array:26 [
  "pii" => "S0870255118301094"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2018.02.003"
  "estado" => "S300"
  "fechaPublicacion" => "2018-02-01"
  "aid" => "1163"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "dis"
  "cita" => "Rev Port Cardiol. 2018;37:167-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1376
    "formatos" => array:3 [
      "EPUB" => 136
      "HTML" => 862
      "PDF" => 378
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204918300618"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2018.03.010"
      "estado" => "S300"
      "fechaPublicacion" => "2018-02-01"
      "aid" => "1163"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "simple-article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "dis"
      "cita" => "Rev Port Cardiol. 2018;37:167-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1664
        "formatos" => array:3 [
          "EPUB" => 127
          "HTML" => 908
          "PDF" => 629
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
        "titulo" => "Renal failure in decompensated heart failure patients&#58; Double trouble"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "167"
            "paginaFinal" => "168"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Insufici&#234;ncia renal em doentes com insufici&#234;ncia card&#237;aca descompensada&#58; um problema duplo"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Daniel Ferreira"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Daniel"
                "apellidos" => "Ferreira"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255118301094"
          "doi" => "10.1016/j.repc.2018.02.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255118301094?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300618?idApp=UINPBA00004E"
      "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300618/v1_201803200458/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S087025511730121X"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2017.06.009"
    "estado" => "S300"
    "fechaPublicacion" => "2018-02-01"
    "aid" => "1079"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2018;37:169-73"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3455
      "formatos" => array:3 [
        "EPUB" => 130
        "HTML" => 2855
        "PDF" => 470
      ]
    ]
    "pt" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original</span>"
      "titulo" => "Rela&#231;&#227;o entre o perfil tensional noturno e a preval&#234;ncia e gravidade da retinopatia hipertensiva"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "169"
          "paginaFinal" => "173"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Relationship between nocturnal blood pressure profiles and the presence and severity of hypertensive retinopathy"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Tatiana Duarte, Sara Gon&#231;alves, Raquel Brito, Catarina S&#225;, Rita Marinheiro, Marta Fonseca, Rita Rodrigues, Filipe Seixo, Anabela Guerreiro, Andreia Fernandes, Cristina Carradas, Isabel Silvestre, Leonel Bernardino, Rui Caria"
          "autores" => array:14 [
            0 => array:2 [
              "nombre" => "Tatiana"
              "apellidos" => "Duarte"
            ]
            1 => array:2 [
              "nombre" => "Sara"
              "apellidos" => "Gon&#231;alves"
            ]
            2 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Brito"
            ]
            3 => array:2 [
              "nombre" => "Catarina"
              "apellidos" => "S&#225;"
            ]
            4 => array:2 [
              "nombre" => "Rita"
              "apellidos" => "Marinheiro"
            ]
            5 => array:2 [
              "nombre" => "Marta"
              "apellidos" => "Fonseca"
            ]
            6 => array:2 [
              "nombre" => "Rita"
              "apellidos" => "Rodrigues"
            ]
            7 => array:2 [
              "nombre" => "Filipe"
              "apellidos" => "Seixo"
            ]
            8 => array:2 [
              "nombre" => "Anabela"
              "apellidos" => "Guerreiro"
            ]
            9 => array:2 [
              "nombre" => "Andreia"
              "apellidos" => "Fernandes"
            ]
            10 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Carradas"
            ]
            11 => array:2 [
              "nombre" => "Isabel"
              "apellidos" => "Silvestre"
            ]
            12 => array:2 [
              "nombre" => "Leonel"
              "apellidos" => "Bernardino"
            ]
            13 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Caria"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204918300084"
        "doi" => "10.1016/j.repce.2017.06.014"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300084?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511730121X?idApp=UINPBA00004E"
    "url" => "/08702551/0000003700000002/v1_201803150415/S087025511730121X/v1_201803150415/pt/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0870255117301907"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2017.06.020"
    "estado" => "S300"
    "fechaPublicacion" => "2018-02-01"
    "aid" => "1162"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Cardiol. 2018;37:159-65"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1545
      "formatos" => array:3 [
        "EPUB" => 157
        "HTML" => 982
        "PDF" => 406
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "159"
          "paginaFinal" => "165"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Caracter&#237;sticas cl&#237;nicas e mortalidade a um ano de acordo com a fun&#231;&#227;o renal &#224; admiss&#227;o&#44; em doentes com a primeira hospitaliza&#231;&#227;o por insufici&#234;ncia card&#237;aca aguda"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1034
              "Ancho" => 1585
              "Tamanyo" => 92329
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier analysis of one-year mortality according to estimated glomerular filtration rate&#46; Log-rank test 23&#46;559&#59; p&#60;0&#46;0001&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Francesc Formiga, Rafael Moreno-Gonzalez, David Chivite, Jes&#250;s Casado, Francesc Escrihuela-Vidal, Xavier Corbella"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Francesc"
              "apellidos" => "Formiga"
            ]
            1 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Moreno-Gonzalez"
            ]
            2 => array:2 [
              "nombre" => "David"
              "apellidos" => "Chivite"
