Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure

Justin L. Grodin, Susanna R. Stevens, Lisa De Las Fuentes, Michael Kiernan, Edo Y. Birati, Divya Gupta, Bradley A. Bart, G. Michael Felker, Horng H. Chen, Javed Butler, Victor G. Dávila-Román, Kenneth B. Margulies, Adrian F. Hernandez, Kevin J. Anstrom, W. H.Wilson Tang

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Background Worsening renal function in heart failure may be related to increased venous congestion, decreased cardiac output, or both. Diuretics are universally used in acute decompensated heart failure, but they may be ineffective and may lead to azotemia. We aimed to compare the decongestive properties of a urine output-guided diuretic adjustment and standard therapy for the management of cardiorenal syndrome in acute decompensated heart failure. Methods and Results Data were pooled from subjects randomized to the stepwise pharmacologic care algorithm (SPCA) in the CARRESS-HF trial and those who developed cardiorenal syndrome (rise in creatinine >0.3 mg/dL) in the DOSE-AHF and ROSE-AHF trials. Patients treated with SPCA (n = 94) were compared with patients treated with standard decongestive therapy (SDT) that included intravenous loop diuretic use (DOSE-AHF and ROSE-AHF; n = 107) at the time of cardiorenal syndrome and followed for net fluid balance, weight loss, and changing renal function. The SPCA group had higher degrees of jugular venous pressure (P <.0001) at the time of cardiorenal syndrome. The group that received SPCA had more weight change (-3.4 ± 5.2 lb) and more net fluid loss (1.705 ± 1.417 L) after 24 hours than the SDT group (-0.8 ± 3.4 lb and 0.892 ± 1.395 L, respectively; P <.001 for both) with a slight improvement in renal function (creatinine change -0.1 ± 0.3 vs 0.0 ± 0.3 mg/dL, respectively; P =.03). Conclusions Compared with SDT, patients who received an intensification of medication therapy for treating persisting congestion had greater net fluid and weight loss without being associated with renal compromise.

Original languageEnglish
Pages (from-to)26-32
Number of pages7
JournalJournal of Cardiac Failure
Issue number1
StatePublished - Jan 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.


E. Y. Birati: research support from Thoratec and Heartware. J. Butler: research support from the National Institutes of Health, European Union, and the Food and Drug Administration; consultant to Amgen, Bayer, Celladon, Covis Medtronic, Janssen, Novartis, Relypsa, Stealthpeptide, Takeda, and Trevena. A. F. Hernandez: research support from Amgen, Astrazeneca, BMS, GSK, Novartis, and Janssen; honoraria from Amgen, Novartis, and Janssen. All other authors have nothing to disclose.

FundersFunder number
National Institutes of Health
U.S. Food and Drug Administration
National Heart, Lung, and Blood InstituteU10HL110338
Takeda Pharmaceutical Company
European Commission


    • Acute decompensated heart failure
    • cardiorenal syndrome
    • diuretics


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