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...

Descripción completa

Detalles Bibliográficos
Autores principales: Rodríguez-Espinosa, Diana, Guzman-Bofarull, Joan, De La Fuente-Mancera, Juan Carlos, Maduell, Francisco, Broseta, José Jesús, Farrero, Marta
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