IMAJ | volume 26
Journal 10, November 2024
pages: 643-649
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 (UO
elec). 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 UO
elec 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 UO
elec 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 UO
elec 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.