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

Ferreira, João Pedroa,d,p,*; Chouihed, Tahara,b,d,*; Nazeyrollas, Pierree; Levy, Brunoa,c; Seronde, Marie F.f,g,k; Bilbault, Pascalh,i; Braun, Françoism; Roul, Géraldj,l; Kénizou, Davido; Zannad, Nouran,d; Girerd, Nicolasa,d; Rossignol, Patricka,d

European Journal of Emergency Medicine: August 2018 - Volume 25 - Issue 4 - p 229–236
doi: 10.1097/MEJ.0000000000000505

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.

aINSERM, Clinical Investigation Center – Unit 1433, Vandoeuvre les Nancy, University of Lorraine

bEmergency Department

cIntensive Care Unit of Brabois, Department of Cardiology and Cardiothoracic Surgery, University Hospital of Nancy

Vandoeuvre les Nancy,dINI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy

eDepartment of Cardiology and Clinical Research Center, University Hospital of Reims

fDepartment of Cardiology, EA 3920, University Hospital of Besançon

gINSERM 942, University Hospital of Lariboisière, Paris

hEmergency Department, University Hospital of Strasbourg

iEA 7293 ‘Vascular Stress, Department of Translational Medicine of Strasbourg’

jDepartment of Cardiology and Cardiothoracic Surgery, Civil Hospital, Strasbourg

kGreat Network

lHeart Failure Unit, Competence Center in Cardiomyopathy

mEmergency Department, Regional Hospital of Mercy

nDepartment of Cardiology, Regional Hospital, Mercy Hospital, Metz

oDepartment of Cardiology, University Hospital, Mulhouse, France

pCardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal

* João Pedro Ferreira and Tahar Chouihed contributed equally to the writing of this article.

Correspondence to Patrick Rossignol, MD, PhD, INSERM, Clinical Investigation Center – Unit 1433, University of Lorraine, University Hospital of Nancy, 54500 Vandoeuvre les Nancy, France Tel: +33 3 83 15 73 33; fax: +33 3 83 15 73 24; e-mail:

Received February 15, 2017

Accepted August 29, 2017

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