Contemporary trends in the pharmacological and extracorporeal management of heart failure: a nephrologic perspective.
Heart failure and chronic kidney disease share a number of risk factors and pathophysiological pathways. These 2 pathological processes coexist in large numbers of patients. Whereas the presence of chronic kidney disease in patients with heart failure adversely influences their survival, cardiovascular disease is the major cause of mortality in individuals with chronic kidney disease. The management of heart failure by cardiologists has recently expanded from pharmacological treatment to extracorporeal strategies; the interaction between (and concurrent use of) these approaches traditionally has been part of nephrology care and training. The purpose of this review is to explore these management strategies from a nephrologic standpoint and cover the pathophysiology of diuretic resistance, new pharmaceutical strategies to induce natriuresis or aquaresis, and the physiological basis and theoretical advantages of fluid removal by nontraditional peritoneal or hemofiltration approaches. This review also focuses on the technical features, safety, and potential risks of dedicated ultrafiltration devices that do not require dialysis staff or facilities and that are now readily available to nonnephrologists.
Kazory
Amir
A
Division of Nephrology, Hypertension, and Transplantation, University of Florida, Gainesville, FL 32610-0224, USA.
Ross
Edward A
EA
D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology; D065092:Antidiuretic Hormone Receptor Antagonists; D002908:Chronic Disease; D015897:Comorbidity; D019468:Disease Management; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007668:Kidney / Q000187:drug effects; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D045265:Natriuretic Peptides / Q000627:therapeutic use; D010530:Peritoneal Dialysis / Q000379:methods; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D017582:Renal Replacement Therapy; D014462:Ultrafiltration / Q000379:methods; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000628:therapy
D065092:Antidiuretic Hormone Receptor Antagonists; D004232:Diuretics; D006454:Hemoglobins; D045265:Natriuretic Peptides