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[PMID]:29375117
[Au] Autor:Nakamura M; Sunagawa O; Kinugawa K
[Ad] Endereço:Second Department of Internal Medicine, University of Toyama.
[Ti] Título:Tolvaptan Improves Prognosis in Responders with Acute Decompensated Heart Failure by Reducing the Dose of Loop Diuretics.
[So] Source:Int Heart J;59(1):87-93, 2018.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:It is unknown whether a response to tolvaptan (TLV) is related to prognosis in patients with acute decompensated heart failure (ADHF). We selected 25 patients as responders by their urinary response to TLV and by reduction of loop diuretics from 37 consecutive ADHF patients treated with TLV. As a control group, we selected 25 patients from 100 consecutive ADHF patients who were not treated with TLV by propensity score matching for age, serum sodium level, serum creatinine level, plasma B-type natriuretic peptide (BNP) level, systolic blood pressure, heart rate, and dose of loop diuretics. The primary outcome was defined as a composite endpoint of mortality and/or hemodialysis. The amount of loop diuretics administered to responders was reduced by TLV from 68.8 ± 26.2 mg to 30.4 ± 18.6 mg of furosemide equivalents per day, whereas the loop diuretic dose administered to non-responders was increased. The event-free survival of the TLV responders during 20 months was significantly better than that of the control group (95.8% versus 68.4%, P = 0.0406). The TLV responders, plasma BNP level, and estimated glomerular filtration rate were significantly related to the events in the Cox proportional hazard analysis. Patients with ADHF who respond to TLV may have a better prognosis than propensity-matched patients not receiving TLV treatment. In TLV responders, it may be possible to improve the patient's prognosis if the dose of loop diuretics can be reduced with TLV therapy.
[Mh] Termos MeSH primário: Benzazepinas/administração & dosagem
Insuficiência Cardíaca/tratamento farmacológico
Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Antagonistas de Receptores de Hormônios Antidiuréticos/administração & dosagem
Intervalo Livre de Doença
Relação Dose-Resposta a Droga
Feminino
Seguimentos
Taxa de Filtração Glomerular/efeitos dos fármacos
Taxa de Filtração Glomerular/fisiologia
Insuficiência Cardíaca/mortalidade
Insuficiência Cardíaca/fisiopatologia
Seres Humanos
Hiponatremia
Japão/epidemiologia
Masculino
Prognóstico
Pontuação de Propensão
Estudos Retrospectivos
Taxa de Sobrevida/tendências
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antidiuretic Hormone Receptor Antagonists); 0 (Benzazepines); 0 (Sodium Potassium Chloride Symporter Inhibitors); 21G72T1950 (tolvaptan)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180130
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.17-099


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[PMID]:28834858
[Au] Autor:Reed BN; Devabhakthuni S
[Ad] Endereço:Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore.
[Ti] Título:Diuretic Resistance in Acute Decompensated Heart Failure: A Challenging Clinical Conundrum.
[So] Source:Crit Care Nurs Q;40(4):363-373, 2017 Oct/Dec.
[Is] ISSN:1550-5111
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Most patients with acute decompensated heart failure (ADHF) present with signs and symptoms of volume overload, and those with a significant history of diuretic exposure may demonstrate varying degrees of diuretic resistance. Although this phenomenon is commonly reported, no consensus definition exists and recommendations regarding an optimal therapeutic approach remain limited. Optimizing the use of intravenous (IV) loop diuretic therapy is the most common initial approach, and therapy may be augmented by the addition of a thiazide-type diuretic or an IV vasodilator. Patients whose resistance to diuretic therapy is due to low cardiac output may require inotropic therapy, and other options (eg, ultrafiltration and vasopressin antagonists) may be considered in select populations. The purpose of this review is to describe diuretic resistance and its underlying mechanisms in ADHF, as well as the most commonly employed strategies for overcoming it. A stepwise approach to managing volume overload in patients with ADHF and diuretic resistance is also provided.
