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Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
419
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

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Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
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Heart Failure Drugs: Inotropic Agents01:26

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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Factors Affecting Renal Clearance: Renal Impairment01:17

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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
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Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
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Related Experiment Video

Updated: Jun 22, 2025

Evaluation of Cardiac Contractility Modulation Therapy in 2D Human Stem Cell-Derived Cardiomyocytes
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Long-Term Renal Function with Cardiac Contractility Modulation Therapy.

Goekhan Yuecel1,2, Babak Yazdani3, Kristin Schreiner1

  • 1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Cardiorenal Medicine
|June 27, 2024
PubMed
Summary

Cardiac contractility modulation (CCM) therapy may stabilize kidney function in heart failure patients long-term. Patients experienced improved heart function, but impaired kidney function indicated higher risks for heart failure complications.

Keywords:
Cardiac contractility modulationCardiorenal syndromeChronic heart failureChronic kidney disease

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Area of Science:

  • Cardiology
  • Nephrology
  • Medical Devices

Background:

  • Cardiac implantable electrical devices can influence kidney function via hemodynamic changes.
  • Cardiac Contractility Modulation (CCM) is a therapy for chronic heart failure (HF) patients unresponsive to medical treatment.
  • Long-term cardiorenal effects of CCM therapy require further investigation.

Purpose of the Study:

  • To evaluate the long-term (up to 60 months) impact of CCM therapy on kidney function in heart failure patients.
  • To compare kidney function changes between patients with advanced chronic kidney disease (aCKD) and those with preserved or mild CKD (pCKD).
  • To assess the relationship between baseline kidney function and HF complications post-CCM.

Main Methods:

  • The study analyzed 187 CCM recipients from the MAINTAINED study over 60 months.
  • Kidney function was monitored using serum creatinine and estimated glomerular filtration rate (eGFR).
  • Patients were stratified into aCKD (eGFR ≤59 mL/min/1.73 m2) and pCKD (eGFR ≥60 mL/min/1.73 m2) groups for comparison.

Main Results:

  • CKD stage distribution remained stable throughout the 60-month follow-up.
  • A slight but significant decline in eGFR was observed in the total cohort after 60 months, primarily in the pCKD group.
  • CCM therapy led to significant improvements in NYHA classification and LVEF in both groups.
  • Patients with aCKD experienced more HF hospitalizations and ventricular tachycardias.

Conclusions:

  • CCM therapy may maintain stable kidney function and CKD stage in heart failure patients long-term.
  • Improvements in LVEF and functional status were observed irrespective of baseline kidney function.
  • Pre-existing impaired kidney function in CCM patients may be linked to increased cardiovascular comorbidities and higher risk of HF complications.