title: Renal function in advanced heart failure.
abstract: Despite recent advances with neurohormonal antagonists and devices, the prognosis of patients with advanced heart failure (HF) remains grave. Renal dysfunction is a common comorbid condition in HF and is associated with adverse outcomes. Current evidence indicates that intrinsic renal disease and inflammation in HF makes the kidney susceptible to hemodynamic compromise and congestion and contributes to a great extent to the development of renal dysfunction. Relief of congestion requires combination treatment with diuretics, neurohormonal antagonists, and occasionally vasodilators as well as inotropes. However, high doses of diuretics may accelerate the development of renal dysfunction by increasing neurohumoral activity and inducing renal structural and functional changes. Ultrafiltration should be reserved for patients with true diuretic resistance. Finally, early identification of the "patient at risk" remains a challenging issue and is limited by the currently used conventional parameters of renal function. However, novel biomarkers of acute kidney ischemia and/or injury are emerging and promise to become a diagnostic option for this patient population.
authors.affiliation: Department of Cardiology, Larissa University Hospital, Greece.
authors.forename: Gregory
authors.initials: G
authors.lastname: Giamouzis
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Filippos
authors.initials: F
authors.lastname: Triposkiadis
mesh_terms: D015415:Biomarkers / Q000032:analysis; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D018377:Neurotransmitter Agents / Q000037:antagonists & inhibitors; D015995:Prevalence; D051437:Renal Insufficiency / Q000453:epidemiology; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D018377:Neurotransmitter Agents; D049993:Sodium Chloride Symporter Inhibitors; D049994:Sodium Potassium Chloride Symporter Inhibitors; D003404:Creatinine