            ]
            3 => array:2 [
              "nombre" => "Jes&#250;s"
              "apellidos" => "Casado"
            ]
            4 => array:2 [
              "nombre" => "Francesc"
              "apellidos" => "Escrihuela-Vidal"
            ]
            5 => array:2 [
              "nombre" => "Xavier"
              "apellidos" => "Corbella"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117301907?idApp=UINPBA00004E"
    "url" => "/08702551/0000003700000002/v1_201803150415/S0870255117301907/v1_201803150415/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:19 [
      "pii" => "S0870255117301907"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2017.06.020"
      "estado" => "S300"
      "fechaPublicacion" => "2018-02-01"
      "aid" => "1162"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Cardiol. 2018;37:159-65"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1545
        "formatos" => array:3 [
          "EPUB" => 157
          "HTML" => 982
          "PDF" => 406
        ]
      ]
      "en" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "159"
            "paginaFinal" => "165"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Caracter&#237;sticas cl&#237;nicas e mortalidade a um ano de acordo com a fun&#231;&#227;o renal &#224; admiss&#227;o&#44; em doentes com a primeira hospitaliza&#231;&#227;o por insufici&#234;ncia card&#237;aca aguda"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1034
                "Ancho" => 1585
                "Tamanyo" => 92329
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier analysis of one-year mortality according to estimated glomerular filtration rate&#46; Log-rank test 23&#46;559&#59; p&#60;0&#46;0001&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Francesc Formiga, Rafael Moreno-Gonzalez, David Chivite, Jes&#250;s Casado, Francesc Escrihuela-Vidal, Xavier Corbella"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "Francesc"
                "apellidos" => "Formiga"
              ]
              1 => array:2 [
                "nombre" => "Rafael"
                "apellidos" => "Moreno-Gonzalez"
              ]
              2 => array:2 [
                "nombre" => "David"
                "apellidos" => "Chivite"
              ]
              3 => array:2 [
                "nombre" => "Jes&#250;s"
                "apellidos" => "Casado"
              ]
              4 => array:2 [
                "nombre" => "Francesc"
                "apellidos" => "Escrihuela-Vidal"
              ]
              5 => array:2 [
                "nombre" => "Xavier"
                "apellidos" => "Corbella"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117301907?idApp=UINPBA00004E"
      "url" => "/08702551/0000003700000002/v1_201803150415/S0870255117301907/v1_201803150415/en/main.assets"
    ]
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>"
    "titulo" => "Renal failure in decompensated heart failure patients&#58; Double trouble"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "167"
        "paginaFinal" => "168"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Daniel Ferreira"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Daniel"
            "apellidos" => "Ferreira"
            "email" => array:1 [
              0 => "dferreira&#64;hospitaldaluz&#46;pt"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Cardiovascular Centre&#44; Hospital da Luz Lisboa&#44; Lisbon&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Insufici&#234;ncia renal em doentes com insufici&#234;ncia card&#237;aca descompensada&#58; um problema duplo"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The association between cardiac and renal disease has been an area of growing interest in recent years&#46; The interactions between these organs play an important role in control of blood pressure&#44; renal sodium and water excretion&#44; arterial perfusion and tissue oxygenation&#44; and&#44; most importantly&#44; extracellular fluid balance&#44; including intravascular volume&#46; It is therefore not surprising that&#44; when one organ becomes dysfunctional&#44; the other may be affected as well&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Heart failure &#40;HF&#41; interacts with renal disease via several pathophysiological pathways in both acute and chronic settings&#46; The expression &#8216;cardiorenal syndrome&#8217; has often been used in the last decade to define this interdependency of the kidneys and the heart&#44; and as an umbrella term for worse outcome when the two organs fail simultaneously&#46; A recent review of the pathophysiological pathways of this syndrome was recently published by Schefold et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although the concept of the cardiorenal syndrome is helpful when describing these heart-kidney interactions&#44; it should be emphasized that the current definition of cardiorenal syndrome includes all forms of two-way connections and is not specific to HF&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">That being said&#44; it is widely documented that renal dysfunction occurs frequently in all phenotypes of HF&#44; and when present&#44; is associated with higher mortality and morbidity&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Over 50 studies have been published describing the association between renal dysfunction and mortality in HF&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> The majority of these studies were observational&#44; since most randomized clinical trials on HF exclude patients with moderate to severe chronic kidney disease &#40;CKD&#41;&#46; However&#44; two landmark retrospective analyses of randomized controlled trials showed that reductions in estimated glomerular filtration rate &#40;eGFR&#41; were associated with higher mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;4</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Worsening renal function</span><p id="par0030" class="elsevierStylePara elsevierViewall">Several meta-analyses have also demonstrated that worsening renal function &#40;WRF&#41; is associated with increased mortality in both inpatients and outpatients&#44; with larger increases in serum creatinine predicting worse outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#44;6</span></a> It has been observed that even a small increase in serum creatinine during hospitalization&#44; as low as 0&#46;2 mg&#47;dl&#44; is associated with poor outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; at least in acute decompensated heart failure &#40;ADHF&#41;&#44; some increase in serum creatinine