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Association of haemodynamic changes measured by serial central venous saturation during ultrafiltration for acutely decompensated heart failure with diuretic resistance and change in renal function.

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Title: Association of haemodynamic changes measured by serial central venous saturation during ultrafiltration for acutely decompensated heart failure with diuretic resistance and change in renal function.
Authors: Vazir, A
Simpkin, VL
Marino, P
Ludman, A
Banya, W
Tavazzi, G
Bastin, AJ
Trenfield, S
Ghori, A
Alexander, PD
Griffiths, M
Price, S
Sharma, R
Cowie, MR
Item Type: Journal Article
Abstract: BACKGROUND: Patients with acute decompensated heart failure with diuretic resistance (ADHF-DR) have a poor prognosis. The aim of this study was to assess in patients with ADHF-DR, whether haemodynamic changes during ultrafiltration (UF) are associated with changes in renal function (Δcreatinine) and whether Δcreatinine post UF is associated with mortality. METHODS: Seventeen patients with ADHF-DR underwent 20 treatments with UF. Serial bloods (4-6 hourly) from the onset of UF treatment were measured for renal function, electrolytes and central venous saturation (CVO2). Univariate and multivariate analysis were performed to assess the relationship between changes in markers of haemodynamics [heart rate (HR), systolic blood pressure (SBP), packed cell volume (PCV) and CVO2] and Δcreatinine. Patients were followed up and mortality recorded. Cox-regression survival analysis was performed to determine covariates associated with mortality. RESULTS: Renal function worsened after UF in 17 of the 20 UF treatments (baseline vs. post UF creatinine: 164±58 vs. 185±69μmol/l, P<0.01). ΔCVO2 was significantly associated with Δcreatinine [β-coefficient of -1.3 95%CI (-1.8 to -0.7), P<0.001] and remained significantly associated with Δcreatinine after considering changes in SBP, HR and PCV [P<0.001]. Ten (59%) patients died at 1-year and 15(88%) by 2-years. Δcreatinine was independently associated with mortality (adjusted-hazard ratio 1.03 (1.01 to 1.07) per 1μmol/l increase in creatinine; P=0.02). CONCLUSIONS: Haemodynamic changes during UF as measured by the surrogate of cardiac output was associated with Δcreatinine. Worsening renal function at end of UF treatment occurred in the majority of patients and was associated with mortality.
Issue Date: 28-Jun-2016
Date of Acceptance: 24-Jun-2016
URI: http://hdl.handle.net/10044/1/43466
DOI: 10.1016/j.ijcard.2016.06.186
ISSN: 1874-1754
Publisher: Elsevier
Start Page: 618
End Page: 622
Journal / Book Title: International Journal of Cardiology
Volume: 220
Copyright Statement: © 2016 Published by Elsevier Ireland Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: Imperial College Trust
Funder's Grant Number: N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Heart failure
Ultrafiltration
Worsening renal function
Central venous saturation
OXYGEN-SATURATION
MORTALITY
TRIAL
Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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