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Evaluation and Management of Kidney Dysfunction in Advanced Heart Failure: A Scientific Statement From the American Heart Association.
- Source :
-
Circulation [Circulation] 2024 Oct 15; Vol. 150 (16), pp. e280-e295. Date of Electronic Publication: 2024 Sep 10. - Publication Year :
- 2024
-
Abstract
- Early identification of kidney dysfunction in patients with advanced heart failure is crucial for timely interventions. In addition to elevations in serum creatinine, kidney dysfunction encompasses inadequate maintenance of sodium and volume homeostasis, retention of uremic solutes, and disrupted endocrine functions. Hemodynamic derangements and maladaptive neurohormonal upregulations contribute to fluctuations in kidney indices and electrolytes that may recover with guideline-directed medical therapy. Quantifying the extent of underlying irreversible intrinsic kidney disease is crucial in predicting whether optimization of congestion and guideline-directed medical therapy can stabilize kidney function. This scientific statement focuses on clinical management of patients experiencing kidney dysfunction through the trajectory of advanced heart failure, with specific focus on (1) the conceptual framework for appropriate evaluation of kidney dysfunction within the context of clinical trajectories in advanced heart failure, including in the consideration of advanced heart failure therapies; (2) preoperative, perioperative, and postoperative approaches to evaluation and management of kidney disease for advanced surgical therapies (durable left ventricular assist device/heart transplantation) and kidney replacement therapies; and (3) the key concepts in palliative care and decision-making processes unique to individuals with concomitant advanced heart failure and kidney disease.
- Subjects :
- Humans
United States epidemiology
Kidney physiopathology
Heart-Assist Devices
Palliative Care methods
Kidney Diseases therapy
Kidney Diseases physiopathology
Kidney Diseases diagnosis
Heart Failure therapy
Heart Failure physiopathology
Heart Failure diagnosis
Heart Failure complications
American Heart Association
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 150
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 39253806
- Full Text :
- https://doi.org/10.1161/CIR.0000000000001273