deputy director of the Institute of clinical medicine of the Medical Institute, RUDN University. Address: 117198, Moscow, 6 Mikloukho-Maklaya St.
E-mail: aytensaf@mail.ru
ORCID: http://orcid.org/0000-0003-2412-5986
Zhanna D. Kobalava, MD, Dr. Sci. (Medicine), professor, corresponding member of RAS, head of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev, director of the Medical institute, RUDN University. Address: 117198, Moscow, 6 Mikloukho-Maklaya St.
E-mail: zkobalava@mail.ru
ORCID: https://orcid.org/0000-0002-5873-1768. Scopus ID: 7004399203. eLibrary SPIN: 9828-5409
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