may be acceptable&#44; as long as the patient&#39;s overall clinical status does not deteriorate&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Patients with WRF and some degree of hemoconcentration&#44; decongestion&#44; or reduction in blood pressure resulting from acute HF treatment&#44; especially with diuretics&#44; have a much better outcome than those who have WRF that appears to be unprovoked&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">9&#8211;11</span></a> In other words&#44; as suggested by Damman et al&#46;&#44; if a patient&#39;s clinical status improves or remains the same and their serum creatinine increases&#44; this &#8216;pseudo-WRF&#8217; may not necessarily mean a poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">On the other hand&#44; Gottlieb et al&#46; found that 47&#37; of patients admitted for ADHF had WRF during the first three days of hospitalization&#44; when they were still hypervolemic&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> This finding challenges the common conception that worsening renal function in ADHF is due to decreased intravascular volume and&#47;or low cardiac output&#46; Clearly overdiuresis and lowering filling pressure can potentially worsen renal function&#44; but this is not the case in almost half of ADHF admissions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Renal function on admission for decompensated heart failure</span><p id="par0045" class="elsevierStylePara elsevierViewall">According to Damman et al&#46;&#44; around 4&#46;5&#37; of the general population have eGFR &#60;60 ml&#47;min&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#44; normally classified as chronic kidney disease &#40;CKD&#41;&#44; while over 50&#37; of patients with acute and chronic HF &#40;both preserved and reduced ejection fraction&#41; have a similar reduction in eGFR&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">It is therefore not surprising that a large percentage of patients admitted to hospital with ADHF present with some degree of renal dysfunction&#46; The exact proportion varies according to the definition of renal failure and the methods used to determine renal function&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Determination of the prognostic significance of low eGFR in ADHF patients on admission in the real world could provide valuable information&#44; considering the increased risk of these patients and the potential implications for therapeutic choices&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">It is well known that patients with renal dysfunction are less likely to be treated with drugs like angiotensin-converting enzyme inhibitors&#44; angiotensin receptor blockers&#44; spironolactone or sacubitril&#44; that can improve HF prognosis&#44; for fear of causing renal dysfunction and electrolyte imbalance&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study by Formiga et al&#46; published in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> sheds more light on this important subject&#46; This observational study included nearly 1000 patients with a first episode of ADHF &#40;52&#46;3&#37; of whom had eGFR &#60;60 ml&#47;min&#41;&#44; and assessed the one-year prognostic significance of renal dysfunction on admission&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The study&#39;s strengths and limitations are well described in the discussion of the paper and should be taken into account when analyzing its results and conclusions&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In our view&#44; the major limitation of this paper &#40;which is also acknowledged by the authors&#41; lies in the fact that data on changes in patients&#8217; eGFR during and after hospitalization were not collected&#44; and so the role of worsening or improving renal function &#40;beyond the spot admission data&#41; in the prognosis of the study population could not be assessed&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Despite this limitation&#44; the study&#39;s results support the authors&#8217; conclusions that assessment of renal failure by the determination of admission eGFR has significant short- and medium-term prognostic value&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In conclusion&#44; careful reading of Formiga et al&#46; is recommended and physicians should understand that patients with combined renal and heart failure have problems that are more than the sum of these diseases alone&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The management of these patients cannot be based on treating both diseases as separate entities&#46; Many pathophysiological and therapeutic factors must be taken into account and a balance sought between hemodynamic and renal factors for each individual&#46; Getting this balance right can favorably modify the patient&#39;s prognosis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">Daniel Ferreira has received honoraria &#40;advisory board member and&#47;or invited speaker&#41; from Astellas&#44; Astra-Zeneca&#44; Bayer&#44; BMS&#47;Pfizer&#44; Boehringer-Ingelheim&#44; Novartis&#44; and Sanofi-Aventis&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Worsening renal function"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Renal function on admission for decompensated heart failure"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:12 [
            0 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heart failure and kidney dysfunction&#58; epidemiology&#44; mechanisms and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;C&#46; Schefold"
                            1 => "G&#46; Filippatos"
                            2 => "G&#46; Hasenfuss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrneph.2016.113"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Nephrol"
                        "fecha" => "2016"
                        "volumen" => "12"
                        "paginaInicial" => "610"
                        "paginaFinal" => "623"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27573728"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The kidney in heart failure&#58; an update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Damman"
                            1 => "J&#46;M&#46; Testani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehv010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2015"
                        "volumen" => "36"
                        "paginaInicial" => "1437"
                        "paginaFinal" => "1444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25838436"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;L&#46; Dries"
