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VOLUME ASSESSMENT IN THE ACUTE HEART AND RENAL FAILURE
BOŽIDAR VUJIČIĆ
; Department of Nephrology and dialysis, Clinical Hospital Centre Rijeka, Rijeka, Croatia
ALEN RUŽIĆ
; Department of Cardiology, Clinic for Internal Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia
LUKA ZAPUTOVIĆ
; Department of Cardiology, Clinic for Internal Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia
SANJIN RAČKI
; Department of Nephrology and dialysis, Clinical Hospital Centre Rijeka, Rijeka, Croatia
Abstract
Acute kidney injury (aki) is an important clinical issue, especially in the setting of critical care. it has been shown in multiple studies to be a key independent risk factor for mortality, even after adjustment for demographics and severity of illness. there is wide agreement that a generally applicable classification system is required for aki which helps to standardize estimation of severity of renal disfunction and to predict outcome associated with this condition. that’s how rifLe (risk-injury-failure-Loss-end-stage renal disease), and akiN (acute kidney injury Network) classifications for aki were found in 2004 and 2007, espectively. in the clinical setting of heart failure, a positive fluid balance (often expressed in the literature as weight gain) is used by disease management programs as a marker of
heart failure decompensation. oliguria is defined as urine output less than 0,3 ml/kg/h for at least 24 h. since any delay in treatment can lead to a dangerous progression of the aki, early recognition of oliguria appears to be crucial. critically ill patients with oliguric aki
are at increased risk for fluid imbalance due to widespread systemic inflammation, reduced plasma oncotic pressure and increased capillary
leak. these patients are particulary at risk of fluid overload and therefore restrictive strategy of fluid administration should be used. objective, rapid and accurate volume assessment is important in undiagnosed patients presenting with critical illness, as errors may
result in interventions with fatal outcomes. the historical tools such as physical exam, and chest radiography suffer from significantlimitations. as gold standard, radioisotopic measurement of volume is impractical in the acute care enviroment. Newer technologies
offer the promise of both rapid and accurate bedside estimation of volume status with the potential to improve clinical outcomes. Blood assessment with bioimpendance vector analysis, and bedside ultrasound seem to be promising technologies for this need.
Keywords
acute renal failure; acute heart failure; bioimpedance; biomarkers; volume assessment
Hrčak ID:
99539
URI
Publication date:
3.4.2013.
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