[Mh] Termos MeSH primário: Diuréticos/administração & dosagem
Insuficiência Cardíaca/terapia
Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem
[Mh] Termos MeSH secundário: Doença Aguda
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Diuretics); 0 (Sodium Potassium Chloride Symporter Inhibitors)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1097/CNQ.0000000000000173


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[PMID]:28739647
[Au] Autor:Rao VS; Planavsky N; Hanberg JS; Ahmad T; Brisco-Bacik MA; Wilson FP; Jacoby D; Chen M; Tang WHW; Cherney DZI; Ellison DH; Testani JM
[Ad] Endereço:Department of Internal Medicine and.
[Ti] Título:Compensatory Distal Reabsorption Drives Diuretic Resistance in Human Heart Failure.
[So] Source:J Am Soc Nephrol;28(11):3414-3424, 2017 Nov.
[Is] ISSN:1533-3450
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Understanding the tubular location of diuretic resistance (DR) in heart failure (HF) is critical to developing targeted treatment strategies. Rodents chronically administered loop diuretics develop DR due to compensatory distal tubular sodium reabsorption, but whether this translates to human DR is unknown. We studied consecutive patients with HF ( =128) receiving treatment with loop diuretics at the Yale Transitional Care Center. We measured the fractional excretion of lithium (FELi), the gold standard for assessment of proximal tubular and loop of Henle sodium handling, to assess sodium exit after loop diuretic administration and FENa to assess the net sodium excreted into the urine. The mean±SD prediuretic FELi was 16.2%±9.5%, similar to that in a control cohort without HF not receiving diuretics ( =52; 16.6%±9.2%; =0.82). Administration of a median of 160 (interquartile range, 40-270) mg intravenous furosemide equivalents increased FELi by 12.6%±10.8% ( <0.001) but increased FENa by only 4.8%±3.3%. Thus, only 34% (interquartile range, 15.6%-75.7%) of the estimated diuretic-induced sodium release did not undergo distal reabsorption. After controlling for urine diuretic levels, the increase in FELi explained only 6.4% of the increase in FENa ( =0.002). These data suggest that administration of high-dose loop diuretics to patients with HF yields meaningful increases in sodium exit from the proximal tubule/loop of Henle. However, little of this sodium seems to reach the urine, consistent with findings from animal models that indicate that distal tubular compensatory sodium reabsorption is a primary driver of DR.
[Mh] Termos MeSH primário: Insuficiência Cardíaca/tratamento farmacológico
Insuficiência Cardíaca/metabolismo
Túbulos Renais Distais/metabolismo
Reabsorção Renal
Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Resistência a Medicamentos
Feminino
Seres Humanos
Masculino
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Sodium Potassium Chloride Symporter Inhibitors)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.1681/ASN.2016111178


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[PMID]:28728476
[Au] Autor:Shah N; Madanieh R; Alkan M; Dogar MU; Kosmas CE; Vittorio TJ
[Ad] Endereço:St. Francis Hospital, The Heart Center ®, Center for Advanced Cardiac Therapeutics, Roslyn, NY, USA.
[Ti] Título:A perspective on diuretic resistance in chronic congestive heart failure.
[So] Source:Ther Adv Cardiovasc Dis;11(10):271-278, 2017 Oct.
[Is] ISSN:1753-9455
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Chronic congestive heart failure (CHF) is a complex disorder characterized by inability of the heart to keep up the demands on it, followed by the progressive pump failure and fluid accumulation. Although the loop diuretics are widely used in heart failure (HF) patients, both pharmacodynamic and pharmacokinetic alterations are thought to be responsible for diuretic resistance in these patients. Strategies to overcome diuretic resistance include sodium intake restriction, changes in diuretic dose and route of administration and sequential nephron diuretic therapy. In this review, we discuss the definition, prevalence, mechanism of development and management strategies of diuretic resistance in HF patients.
