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Retrospective analysis of clinical and analytical patterns of cardiorenal syndrome in a series of 58 patients admitted to a level 2 intermediate care unit

Author(s): H. Viegas*, G Mendes, P Freitas, B Lobao, S Marques

Background: In recent years new data on the pathophysiology of cardiorenal syndromes (CRS) has been collected but the impact in acute management is still to be established. Hypothesis: We tried to find different patterns using simple clinical and analytical data that could point to the main decompensated mechanism by accessing the impact of Non-invasive ventilation (NIV), the previous renin angiotensin inhibition and the diuretic strategy, bolus vs perfusion, on these different patterns. Methods: We selected 110 patients with decompensation of heart or renal function but excluded 52 for not having CRS or for presenting acute type 5 (sepsis). Results: Mean age was 76,2 yo. 55,2% males. Mortality was 20,7%. 72,41% had preserved left the ventricular function. There were 2 peaks of time/worst renal function, at first 24hrs and between day 3 and 4. Patients with isolated pulmonary congestion were worst at 2,1 days and peripheral only at 4,3 days p=0,0862. Those with peripheral congestion had the same worsening of renal function with furosemide in bolus versus perfusion despite higher doses. Isolated pulmonary congestion combined with a higher dose of furosemide administered by perfusion had a more severe AKI. Patients doing Non Invasive Ventilation with Jugular Venous Distention or Congestive Liver (N=4 of 37) had worst AKI than those without (p<0,05). Previous RAS-inhibitors at maximum dose were protective vs no RAS-inhibition (p=0,03). Conclusion: In conclusion, there are more subtypes than the traditional classification of the cardiorenal lesion in 5 syndromes and the 3 types of heart failure at least based on the location of congestion.

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