Related Experiment Video
Updated: Jun 7, 2025
Use of a Hanging-weight System for Isolated Renal Artery Occlusion
Published on: July 19, 2011
Using Urine Output Trending for the Management of Acute Cardiorenal Syndrome
Anna Rozenfeld1, Aliza Goldman2, Tal Stern2
1Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
Real-time urinary output monitoring in acute decompensated heart failure (ADHF) patients improves fluid balance and reduces acute kidney injury (AKI). This early intervention strategy leads to better clinical outcomes and faster AKI resolution.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Acute decompensated heart failure (ADHF) frequently leads to cardiorenal syndrome (CRS), characterized by worsening kidney function.
- Type I CRS is associated with increased mortality, prolonged hospitalization, and higher readmission rates in ADHF patients.
Purpose of the Study:
- To evaluate the impact of continuous urinary output (UO) monitoring on personalized treatment strategies in ADHF patients.
- To assess the effect of real-time UO monitoring on fluid balance and clinical outcomes within a cardiac intensive care unit setting.
Main Methods:
- A cohort of 35 ADHF patients underwent continuous UO monitoring (UOelec).
- Standard diuretic and fluid protocols were initiated after 2 hours of oliguria.
- Outcomes, including fluid balance and acute kidney injury (AKI) incidence, were compared to a historical matched control (HMC) group.
Main Results:
- The UOelec group showed significantly greater negative fluid balance daily and cumulatively (91%) compared to the HMC group (20%).
- The incidence of AKI was substantially lower in the UOelec group (23%) versus the HMC group (57%).
- Higher AKI resolution rates and lower peak serum creatinine levels were observed in the UOelec cohort.
Conclusions:
- Real-time UO monitoring facilitates early detection of oliguria and goal-directed therapeutic adjustments in ADHF.
- This approach effectively reduces fluid overload (congestion) and promotes earlier resolution of acute kidney injury.
- Implementing continuous UO monitoring can improve patient outcomes in critical care settings for ADHF.
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.
Related Concept Videos
01:22Heart Failure Drugs: Diuretics
01:26Regulation of Water Output
01:11Renal Failure: Dose Adjustments
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...
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:28Renal Drug Excretion: Tubular Secretion