Cargando…
Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach
Refractory congestion is common in acute and chronic heart failure, and it significantly impacts functional class, renal function, hospital admissions, and survival. In this paper, the pathophysiological mechanisms involved in cardiorenal syndrome and the interplay between heart failure and chronic...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9304751/ https://www.ncbi.nlm.nih.gov/pubmed/35874534 http://dx.doi.org/10.3389/fphys.2022.913580 |
_version_ | 1784752161004978176 |
---|---|
author | Rodríguez-Espinosa, Diana Guzman-Bofarull, Joan De La Fuente-Mancera, Juan Carlos Maduell, Francisco Broseta, José Jesús Farrero, Marta |
author_facet | Rodríguez-Espinosa, Diana Guzman-Bofarull, Joan De La Fuente-Mancera, Juan Carlos Maduell, Francisco Broseta, José Jesús Farrero, Marta |
author_sort | Rodríguez-Espinosa, Diana |
collection | PubMed |
description | Refractory congestion is common in acute and chronic heart failure, and it significantly impacts functional class, renal function, hospital admissions, and survival. In this paper, the pathophysiological mechanisms involved in cardiorenal syndrome and the interplay between heart failure and chronic kidney disease are reviewed. Although the physical exam remains key in identifying congestion, new tools such as biomarkers or lung, vascular, and renal ultrasound are currently being used to detect subclinical forms and can potentially impact its management. Thus, an integrated multimodal diagnostic algorithm is proposed. There are several strategies for treating congestion, although data on their efficacy are scarce and have not been validated. Herein, we review the optimal use and monitorization of different diuretic types, administration route, dose titration using urinary volume and natriuresis, and a sequential diuretic scheme to achieve a multitargeted nephron blockade, common adverse events, and how to manage them. In addition, we discuss alternative strategies such as subcutaneous furosemide, hypertonic saline, and albumin infusions and the available evidence of their role in congestion management. We also discuss the use of extracorporeal therapies, such as ultrafiltration, peritoneal dialysis, or conventional hemodialysis, in patients with normal or impaired renal function. This review results from a multidisciplinary view involving both nephrologists and cardiologists. |
format | Online Article Text |
id | pubmed-9304751 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93047512022-07-23 Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach Rodríguez-Espinosa, Diana Guzman-Bofarull, Joan De La Fuente-Mancera, Juan Carlos Maduell, Francisco Broseta, José Jesús Farrero, Marta Front Physiol Physiology Refractory congestion is common in acute and chronic heart failure, and it significantly impacts functional class, renal function, hospital admissions, and survival. In this paper, the pathophysiological mechanisms involved in cardiorenal syndrome and the interplay between heart failure and chronic kidney disease are reviewed. Although the physical exam remains key in identifying congestion, new tools such as biomarkers or lung, vascular, and renal ultrasound are currently being used to detect subclinical forms and can potentially impact its management. Thus, an integrated multimodal diagnostic algorithm is proposed. There are several strategies for treating congestion, although data on their efficacy are scarce and have not been validated. Herein, we review the optimal use and monitorization of different diuretic types, administration route, dose titration using urinary volume and natriuresis, and a sequential diuretic scheme to achieve a multitargeted nephron blockade, common adverse events, and how to manage them. In addition, we discuss alternative strategies such as subcutaneous furosemide, hypertonic saline, and albumin infusions and the available evidence of their role in congestion management. We also discuss the use of extracorporeal therapies, such as ultrafiltration, peritoneal dialysis, or conventional hemodialysis, in patients with normal or impaired renal function. This review results from a multidisciplinary view involving both nephrologists and cardiologists. Frontiers Media S.A. 2022-07-08 /pmc/articles/PMC9304751/ /pubmed/35874534 http://dx.doi.org/10.3389/fphys.2022.913580 Text en Copyright © 2022 Rodríguez-Espinosa, Guzman-Bofarull, De La Fuente-Mancera, Maduell, Broseta and Farrero. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Physiology Rodríguez-Espinosa, Diana Guzman-Bofarull, Joan De La Fuente-Mancera, Juan Carlos Maduell, Francisco Broseta, José Jesús Farrero, Marta Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach |
title | Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach |
title_full | Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach |
title_fullStr | Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach |
title_full_unstemmed | Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach |
title_short | Multimodal Strategies for the Diagnosis and Management of Refractory Congestion. An Integrated Cardiorenal Approach |
title_sort | multimodal strategies for the diagnosis and management of refractory congestion. an integrated cardiorenal approach |
topic | Physiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9304751/ https://www.ncbi.nlm.nih.gov/pubmed/35874534 http://dx.doi.org/10.3389/fphys.2022.913580 |
work_keys_str_mv | AT rodriguezespinosadiana multimodalstrategiesforthediagnosisandmanagementofrefractorycongestionanintegratedcardiorenalapproach AT guzmanbofarulljoan multimodalstrategiesforthediagnosisandmanagementofrefractorycongestionanintegratedcardiorenalapproach AT delafuentemancerajuancarlos multimodalstrategiesforthediagnosisandmanagementofrefractorycongestionanintegratedcardiorenalapproach AT maduellfrancisco multimodalstrategiesforthediagnosisandmanagementofrefractorycongestionanintegratedcardiorenalapproach AT brosetajosejesus multimodalstrategiesforthediagnosisandmanagementofrefractorycongestionanintegratedcardiorenalapproach AT farreromarta multimodalstrategiesforthediagnosisandmanagementofrefractorycongestionanintegratedcardiorenalapproach |