[Mh] Termos MeSH primário: Diurese/efeitos dos fármacos
Resistência a Medicamentos
Insuficiência Cardíaca/tratamento farmacológico
Hemodinâmica/efeitos dos fármacos
Rim/efeitos dos fármacos
Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico
[Mh] Termos MeSH secundário: Doença Crônica
Insuficiência Cardíaca/diagnóstico
Insuficiência Cardíaca/fisiopatologia
Seres Humanos
Rim/fisiopatologia
Fatores de Risco
Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos
Inibidores de Simportadores de Cloreto de Sódio e Potássio/farmacocinética
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Sodium Potassium Chloride Symporter Inhibitors)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170722
[St] Status:MEDLINE
[do] DOI:10.1177/1753944717718717


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[PMID]:28651510
[Au] Autor:Huang A; Luethi N; Mårtensson J; Bellomo R; Cioccari L
[Ad] Endereço:Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. luca.cioccari@gmail.com.
[Ti] Título:Pharmacodynamics of intravenous frusemide bolus in critically ill patients.
[So] Source:Crit Care Resusc;19(2):142-149, 2017 Jun.
[Is] ISSN:1441-2772
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess the physiological, biochemical and haemodynamic response to a single intravenous (IV) dose of frusemide in critically patients. DESIGN, SETTING AND PATIENTS: A prospective observational study of 21 critically ill patients in a tertiary intensive care unit in Australia. INTERVENTIONS: We collected information on urine output (UO), fluid balance, serum and urinary electrolyte levels, serum biochemical levels and haemodynamics. We compared data from the 6-hour period before administration of a single IV bolus of frusemide 40 mg with data from the 6-hour period after administration. RESULTS: We studied 21 patients (12 of whom were women) with a median age of 73 years (interquartile range [IQR], 64-80 years). The IV bolus induced a > 1000 mL increase in UO in six patients (28.6%); a 500-1000 mL increase in six patients (28.6%) and a < 500 mL increase in nine patients (42.8%). The median difference in UO before and after frusemide was 590 mL (IQR, 290-1111 mL). The 6-hour fluid balance became negative in 15 patients (71.4%) and positive in six patients (28.6%), with a median change of -595 mL (IQR, -880 to 98 mL). Frusemide significantly increased urinary sodium, potassium and chloride losses and decreased blood chloride levels. There were no detectable changes in haemodynamics. On linear regression analysis, sodium excretion and UO correlated with higher mean arterial pressure (MAP) and age, and with lower albumin and creatinine levels. CONCLUSIONS: In a cohort of critically ill patients without chronic renal impairment, frusemide increased UO and urinary sodium, potassium and chloride losses, and induced hypochloraemia and metabolic alkalosis. However, its diuretic effects were extremely variable and were modified by age, MAP and creatinine and albumin levels.
[Mh] Termos MeSH primário: Estado Terminal/terapia
Furosemida/farmacologia
Furosemida/farmacocinética
Inibidores de Simportadores de Cloreto de Sódio e Potássio/farmacologia
Inibidores de Simportadores de Cloreto de Sódio e Potássio/farmacocinética
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Relação Dose-Resposta a Droga
Eletrólitos/sangue
Feminino
Furosemida/administração & dosagem
Seres Humanos
Infusões Intravenosas
Masculino
Meia-Idade
Estudos Prospectivos
Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem
Urodinâmica/efeitos dos fármacos
Equilíbrio Hidroeletrolítico/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Electrolytes); 0 (Sodium Potassium Chloride Symporter Inhibitors); 7LXU5N7ZO5 (Furosemide)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE


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[PMID]:28532770
[Au] Autor:Martens P; Verbrugge FH; Nijst P; Dupont M; Mullens W
[Ad] Endereço:Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
[Ti] Título:Changes in Loop Diuretic Dose and Outcome After Cardiac Resynchronization Therapy in Patients With Heart Failure and Reduced Left Ventricular Ejection Fractions.
