Optimizing fluid management in patients with acute decompensated heart failure ADHF: the emerging role of combined measurement of body hydration status and brain natriuretic peptide BNP levelsReportar como inadecuado




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Heart Failure Reviews

, Volume 16, Issue 6, pp 519–529

First Online: 22 May 2011

Abstract

The study tests the hypothesis that in patients admitted with acutely decompensated heart failure ADHF, achievement of adequate body hydration status with intensive medical therapy, modulated by combined bioelectrical vectorial impedance analysis BIVA and B-type natriuretic peptide BNP measurement, may contribute to optimize the timing of patient’s discharge and to improve clinical outcomes. Three hundred patients admitted for ADHF underwent serial BIVA and BNP measurement. Therapy was titrated to reach a BNP value of <250 pg-ml, whenever possible. Patients were categorized as early responders rapid BNP fall below 250 pg-ml; late responders slow BNP fall below 250 pg-ml, after aggressive therapy; and non-responders BNP persistently >250 pg-ml. Worsening of renal function WRF was evaluated during hospitalization. Death and rehospitalization were monitored with a 6-month follow-up. BNP value on discharge of ≤250 pg-ml led to a 25% event rate within 6 months Group A: 17.4%; Group B: 21%, Chi2; n.s., whereas a value >250 pg-ml Group C was associated with a far higher percentage 37%. At discharge, body hydration was 73.8 ± 3.2% in the total population and 73.2 ± 2.1, 73.5 ± 2.8, 74.1 ± 3.6% in the three groups, respectively. WRF was observed in 22.3% of the total. WRF occurred in 22% in Group A, 32% in Group B, and 20% in Group C P = n.s

Our study confirms the hypothesis that combined BNP-BIVA sequential measurements help to achieve adequate fluid balance status in patients with ADHF and can be used to drive a -tailored therapy,- allowing clinicians to identify high-risk patients and possibly to reduce the incidence of complications secondary to fluid management strategies.

KeywordsAcute kidney injury Diuretics Heart failure Natriuretic peptides Water-electrolyte balance AbbreviationsADHFacute decompensated heart failure

AHFacute heart failure

BNPB-type natriuretic peptide

BIVAbioelectrical impedance vectorial analysis

CRScardiorenal syndrome

CHFchronic heart failure

CKDchronic kidney disease

CVcardiovascular

eGFRestimated glomerular filtration rate

EFejection fraction

HFheart failure

HFUheart failure unit

LVEFleft ventricular ejection fraction

NYHANew York Heart Associaction Functional Class

WRFworsening renal function

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Autor: Roberto Valle - Nadia Aspromonte - Loredano Milani - Frank W. Peacock - Alan S. Maisel - Massimo Santini - Claudio Ronco

Fuente: https://link.springer.com/



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