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Heart failure
Published in Henry J. Woodford, Essential Geriatrics, 2022
Classical heart failure symptoms are breathlessness on exertion, ankle swelling and orthopnoea. Medications that can contribute to fluid overload should be identified (seeTable 17.1). There is a risk that the precipitation of oedema can be wrongly labelled as heart failure leading to a prescribing cascade (see page 55).
Cardiology
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Presents as a pan-systolic murmur heard at the apex of the heart radiating to the axilla (Figure 1.4.3). Best heard rolling onto left-hand side and breathing out. Causes: (1) Papillary muscle dysfunction/chordal rupture (post-MI), (2) dilated cardiomyopathy, (3) rheumatic fever/IE, (4) CTD.Symptoms: Dyspnoea, palpitations, fatigue.O/E: Pan-systolic murmur heard at the 5th intercostal space, mid-clavicular apex of the heart radiating to the axilla. AF, displaced thrusting apex (fluid overload), soft S1, LVF (S3, pulmonary oedema), loud P2 and right ventricular heave (pulmonary hypertension).Investigations: ECG (LVH, AF ± p-mitrale), CXR (pulmonary oedema, cardiomegaly), echocardiogram.Management: Control rate if in AF and anticoagulated. Diuretics for fluid overload. Surgery for deteriorating symptoms.
Hemorrhagic Fever with Renal Syndrome: A Historical Perspective and Review of Recent Advances
Published in James H. S. Gear, CRC Handbook of Viral and Rickettsial Hemorrhagic Fevers, 2019
The diuretic phase, lasting from a few days to several weeks, is associated with improvement in renal function and marks the beginning of clinical recovery. However, in a severely ill patient, already dehydrated or with electrolyte disturbances, a sudden diuresis of 3 or more liters daily can result in life-threatening shock. Fluid overload, on the other hand, may lead to hypertension and pulmonary edema, which account for many of the iatrogenic deaths occurring during this phase. During the convalescent phase, patients (except those suffering central nervous system insults) recover completely, gradually regaining appetite and strength. Proteinuria and azotemia resolve over a few weeks, but renal function, particularly urine-concentrating ability, may not return to normal for several weeks to 6 months or more.41,42
Effect of bioelectrical impedance technology on the prognosis of dialysis patients: a meta-analysis of randomized controlled trials
Published in Renal Failure, 2023
Kaibi Yang, Shujun Pan, Nan Yang, Juan Wu, Yueming Liu, Qiang He
Fluid overload is highly associated with patient mortality [30]. Clinical auxiliary tools allow clinicians to better manage the dry weight of dialysis patients; however, before applying these tools on a large scale, we must first establish their benefit to patients. The clear criterion is the mortality rate of the patient. The results of our meta-analysis demonstrate that bioelectrical impedance technology could reduce the risk of death of patients. Volume overload has been presumed to be one of the main causes of death in dialysis patients. However, the results of the current three meta-analyses showed that although bioelectrical impedance technology intervention could reduce systolic blood pressure and excessive hydration in dialysis patients, it has no positive effect on their mortality [31–33]. The factors affecting the death of dialysis patients are intricate. Studies have shown that age, diabetes, tumors, smoking, inflammation, residual renal function, and LVH are related to the death of dialysis patients [34,35]. Adjusting the fluid volume in patients with end-stage renal failure to an appropriate ‘dry body weight’ is a slow and persistent process that must be followed up long enough to observe clinically meaningful results. Previous meta-analyses included relatively few RCTs; we included more RCTs with larger sample sizes. Hence, the results are more convincing.
The role of plasma volume and fluid overload in the tolerance to ultrafiltration and hypotension in hemodialysis patients
Published in Renal Failure, 2023
Jesús Manolo Ramos-Gordillo, Carlos Pérez-Campuzano, Elizabeth Relles-Andrade, José Carlos Peña-Rodríguez
With BIS we estimated further the impact of the UF in the body water distribution. The results obtained after UF showed a significant decrease in TBW Post and ECW Post and at 2 h (p < 0.001); a full recovery was observed after 48 and 72 h (Figure 5). In Table 4 and Figure 6, we displayed the results before and after UF. The decrease in BW, TBW; ECW, PV and FO, showed a significant fall after UF, and a significant increase in the PhA (Table 6). We also analyzed these results accordingly to the state of fluid overload. For that purpose, we estimated the amount of FO in liters. We divided the population in two groups the ones with an FO of 2.48 ± 1.24 liters or Low group (n = 27); and another with a mean FO of 6.85 ± 1.94 or High group (n = 12); the non-paired t test among these groups was significant (p < 0.003).
Effects of sacubitril-valsartan in patients undergoing maintenance dialysis
Published in Renal Failure, 2023
Ying Ding, Li Wan, Zhou-cang Zhang, Qing-hua Yang, Jia-xiang Ding, Zhen Qu, Feng Yu
We further carried out a subgroup analysis. Interestingly, SV-PD (SV group-PD subgroup) group had a more pronounced decrease in cardio-markers compared to HD patients. A significant improvement in LVEF was found in PD when compared to its corresponding control group, which was not observed in the SV-HD (SV group-HD subgroup) group. As this phenomenon was not reported by previous studies, the possible mechanism remained to be elucidated. It was inferred that changes in body fluid might make a contribution. Fluid overload is one of the major determinants of mortality in advanced CKD patients which would act on the cardiovascular system, leading to hypertension, left ventricular hypertrophy, and finally heart failure [22,23]. Peritoneal ultrafiltration and residual renal function are the two main ways of removing excess water from PD patients. A loss of urine output was noted in both SV and the control groups, which indicated that SV was not able to retain the residual renal function. So, the alleviation of the fluid should attribute to the increasing peritoneal ultrafiltration after SV initiation. Numerous factors can influence PD ultrafiltration [24, 25] which rendered the ultrafiltration more difficult to control compared to HD patients. Zhang F et al. conducted a short-term observation of the effect of SV on peritoneal ultrafiltration and found that SV increased ultrafiltration by 66.4 mL/24h in PD patients within 7 days after its use [26]. Our study had similar results, and moreover, we had a much longer follow-up time which proved that the effect of SV on increasing peritoneal ultrafiltration was sustainable.