Cardio-Renal Syndrome: Latest Developments in Device-Based Therapy DOI Open Access

Vlad Meche,

Nilima Rajpal Kundnani, Abhinav Sharma

и другие.

Journal of Clinical Medicine, Год журнала: 2024, Номер 13(24), С. 7814 - 7814

Опубликована: Дек. 20, 2024

Background: Cardio-renal syndrome (CRS) is a complex condition involving bidirectional dysfunction of the heart and kidneys, in which failure one organ exacerbates other. Traditional pharmacologic treatments are often insufficient to manage hemodynamic neurohormonal abnormalities underlying CRS, especially cases resistant standard therapies. Device-based therapies have emerged as promising adjunct or alternative approach, offering targeted intervention relieve congestion, improve renal perfusion, modulate hemodynamics. This study aimed evaluate efficacy safety various device-based CRS management, utilizing DRI2P2S classification categorize interventions dilators, reducers, interstitial modulators, pullers, pushers, shifters. Methods: A comprehensive analysis clinical trial data observational studies patients with was conducted, focus on endpoints, cardiac function, symptom relief, adverse events. Devices included were splanchnic denervation systems (dilators), devices for central pulmonary pressure reduction (reducers), targeting fluid (fluid shifters), among others. systematic literature review from 2004 2024 performed using databases including PubMed, Embase, ClinicalTrials.gov, following PRISMA guidelines selection. Data extracted patient demographics, device type, design, outcomes, follow-up duration. Results: demonstrated varying levels significant improvements observed specific parameters. Notable results venous improved diuretic responsiveness acute cases, while also stabilizing improving function. Other relevant endpoints fewer hospitalizations events, reduced tissue congestion quality life scores. However, some presented challenges, procedure-related complications learning curve optimal implantation. Conclusions: offer valuable addition treatment paradigm, particularly unresponsive conventional diuretics other measures. Each them addresses pathophysiological components shows promise outcomes. Nevertheless, further large-scale, long-term trials needed establish these therapies’ roles care optimize selection criteria. Enhanced understanding mechanisms refinement will be key maximizing impact outcomes patients.

Язык: Английский

Counteracting the Mechanisms of Heart Failure is the Most Effective Way to Decongest Patients while Improving Outcomes DOI Creative Commons
Jelena Čelutkienė, Alexandre Mebazaa, Jan Biegus

и другие.

Cardiac failure review, Год журнала: 2025, Номер 11

Опубликована: Фев. 4, 2025

Diuretic therapy is not associated with improved outcomes in heart failure and may cause significant side effects. Counteracting the core pathophysiological mechanisms of through neurohormonal blockade while reducing reliance on diuretics potentially most effective method decongestion.

Язык: Английский

Процитировано

0
[Effects and Efficacy of Wenyang Huayin Yangxin Prescription on the Traditional Chinese Medicine Syndromes of Patients With Chronic Heart Failure Combined With Diuretic Resistance]. DOI
Jiali Wu, Dan Xiao, Tao Zhan

и другие.

PubMed, Год журнала: 2025, Номер 56(1), С. 94 - 101

Опубликована: Янв. 20, 2025

To study the traditional Chinese medicine (TCM) syndromes of patients with chronic heart failure (CHF) combined diuretic resistance by using Wenyang Huayin Yangxin Prescription, and to observe its therapeutic efficacy. A total 68 CHF complicated who had Yangqi deficiency presenting blood stasis syndrome Tanyin were randomly assigned a control group an observation group. The was given intravenous furosemide (≥ 80 mg/d) via infusion pump in addition standard Western medical treatment, while (< along Prescription (30 g Astragalus, 15 Poria, Baizhu, Chuanxiong, 10 Danfu tablet, Cassia, Alisma, Zhimu). quantitative index used as primary outcome measure. In addition, differences between two groups TCM syndromes, cardiac function-related indicators, incidence endpoint events, readmission rate compared. After 2 weeks filtration sodium excretion fraction (FENa) (0.18 ± 0.04)%, that (0.16 0.03)%, showing statistically significant difference (P = 0.037). 24-hour urine volume Na+/K+ ratio increased significantly from baseline levels higher than those < 0.05). changes volume, sodium, FENa, scores decreased both after greater reduction compared 0.001). showed improvements palpitations, shortness breath, facial limb edema, spontaneous sweating, chest tightness (pain), asthma, oliguria data 0.05), only Except for asthma better outcomes at various time points treatment output (CO) stroke (SV) N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection (LVEF), SV, CO 24 follow-up, no end-point events or rates observed. low-dose administered through pump, can improve resistance. This improves patients' function resistance, reduces dosage diuretic, enhances clinical approach should be more widely applied settings.