                            1 => "D&#46;V&#46; Exner"
                            2 => "M&#46;J&#46; Domanski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2000"
                        "volumen" => "35"
                        "paginaInicial" => "681"
                        "paginaFinal" => "689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10716471"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal function&#44; neurohormonal activation&#44; and survival in patients with chronic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46;L&#46; Hillege"
                            1 => "A&#46;R&#46; Girbes"
                            2 => "P&#46;J&#46; de Kam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2000"
                        "volumen" => "102"
                        "paginaInicial" => "203"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10889132"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal impairment and outcomes in heart failure&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "G&#46;L&#46; Smith"
                            1 => "J&#46;H&#46; Lichtman"
                            2 => "M&#46;B&#46; Bracken"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2005.11.084"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2006"
                        "volumen" => "47"
                        "paginaInicial" => "1987"
                        "paginaFinal" => "1996"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16697315"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Worsening renal function and prognosis in heart failure&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Damman"
                            1 => "G&#46; Navis"
                            2 => "A&#46;A&#46; Voors"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cardfail.2007.04.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2007"
                        "volumen" => "13"
                        "paginaInicial" => "599"
                        "paginaFinal" => "608"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17923350"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prognostic importance of different definitions of worsening renal function in congestive heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;S&#46; Gottlieb"
                            1 => "W&#46; Abraham"
                            2 => "J&#46; Butler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Card Fail"
                        "fecha" => "2002"
                        "volumen" => "8"
                        "paginaInicial" => "136"
                        "paginaFinal" => "141"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12140805"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Terminology and definition of changes renal function in heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "K&#46; Damman"
                            1 => "W&#46;H&#46; Tang"
                            2 => "J&#46;M&#46; Testani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu320"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
                        "volumen" => "35"
                        "paginaInicial" => "3413"
                        "paginaFinal" => "3416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25157110"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Timing of hemoconcentration during treatment of acute decompensated heart failure and subsequent survival&#58; importance of sustained decongestion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Testani"
                            1 => "M&#46;A&#46; Brisco"
                            2 => "J&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2013.05.027"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2013"
                        "volumen" => "62"
                        "paginaInicial" => "516"
                        "paginaFinal" => "524"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23747773"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is worsening renal function an ominous prognostic sign in patients with acute heart failure&#63; The role of congestion and its interaction with renal function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Metra"
                            1 => "B&#46; Davison"
                            2 => "L&#46; Bettari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCHEARTFAILURE.111.963413"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Heart Fail"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "54"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22167320"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Testani"
                            1 => "S&#46;G&#46; Coca"
                            2 => "B&#46;D&#46; McCauley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurjhf/hfr070"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2011"
                        "volumen" => "13"
                        "paginaInicial" => "877"
                        "paginaFinal" => "884"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21693504"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Formiga"
                            1 => "R&#46; Moreno-Gonzalez"
                            2 => "D&#46; Chivite"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2018"
                        "volumen" => "37"
                        "paginaInicial" => "159"
                        "paginaFinal" => "165"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003700000002/v1_201803150415/S0870255118301094/v1_201803150415/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29261"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Artigos Originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003700000002/v1_201803150415/S0870255118301094/v1_201803150415/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255118301094?idApp=UINPBA00004E"
]
Partilhar
Informação da revista
Vol. 37. Núm. 2.
Páginas 167-168 (fevereiro 2018)
Partilhar
Partilhar
Baixar PDF
Mais opções do artigo
Visitas
4539
Vol. 37. Núm. 2.
Páginas 167-168 (fevereiro 2018)
Editorial comment
Open Access
Renal failure in decompensated heart failure patients: Double trouble
Insuficiência renal em doentes com insuficiência cardíaca descompensada: um problema duplo
Visitas
4539
Daniel Ferreira
Cardiovascular Centre, Hospital da Luz Lisboa, Lisbon, Portugal
Conteúdo relacionado
Francesc Formiga, Rafael Moreno-Gonzalez, David Chivite, Jesús Casado, Francesc Escrihuela-Vidal, Xavier Corbella
Este item recebeu

