Abstract: TH-OR15
Ultrasound-Guided Diuretic Therapy in Type 1 Cardiorenal Syndrome: A Randomized, Double-Blind Controlled Trial
Session Information
- AKI: New Frontiers in Prognostication and Management
October 24, 2024 | Location: Room 6C, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Gomez Johnson, Victor Hugo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Estado de Mexico, Mexico
- Jaime Borja, Erika Elizabet, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Estado de Mexico, Mexico
- Fuentes Mercado, Alfredo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Estado de Mexico, Mexico
- Amaro Palomo, Eder Jonathan, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Estado de Mexico, Mexico
- Arias Escarpulli, Romeo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Estado de Mexico, Mexico
- Gopar-Nieto, Rodrigo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Estado de Mexico, Mexico
- Gil, Salvador Lopez, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Estado de Mexico, Mexico
Group or Team Name
- NEEDED-Trial.
Background
Traditional diuretic titration in cardiorenal syndrome (CRS) relies on physical exams.New tools like VExUS show potential, but evidence is limited.This study compares VExUS-guided decongestion to physical exams in improving outcomes.
Methods
In this double-blind, randomized, controlled trial, 34 CRS patients undergoing decongestive therapy were enrolled. Clinical Congestion Score (CCS) group with a single observer assessed orthopnea, jugular venous distension, and edema on a scale of 0-3. VExUS group had a different observer evaluating inferior vena cava diameter, hepatic vein, portal vein, and intra-renal venous doppler. Both assessments continued until decongestion (CCS<3;VExUS 0-1) or 7 days.
Results
Baseline characteristics were similar, including sick patients (SCr 2.1mg/dL, LVEF 27%, NT-proBNP 19336pg/mL).VExUS-guided treatment showed better trends: higher UNa, lower discharge NT-proBNP, fewer readmissions, and lower in-hospital mortality (see table 1). 30-day mortality was lower in the VExUS-guided group (p=0.05).
Conclusion
VExUS-guided treatment was associated to lower 30-day mortality (p=0.05), increased UNa, decreased NT-proBNP at discharge, fewer readmissions, and reduced in-hospital mortality. As the trial continues, a larger population is anticipated to provide more definitive results. Further studies should assess the relevance and impact on these patients.
Table 1. Outcomes
| Variables | Total n=34 | Control group n=12 | VExUS group n=22 | p |
| Heart failure readmission n(%) | 7(21.9) | 4(33.3) | 3(15) | 0.37 |
| NT-proBNP at discharge (pg/mL) Median (IQR) | 9333(4064-29058) | 15658(3492-34813) | 7997(4500-26380) | 0.19 |
| In-hospital mortality n(%) | 4(12.1) | 3(25) | 1(4.8) | 0.12 |
| Urinary sodium (mmol/L) Median (IQR) | 86.2(65-112.6) | 85.4(63.5-100.4) | 91.5(69-117) | 0.36 |
| 30-day mortality n(%) | 2(6.2) | 2(16.7) | 0 | 0.05 |