Язык: Английский

Процитировано

0
Decongestion in heart failure: medical and device therapies DOI
Zachary L. Cox, Kevin Damman, Jeffrey M. Testani

и другие.

Nature Reviews Cardiology, Год журнала: 2025, Номер unknown

Опубликована: Апрель 28, 2025

Язык: Английский

Процитировано

0
Recent advances in the understanding of the peritoneal membrane DOI

François Seghers,

Michel Tintillier,

Johann Morelle

и другие.

Current Opinion in Nephrology & Hypertension, Год журнала: 2024, Номер unknown

Опубликована: Сен. 18, 2024

Purpose of review The efficiency peritoneal dialysis (PD) as a life-sustaining replacement therapy for patients with kidney failure relies on the integrity and function membrane. Here, we most recent advances in understanding membrane its role PD. Recent findings A update ISPD guidelines proposed revised definition dysfunction, emphasizing importance fluid balance treated PD identified three main mechanisms leading to insufficient ultrafiltration (UF). Bio-PD study, first genomewide association study PD, demonstrated that 20% interindividual variability solute transfer rate is genetically determined, several loci potential relevance transport. candidate-gene approach characterized common functional variant promoter AQP1 gene associated water transport clinical outcomes Innovative strategies preserve enhance UF are also discussed, including use gliflozins; steady glucose concentration PD; modulation GLUT proteins; cytoprotective additives. Summary comprehensive driving may help individualizing prescription improving

Язык: Английский

Процитировано

0
Cardio-Renal Syndrome: Latest Developments in Device-Based Therapy DOI Open Access

Vlad Meche,

Nilima Rajpal Kundnani, Abhinav Sharma

и другие.

Journal of Clinical Medicine, Год журнала: 2024, Номер 13(24), С. 7814 - 7814

Опубликована: Дек. 20, 2024

Background: Cardio-renal syndrome (CRS) is a complex condition involving bidirectional dysfunction of the heart and kidneys, in which failure one organ exacerbates other. Traditional pharmacologic treatments are often insufficient to manage hemodynamic neurohormonal abnormalities underlying CRS, especially cases resistant standard therapies. Device-based therapies have emerged as promising adjunct or alternative approach, offering targeted intervention relieve congestion, improve renal perfusion, modulate hemodynamics. This study aimed evaluate efficacy safety various device-based CRS management, utilizing DRI2P2S classification categorize interventions dilators, reducers, interstitial modulators, pullers, pushers, shifters. Methods: A comprehensive analysis clinical trial data observational studies patients with was conducted, focus on endpoints, cardiac function, symptom relief, adverse events. Devices included were splanchnic denervation systems (dilators), devices for central pulmonary pressure reduction (reducers), targeting fluid (fluid shifters), among others. systematic literature review from 2004 2024 performed using databases including PubMed, Embase, ClinicalTrials.gov, following PRISMA guidelines selection. Data extracted patient demographics, device type, design, outcomes, follow-up duration. Results: demonstrated varying levels significant improvements observed specific parameters. Notable results venous improved diuretic responsiveness acute cases, while also stabilizing improving function. Other relevant endpoints fewer hospitalizations events, reduced tissue congestion quality life scores. However, some presented challenges, procedure-related complications learning curve optimal implantation. Conclusions: offer valuable addition treatment paradigm, particularly unresponsive conventional diuretics other measures. Each them addresses pathophysiological components shows promise outcomes. Nevertheless, further large-scale, long-term trials needed establish these therapies’ roles care optimize selection criteria. Enhanced understanding mechanisms refinement will be key maximizing impact outcomes patients.

Язык: Английский

Процитировано

0