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CLEAR FILTERS
Plasma volume variation and glomerular filtration rate in heart failure admissions
Session:
Posters (Sessão 5 - Écran 4) - Insuficiência Cardíaca 5 - Marcadores Serológicos
Speaker:
Carolina Pereira Mateus
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.6 Acute Heart Failure - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Carolina Pereira Mateus; Mariana Passos; Inês Fialho; Joana Lima Lopes; Marco Beringuilho; João Baltazar Ferreira; David Roque
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><strong>Introduction</strong>: </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">The use of diuretics as management of Acute Heart Failure (AHF) is part of our daily routines. A known side effect of overly vascular volume depletion is worsening of renal function, which can also lead to activation of Renin-Angiotensin-Aldosterone System (RAAS), perpetuating the maladaptive pathophysiological mechanisms. The goal of this study was to assess the correlation between vascular volume contraction after diuretic usage, and glomerular filtration rate (GFR) in patients admitted for AHF. </span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><strong>Methods</strong>: </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Single center, retrospective study involving 258 consecutive patients admitted a district hospital’s Emergency Department in a period of 6 consecutive months (median age of 74.3 ± 17.3 years, 54.3% female). Patients included exhibited AHF, defined as ≥2 clinical signs of Heart Failure, and were treated with diuretics. Differences between discharge and admission laboratory values for Haematocrit (</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Δ</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Htc), Haemoglobin (</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Δ</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Hb), Sodium (</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Δ</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Na) and GFR (</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Δ</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">GFR), using the Modification of Diet in Renal Disease (MDRD), were calculated. Weight difference was not taken into consideration because of inconsistent data. The relative change in plasma volume (PV) from admission until discharge was estimated using the formula: {([Hb admission/Hb discharge]x[(100-Htc discharge)/(100-Htc admission)])-1}x100.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><strong>Results</strong>: </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">From a total of 258 patients admitted with AHF, 11,6% were excluded for lacking laboratory assessment at admission or discharge, as well as patients suffering from documented bleeding or blood transfusions during the hospital stay. After furosemide treatment (mean of the maximum dosage was 69.3±17.3mg), PV increased in 61% (n=139) and decreased in 39% (n=89). Two groups were established, according to the mean percentage of PV (2.5%): Group 1 (G1), with preserved volume [%PV > 2.5% (varying between > 2.5% and 44%, n=101] and Group 2 (G2), with non-preserved volume [%PV < 2.5% (varying between -13.8% and <1.5%, n=127]. </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Δ</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Na did not exhibit significant statistical differences between both groups (mean 0.73±3.52 in G1 vs. 1.52±4.56mEq in G2, p=0.396). Patients from G2 had significantly less positive variations in </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Δ</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Hb (mean of -1.34±0.78 in G1 vs. 0.57±1.01g/dL in G2, p=<0.001) and in </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Δ</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Htc (mean of -4.66±2.69% in G1 vs. 2.21±3.23% in G2, p=<0.001). Also, patients in G2, with the greater PV contraction are those who have the lowest GFR during hospital stay (mean of 49.7±25.9 in G1 vs 41.8±19.8ml/min/1.73m<sup>2</sup> in G2, p= 0.045).</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><strong>Conclusions</strong>: </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">This study was able to find a correlation between the percentage of variation in plasma volume and the nadir of GFR in patients with AHF under diuretic treatment. Hb and Htc levels revealed as useful tools to assess congestion and volume contraction. Sequence calculation of PV variation may be an additional measure to be taken into consideration to avoid over-using diuretics and reduce the incidence of worsening renal function during hospital admission.</span></span></span></span></p>
Slides
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