[So] Source:Am J Cardiol;120(2):267-273, 2017 Jul 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Cardiac resynchronization therapy (CRT) improves cardiac hemodynamics. Therefore, the maintenance dose of loop diuretic therapy might be reduced. Consecutive patients who underwent CRT (n = 648) were retrospectively evaluated. Loop diuretic dose was recorded at baseline before implantation and 6 months later with patients classified into 4 groups: (1) no loop diuretic, (2) down-titration, (3) unchanged dose, and (4) up-titration. Afterward total loop diuretic exposure was calculated. Renal function trajectories were evaluated as the difference between implantation and censoring serum creatinine (Cr) value. Clinical outcome was evaluated as the combined end point of heart failure readmissions and all-cause mortality. Independent predictors of successful loop diuretic down-titration were identified. Two hundred ninety-six patients (46%) received no loop diuretic at follow-up, 126 (19%) underwent down-titration, 137 (21%) remained on a stable dose, and 89 (14%) underwent up-titration. In comparison with the group that was free from loop diuretics (Cr = +0.06 mg/dl), renal function deteriorated faster during follow-up in patients on stable doses (Cr = +0.29 mg/dl; p = 0.045) and those underwent up-titration (Cr = +0.44 mg/dl; p = 0.009) but not in patients who were down-titrated (Cr = +0.13 mg/dl; p = 1.00). Patients receiving down-titration had a lower risk for the combined clinical end point (adjusted hazards ratio 0.43; confidence interval 0.22 to 0.83; p = 0.012). Factors associated with successful down-titration after 6 months of CRT included nonischemic cardiomyopathy, higher baseline dose of diuretics, higher ejection fraction at 6 weeks, and lower right ventricular systolic pressure at 6 weeks. In conclusion, after CRT, down-titration of loop diuretics is often feasible and associated with improved outcome and a slower rate of kidney function decline. Patients with nonischemic cardiomyopathy, treated with high doses of loop diuretics before implantation and beneficial left ventricular remodeling with CRT, are most likely to tolerate loop diuretic down-titration.
[Mh] Termos MeSH primário: Terapia de Ressincronização Cardíaca/métodos
Insuficiência Cardíaca/terapia
Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem
Volume Sistólico/fisiologia
Disfunção Ventricular Esquerda/fisiopatologia
Função Ventricular Esquerda/fisiologia
[Mh] Termos MeSH secundário: Idoso
Relação Dose-Resposta a Droga
Ecocardiografia
Feminino
Seguimentos
Insuficiência Cardíaca/complicações
Insuficiência Cardíaca/fisiopatologia
Seres Humanos
Masculino
Estudos Retrospectivos
Fatores de Tempo
Resultado do Tratamento
Disfunção Ventricular Esquerda/complicações
Disfunção Ventricular Esquerda/terapia
Remodelação Ventricular
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Sodium Potassium Chloride Symporter Inhibitors)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170810
[Lr] Data última revisão:
170810
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE


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[PMID]:28438307
[Au] Autor:Aoki S; Okumura T; Sawamura A; Kitagawa K; Morimoto R; Sakakibara M; Murohara T
[Ad] Endereço:Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Handa City Hospital, Handa, Japan.
[Ti] Título:Usefulness of the Combination of In-Hospital Poor Diuretic Response and Systemic Congestion to Predict Future Cardiac Events in Patients With Acute Decompensated Heart Failure.
