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Eur J Emerg Med. 2018 Aug;25(4):229-236. doi: 10.1097/MEJ.0000000000000505.

Practical management of concomitant acute heart failure and worsening renal function in the emergency department.

Author information

1
INSERM, Clinical Investigation Center - Unit 1433, Vandoeuvre les Nancy, University of Lorraine.
2
Vandoeuvre les Nancy,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy.
3
Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
4
Emergency Department.
5
Department of Cardiology and Clinical Research Center, University Hospital of Reims.
6
Intensive Care Unit of Brabois, Department of Cardiology and Cardiothoracic Surgery, University Hospital of Nancy.
7
Department of Cardiology, EA 3920, University Hospital of Besançon.
8
INSERM 942, University Hospital of Lariboisière, Paris.
9
Great Network.
10
Emergency Department, University Hospital of Strasbourg.
11
EA 7293 'Vascular Stress, Department of Translational Medicine of Strasbourg'.
12
Emergency Department, Regional Hospital of Mercy.
13
Department of Cardiology and Cardiothoracic Surgery, Civil Hospital, Strasbourg.
14
Heart Failure Unit, Competence Center in Cardiomyopathy.
15
Department of Cardiology, University Hospital, Mulhouse, France.
16
Department of Cardiology, Regional Hospital, Mercy Hospital, Metz.

Abstract

Worsening renal function (i.e. any increase in creatinine or decrease in the estimated glomerular filtration rate) is common in patients admitted for acute heart failure in the emergency department. Although worsening renal function (WRF) has been associated with the occurrence of dismal outcomes, this only appears to be the case when associated with clinical deterioration. However, if the clinical status of the patient is improving, a certain increase in serum creatinine may be acceptable. This WRF, which is not associated with clinical deterioration or adverse outcomes (e.g. during treatment up-titration), has been referred to as 'pseudo-WRF' and should not detract clinicians from targeting 'guideline-recommended' therapies. This is an important message for emergency physicians to pursue diuretics as long as signs of pulmonary congestion persist to improve the clinical status of the patient. In the present review, we aim to provide clinicians in acute settings with an integrative and comprehensive approach to cardiorenal interactions in acute heart failure.

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