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עמוד בית
Sat, 07.12.24

ORIGINALS

IMAJ | volume 26

Journal 10, November 2024
pages: 643-649

Using Urine Output Trending for the Management of Acute Cardiorenal Syndrome

1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel 2 Clinical Research Department, RenalSense Ltd, Jerusalem, Israel

Summary

Background:

One-third of patients with acute decompensated heart failure (ADHF) develop worsening kidney function, known as type I cardiorenal syndrome (CRS). CRS is linked to higher mortality rates, prolonged hospital stays, and increased readmissions.

Objectives:

To explore the impact of real-time monitoring of urinary output (UO) trends on personalized pharmacologic management, fluid balance, and clinical outcomes of patients with ADHF admitted to a cardiac intensive care unit.

Methods:

Our study comprised 35 patients who were hospitalized with ADHF and continuously monitored for UO (UOelec). Standard diuretic and fluid protocols were implemented after 2 hours of oliguria, and patient outcomes were compared to a historical matched control (HMC) group. Patients were assessed for daily and cumulative fluid balance (over 72 hours) as well as for the occurrence of acute kidney injury (AKI).

Results:

Significantly more patients in the UOelec group demonstrated negative fluid balance daily and cumulatively over time in the intensive care unit compared to the HMC group: 91% vs. 20%, respectively (P < 0.0001 for 72-hour cumulative fluid balance). The incidence of AKI was significantly lower in the UOelec monitoring cohort compared to the HMC: 23% vs. 57%, respectively (P = 0.003). Moreover, higher AKI resolution, and lower peak serum creatinine levels were demonstrated in the UOelec group vs. the HMC group.

Conclusions:

Implementing real-time monitoring of UO in ADHF patients allowed for early response to oliguria and goal-directed adjustment to treatment. This finding ultimately led to reduced congestion and contributed to early resolution of AKI.

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