[So] Source:Am J Cardiol;119(12):2010-2016, 2017 Jun 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We aimed to (1) investigate the relation between diuretic response (DR) with or without systemic congestion and prognosis and (2) explore the potential predictors of poor DR for risk stratification in patients with acute decompensated heart failure (ADHF). We enrolled 186 consecutive patients hospitalized for ADHF. The DR was defined as (body weight at discharge - body weight at admission)/40 mg furosemide or equivalent loop diuretic dose. Systemic congestion on admission was simply evaluated by the presence of leg edema or jugular venous distention. All patients were divided into 4 groups based on the median of DR (-0.50 kg/40 mg) and the status of systemic congestion; GR/C (good DR with systemic congestion, n = 66), GR/N (good DR without systemic congestion, n = 27), PR/C (poor DR with systemic congestion, n = 48); and PR/N (poor DR without systemic congestion, n = 45). The composite outcome was defined as cardiac death and rehospitalization for worsening heart failure. In survival analysis, the cardiac event-free rate in PR/C was significantly lower than that in any other groups (log-rank, p <0.001), and PR/C was an independent predictor of cardiac events (hazard ratio 2.17, p = 0.016). In conclusion, the combination of in-hospital poor DR, characterized by previous ischemic heart disease, and prehospital dose of daily loop diuretics, and systemic congestion provides a risk stratification for future cardiac events in patients with ADHF.
[Mh] Termos MeSH primário: Edema/etiologia
Insuficiência Cardíaca/tratamento farmacológico
Pacientes Internados
Medição de Risco
Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Idoso de 80 Anos ou mais
Progressão da Doença
Relação Dose-Resposta a Droga
Edema/tratamento farmacológico
Edema/epidemiologia
Feminino
Seguimentos
Insuficiência Cardíaca/complicações
Insuficiência Cardíaca/epidemiologia
Seres Humanos
Incidência
Japão/epidemiologia
Masculino
Prognóstico
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Sodium Potassium Chloride Symporter Inhibitors)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170426
[St] Status:MEDLINE


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[PMID]:28321027
[Au] Autor:Asami M; Aoki J; Tanimoto S; Horiuchi Y; Watanabe M; Furui K; Yasuhara K; Sato T; Tanabe K; Hara K
[Ad] Endereço:Division of Cardiology, Mitsui Memorial Hospital.
[Ti] Título:Effects of Long-Acting Loop Diuretics in Heart Failure With Reduced Ejection Fraction Patients With Cardiac Resynchronization Therapy.
[So] Source:Int Heart J;58(2):211-219, 2017 Apr 06.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:There have been no reports evaluating the impact of long-acting loop diuretics (LLD) on the outcome of heart failure (HF) and arrhythmia treatment in HF with reduced ejection fraction (HFrEF) patients implanted with a cardiac resynchronization therapy (CRT) device.This was a prospective, single-blind, randomized crossover study. We allocated 21 consecutive CRT implanted patients into 2 groups. The furosemide group received furosemide as a first treatment and azosemide as a second treatment. The azosemide group received this treatment in the reverse order. The first treatment was given to each group for 6 months and the second treatment continued for an additional 6 months. We combined the data of each medication regimen in each group and analyzed it at baseline, 6 months, and 1 year. The primary endpoints were the variation of fluid index and thoracic impedance measured by CRT at 6 months.The baseline characteristics were similar for both groups. The difference in the primary endpoints was not statistically significant between the 2 medication arms (fluid index: -29.6 ± 64.4 versus 16.2 ± 48.2; P = 0.22, thoracic impedance: -0.49 ± 17.8 versus 2.45 ± 12.5; P = 0.56). Likewise, the clinical outcome of HF and the CRT derived parameters in both arms were comparable.HFrEF patients taking LLD after CRT implantation might be comparable to those taking short-acting loop diuretics in the treatment of HF and HF-associated arrhythmias.
[Mh] Termos MeSH primário: Arritmias Cardíacas/induzido quimicamente
Terapia de Ressincronização Cardíaca
Insuficiência Cardíaca/tratamento farmacológico
Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Doença Crônica
Estudos Cross-Over
Feminino
Insuficiência Cardíaca/complicações
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Volume Sistólico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Sodium Potassium Chloride Symporter Inhibitors)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170502
[Lr] Data última revisão:
170502
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.16-290


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[PMID]:28302060
[Au] Autor:Muñoz MA; Mundet-Tuduri X; Real J; Del Val JL; Domingo M; Vinyoles E; Calero E; Checa C; Soldevila-Bacardit N; Verdú-Rotellar JM
[Ad] Endereço:Institut Català de la Salut, Barcelona, Spain.