Under a Creative Commons license
Informação do artigo
Texto Completo
Bibliografia
Baixar PDF
Estatísticas
Texto Completo

The association between cardiac and renal disease has been an area of growing interest in recent years. The interactions between these organs play an important role in control of blood pressure, renal sodium and water excretion, arterial perfusion and tissue oxygenation, and, most importantly, extracellular fluid balance, including intravascular volume. It is therefore not surprising that, when one organ becomes dysfunctional, the other may be affected as well.

Heart failure (HF) interacts with renal disease via several pathophysiological pathways in both acute and chronic settings. The expression ‘cardiorenal syndrome’ has often been used in the last decade to define this interdependency of the kidneys and the heart, and as an umbrella term for worse outcome when the two organs fail simultaneously. A recent review of the pathophysiological pathways of this syndrome was recently published by Schefold et al.1

Although the concept of the cardiorenal syndrome is helpful when describing these heart-kidney interactions, it should be emphasized that the current definition of cardiorenal syndrome includes all forms of two-way connections and is not specific to HF.

That being said, it is widely documented that renal dysfunction occurs frequently in all phenotypes of HF, and when present, is associated with higher mortality and morbidity.

Over 50 studies have been published describing the association between renal dysfunction and mortality in HF.2 The majority of these studies were observational, since most randomized clinical trials on HF exclude patients with moderate to severe chronic kidney disease (CKD). However, two landmark retrospective analyses of randomized controlled trials showed that reductions in estimated glomerular filtration rate (eGFR) were associated with higher mortality.3,4

Worsening renal function

Several meta-analyses have also demonstrated that worsening renal function (WRF) is associated with increased mortality in both inpatients and outpatients, with larger increases in serum creatinine predicting worse outcomes.2,5,6 It has been observed that even a small increase in serum creatinine during hospitalization, as low as 0.2 mg/dl, is associated with poor outcomes.7

However, at least in acute decompensated heart failure (ADHF), some increase in serum creatinine may be acceptable, as long as the patient's overall clinical status does not deteriorate.8 Patients with WRF and some degree of hemoconcentration, decongestion, or reduction in blood pressure resulting from acute HF treatment, especially with diuretics, have a much better outcome than those who have WRF that appears to be unprovoked.9–11 In other words, as suggested by Damman et al., if a patient's clinical status improves or remains the same and their serum creatinine increases, this ‘pseudo-WRF’ may not necessarily mean a poor prognosis.8

On the other hand, Gottlieb et al. found that 47% of patients admitted for ADHF had WRF during the first three days of hospitalization, when they were still hypervolemic.7 This finding challenges the common conception that worsening renal function in ADHF is due to decreased intravascular volume and/or low cardiac output. Clearly overdiuresis and lowering filling pressure can potentially worsen renal function, but this is not the case in almost half of ADHF admissions.

Renal function on admission for decompensated heart failure

According to Damman et al., around 4.5% of the general population have eGFR <60 ml/min/1.73 m2, normally classified as chronic kidney disease (CKD), while over 50% of patients with acute and chronic HF (both preserved and reduced ejection fraction) have a similar reduction in eGFR.2

It is therefore not surprising that a large percentage of patients admitted to hospital with ADHF present with some degree of renal dysfunction. The exact proportion varies according to the definition of renal failure and the methods used to determine renal function.

