Abstract: PUB044
Inadequate Diuresis due to AKI in Cardiorenal Syndrome Patients
Session Information
Category: Acute Kidney Injury
- 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention
Authors
- Medikayala, Sushma, Cleveland Clinic Florida, Weston, Florida, United States
- Njaravelil, Kristi A., Nova Southeastern University, Fort Lauderdale, Florida, United States
- Gebreselassie, Surafel K., Cleveland Clinic Florida, Weston, Florida, United States
Background
Objective: To find out if patients with CHF are underdiuresed due to AKI. Background: 20-40% of inpatients with acute CHF develop AKI. Providers in dilemma to continue diuretics to treat fluid overload or reduce diuretics to avoid dialysis. This is a grey zone with no clear answers, consensus or treatment protocols. Renal parameter used to define AKI is creatinine (Cr). In AKI, Cr relates to glomerular function and does not represent true tubular injury. Is the AKI present on admission (CRS) or developed with the use of diuretics?
In patients that receive diuretics, elevation of Cr could be due to: i) Redistribution of fluid occurs within different body compartments. Increase in Cr is a reflection of changed hemodynamic and hormonal changes. ii) hypovolemia with prerenal state due to diuresis- as kidney sees less volume, it will increase reabsorption of Na, Urea, Uric acid, Creatinine, leading to elevated Cr and Bun. At this stage, there is no anatomic injury to the nephrons. iii) True AKI - either directly from long standing CRS or persistant hypovolemia from aggressive diuresis, ATN develops. Here, there is real damage to the tubules. It is a common myth that Lasix is nephrotoxic. In reality, Lasix is not Nephrotoxic. But why does the creatinine rise with diuretics? It is due to the hypovolemia, prerenal state caused by Lasix. Lasix does not cause direct toxic injury to the tubules.
iv) Acute GN- Patient has concomitant Glomerulo nephritis unrelated to CRS. v) ineffective diuresis due to hypoalbuminemia as albumin is the carrier for Lasix to the site of action in renal tubules. vi) Nephrotic syndrome- albumin in the tubules binds Lasix and effective circulatory Lasix is reduced. i-iii - not associated with true renal tubule damage. There is a critical need for guidelines and best clinical practice models for management of diuresis in cardiorenal syndrome patients.
Methods
Retrospective Chart Review
Results
Pts with CHF and AKI-145. Pts with AKI as per RIFLE classification- 16, 3 with indadequate data. Pts with CRS 10, developed AKI due to diuresis 3. Of the 10 CRS patients, at the time of discharge, 5 gained wt, 5 lost wt, 4 readmissions. AKI due to diuretics-3, at the time of discharge, 2 gained wt, 1 lost wt and 1 readmission.
Conclusion
Though small sample size, study indicates that CRS patients are underdiuresed due to AKI leading to readmissions. Future prospective studies needed.