[Ti] Título:Heart failure labelled patients with missing ejection fraction in primary care: prognosis and determinants.
[So] Source:BMC Fam Pract;18(1):38, 2017 Mar 17.
[Is] ISSN:1471-2296
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It is common to find a high variability in the accuracy of heart failure (HF) diagnosis in electronic primary care medical records (EMR). Our aims were to ascertain (i) whether the prognosis of HF labelled patients whose ejection fraction (EF) was missing in their EMR differed from those that had it registered, and (ii) the causes contributing to the differences in the availability of EF in EMR. METHODS: Retrospective cohort analyses based on clinical records of HF and attended at 52 primary healthcare centres of Barcelona (Spain). Information of 8376 HF patients aged > 40 years followed during five years was analyzed. RESULTS: EF was available only in 8.5% of primary care medical records. Cumulate incidence for mortality and hospitalization from 1st January 2009 to 31th December 2012 was 37.6%. The highest rate was found in patients with missing EF (HR 1.84, 95% CI 1.68 -1.95) compared to those with preserved EF. Patients hospitalized the previous year and those requiring home healthcare (HR 1.81, 95% Confidence Interval 1.68-1.95 and HR 1.58, 95% CI 1.46-1.71, respectively) presented a higher risk of having an adverse outcome. Older patients, those more socio-economically disadvantaged, obese, requiring home healthcare, and taking loop diuretics were less likely to have an EF registered. CONCLUSIONS: EF is poorly recorded in primary care. HF patients with EF missing at medical records had the worst prognosis. They tended to be older, socio-economically disadvantaged, and more fragile.
[Mh] Termos MeSH primário: Documentação
Registros Eletrônicos de Saúde
Insuficiência Cardíaca/fisiopatologia
Serviços de Assistência Domiciliar/utilização
Hospitalização/estatística & dados numéricos
Atenção Primária à Saúde
Volume Sistólico/fisiologia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Comorbidade
Ecocardiografia
Feminino
Insuficiência Cardíaca/diagnóstico por imagem
Insuficiência Cardíaca/tratamento farmacológico
Insuficiência Cardíaca/mortalidade
Seres Humanos
Masculino
Meia-Idade
Mortalidade
Obesidade/epidemiologia
Prognóstico
Estudos Retrospectivos
Fatores Socioeconômicos
Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico
Espanha
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Sodium Potassium Chloride Symporter Inhibitors)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170318
[St] Status:MEDLINE
[do] DOI:10.1186/s12875-017-0612-6


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[PMID]:28274925
[Au] Autor:Slattery P; Frölich S; Goren I; Nüsing RM
[Ad] Endereço:Institute of Clinical Pharmacology, Goethe-University, Frankfurt, Germany; and.
[Ti] Título:Salt supplementation ameliorates developmental kidney defects in COX-2 mice.
[So] Source:Am J Physiol Renal Physiol;312(6):F1044-F1055, 2017 Jun 01.
[Is] ISSN:1522-1466
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Deficiency of cyclooxygenase-2 (COX-2) activity in the early postnatal period causes impairment of kidney development leading to kidney insufficiency. We hypothesize that impaired NaCl reabsorption during the first days of life is a substantial cause for nephrogenic defects observed in COX-2 mice and that salt supplementation corrects these defects. Daily injections of NaCl (0.8 mg·g ·day ) for the first 10 days after birth ameliorated impaired kidney development in COX-2 pups resulting in an increase in glomerular size and fewer immature superficial glomeruli. However, impaired renal subcortical growth was not corrected. Increasing renal tubular flow by volume load or injections of KCl did not relieve the renal histomorphological damage. Administration of torsemide and spironolactone also affected nephrogenesis resulting in diminished glomeruli and cortical thinning. Treatment of COX-2 pups with NaCl/DOCA caused a stronger mitigation of glomerular size and induced a slight but significant growth of cortical tissue mass. After birth, renal mRNA expression of NHE3, NKCC2, ROMK, NCCT, ENaC, and Na /K -ATPase increased relative to postnatal day 2 in wild-type mice. However, in COX-2 mice, a significantly lower expression was observed for NCCT, whereas NaCl/DOCA treatment significantly increased NHE3 and ROMK expression. Long-term effects of postnatal NaCl/DOCA injections indicate improved kidney function with normalization of pathologically enhanced creatinine and urea plasma levels; also, albumin excretion was observed. In summary, we present evidence that salt supplementation during the COX-2-dependent time frame of nephrogenesis partly reverses renal morphological defects in COX-2 mice and improves kidney function.