Determination of the prognostic significance of low eGFR in ADHF patients on admission in the real world could provide valuable information, considering the increased risk of these patients and the potential implications for therapeutic choices.

It is well known that patients with renal dysfunction are less likely to be treated with drugs like angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, spironolactone or sacubitril, that can improve HF prognosis, for fear of causing renal dysfunction and electrolyte imbalance.

The study by Formiga et al. published in this issue of the Journal12 sheds more light on this important subject. This observational study included nearly 1000 patients with a first episode of ADHF (52.3% of whom had eGFR <60 ml/min), and assessed the one-year prognostic significance of renal dysfunction on admission.

The study's strengths and limitations are well described in the discussion of the paper and should be taken into account when analyzing its results and conclusions.

In our view, the major limitation of this paper (which is also acknowledged by the authors) lies in the fact that data on changes in patients’ eGFR during and after hospitalization were not collected, and so the role of worsening or improving renal function (beyond the spot admission data) in the prognosis of the study population could not be assessed.

Despite this limitation, the study's results support the authors’ conclusions that assessment of renal failure by the determination of admission eGFR has significant short- and medium-term prognostic value.

In conclusion, careful reading of Formiga et al. is recommended and physicians should understand that patients with combined renal and heart failure have problems that are more than the sum of these diseases alone.

The management of these patients cannot be based on treating both diseases as separate entities. Many pathophysiological and therapeutic factors must be taken into account and a balance sought between hemodynamic and renal factors for each individual. Getting this balance right can favorably modify the patient's prognosis.

Conflicts of interest

Daniel Ferreira has received honoraria (advisory board member and/or invited speaker) from Astellas, Astra-Zeneca, Bayer, BMS/Pfizer, Boehringer-Ingelheim, Novartis, and Sanofi-Aventis.

References
[1]
J.C. Schefold, G. Filippatos, G. Hasenfuss, et al.
Heart failure and kidney dysfunction: epidemiology, mechanisms and management.
Nat Rev Nephrol, 12 (2016), pp. 610-623
[2]
K. Damman, J.M. Testani.
The kidney in heart failure: an update.
Eur Heart J, 36 (2015), pp. 1437-1444
[3]
D.L. Dries, D.V. Exner, M.J. Domanski, et al.
The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction.
J Am Coll Cardiol, 35 (2000), pp. 681-689
[4]
H.L. Hillege, A.R. Girbes, P.J. de Kam, et al.
Renal function, neurohormonal activation, and survival in patients with chronic heart failure.
Circulation, 102 (2000), pp. 203-210
[5]
G.L. Smith, J.H. Lichtman, M.B. Bracken, et al.
Renal impairment and outcomes in heart failure: systematic review and meta-analysis.
J Am Coll Cardiol, 47 (2006), pp. 1987-1996
[6]
K. Damman, G. Navis, A.A. Voors, et al.
Worsening renal function and prognosis in heart failure: systematic review and meta-analysis.
J Card Fail, 13 (2007), pp. 599-608
[7]
S.S. Gottlieb, W. Abraham, J. Butler, et al.
The prognostic importance of different definitions of worsening renal function in congestive heart failure.
J Card Fail, 8 (2002), pp. 136-141
[8]
K. Damman, W.H. Tang, J.M. Testani, et al.
Terminology and definition of changes renal function in heart failure.
Eur Heart J, 35 (2014), pp. 3413-3416
[9]
J.M. Testani, M.A. Brisco, J. Chen, et al.
Timing of hemoconcentration during treatment of acute decompensated heart failure and subsequent survival: importance of sustained decongestion.
J Am Coll Cardiol, 62 (2013), pp. 516-524
[10]
M. Metra, B. Davison, L. Bettari, et al.
Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function.
Circ Heart Fail, 5 (2012), pp. 54-62
[11]
J.M. Testani, S.G. Coca, B.D. McCauley, et al.
Impact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes.
Eur J Heart Fail, 13 (2011), pp. 877-884
[12]
F. Formiga, R. Moreno-Gonzalez, D. Chivite, et al.
Clinical characteristics and one-year mortality according to admission renal function in patients with a first acute heart failure hospitalization.
Rev Port Cardiol, 37 (2018), pp. 159-165
Copyright © 2018. Sociedade Portuguesa de Cardiologia
Idiomas
Revista Portuguesa de Cardiologia
Opções de artigo
Ferramentas
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.