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Intrarenal venous doppler guided diuretic management on hospital stay
Session:
SESSÃO DE POSTERS 30 - INSUFICIÊNCIA CARDÍACA CRÓNICA: TRATAMENTO
Speaker:
Ana Filipa Mesquita Gerardo
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.3 Acute Heart Failure – Diagnostic Methods
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Filipa Mesquita Gerardo; Carolina Mateus; Inês Miranda; Mariana Passos; Inês Fialho; Mara Sarmento; Rodrigo Brandão; Célia Henriques; Ana Oliveira Soares; David Roque
Abstract
<p>Background: In acute heart failure (AHF), intravascular congestion and elevated central venous pressure cause renal parenchymal congestion. Kidney interstitial oedema reduces renal perfusion pressure, leading to hypoxia. Excessive diuretic therapy poses a risk of hypotension and renal hypoperfusion. Detecting euvolemia and determining the optimal time for reducing and transitioning to oral administration are crucial for effective decongestion without inducing acute kidney injury.</p> <p>Purpose: Assessing the value of intrarenal venous doppler (IRVD) to guide diuretic therapy versus usual standard of care and its impact on total hospital duration time.</p> <p>Methods: We conducted a single­center, prospective, observational cohort study from September 2022 to November 2023 on AHF patients (pts) with hemodynamic profile B. Pts were randomized into two groups: IRVD group, guiding diuretic management with IRVD alongside standard congestion evaluation; control group, guided by standard congestion assessment alone with physician blinding to IRVD results. Daily IRVD was performed in both groups. In the IRVD group, continuous trace presence prompted switching IV diuretics to oral.</p> <p>Results: A total of 29 pts were included (33.3% female; mean age 68.4±11.7 years); 12 pts were randomized to the control group and the remaining 17 to the IRVD group. At admission, in both groups, the mean ADVOR congestion score was 3±2 (p=0.939) and there were no differences on the IV furosemide dose administrated on the first day (p=0.910). According to the study protocol, on average, IV furosemide was switched to oral in the second day of hospitalization in the IRVD group vs the fourth day in the control group (p=0.002). There was no difference in total hospitalization stay because most of the patients stayed hospitalized besides euvolemia for other reasons (p=0.402). There were no differences in NTproBNP, haematocrit or serum creatinine variation between admission and the end of the study protocol. If the IRVD was known in the control group it had led to 9 different decisions: in 5 patients (41.7%) the doppler was continuous in the previous days which means the transition to oral could have been done earlier; in 4 patients (33.3%) the doppler was still discontinuous by the end of the study protocol, and half of those patients was readmitted 30 days after discharge. However, there were no differences between groups regarding 30­ and 90­day readmission rate (p=0.125 and 0.675 respectively).</p> <p>Conclusion: The IVRD, combined with standard congestion evaluation, reduces IV diuretic duration by half. In our small cohort, no differences in total hospitalization time or readmission rates were observed. Nevertheless, IRVD­ guided diuretic management may reduce overall hospitalization time, potentially mitigate hospital­ associated complications, enhancing quality of life, with the prospect of reducing readmission rates.</p>
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