[Mh] Termos MeSH primário: Ciclo-Oxigenase 2/deficiência
Rim/efeitos dos fármacos
Cloreto de Sódio na Dieta/administração & dosagem
Anormalidades Urogenitais/tratamento farmacológico
[Mh] Termos MeSH secundário: Animais
Animais Recém-Nascidos
Ciclo-Oxigenase 2/genética
Acetato de Desoxicorticosterona/administração & dosagem
Modelos Animais de Doenças
Canais Epiteliais de Sódio/genética
Canais Epiteliais de Sódio/metabolismo
Feminino
Regulação da Expressão Gênica no Desenvolvimento
Predisposição Genética para Doença
Rim/anormalidades
Rim/enzimologia
Rim/crescimento & desenvolvimento
Masculino
Camundongos Endogâmicos C57BL
Camundongos Knockout
Antagonistas de Receptores de Mineralocorticoides/farmacologia
Morfogênese
Fenótipo
Canais de Potássio Corretores do Fluxo de Internalização/genética
Canais de Potássio Corretores do Fluxo de Internalização/metabolismo
RNA Mensageiro/genética
RNA Mensageiro/metabolismo
Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem
Trocador 3 de Sódio-Hidrogênio
Trocadores de Sódio-Hidrogênio/genética
Trocadores de Sódio-Hidrogênio/metabolismo
ATPase Trocadora de Sódio-Potássio/genética
ATPase Trocadora de Sódio-Potássio/metabolismo
Membro 1 da Família 12 de Carreador de Soluto/genética
Membro 1 da Família 12 de Carreador de Soluto/metabolismo
Membro 3 da Família 12 de Carreador de Soluto/genética
Membro 3 da Família 12 de Carreador de Soluto/metabolismo
Espironolactona/administração & dosagem
Sulfonamidas/administração & dosagem
Anormalidades Urogenitais/enzimologia
Anormalidades Urogenitais/genética
Anormalidades Urogenitais/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Epithelial Sodium Channels); 0 (Kcnj1 protein, mouse); 0 (Mineralocorticoid Receptor Antagonists); 0 (Potassium Channels, Inwardly Rectifying); 0 (RNA, Messenger); 0 (Slc12a1 protein, mouse); 0 (Slc12a3 protein, mouse); 0 (Slc9a3 protein, mouse); 0 (Sodium Chloride, Dietary); 0 (Sodium Potassium Chloride Symporter Inhibitors); 0 (Sodium-Hydrogen Exchanger 3); 0 (Sodium-Hydrogen Exchangers); 0 (Solute Carrier Family 12, Member 1); 0 (Solute Carrier Family 12, Member 3); 0 (Sulfonamides); 27O7W4T232 (Spironolactone); 6E0A168OB8 (Desoxycorticosterone Acetate); EC 1.14.99.- (Ptgs2 protein, mouse); EC 1.14.99.1 (Cyclooxygenase 2); EC 3.6.3.9 (Sodium-Potassium-Exchanging ATPase); W31X2H97FB (torsemide)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170310
[St] Status:MEDLINE
[do] DOI:10.1152/ajprenal.00565.2016



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