Heart Failure and Kidney Disease: Management in the Short-Stay Unit

Abstract

Both heart failure and kidney disease are among the fastest growing diagnoses in the United States. The presentation of a patient with heart failure and concomitant kidney disease describes one of the most complex patient populations to manage. Unfortunately, recent data indicates that more than half of heart failure patients have underlying kidney dysfunction. Current treatment options for managing acutely decompensated heart failure focus on improving heart function through reductions in preload, afterload, and increasing cardiac output. However, these modalities can damage renal function; therefore, additional treatment options must be considered when managing patients with heart failure and underlying renal dysfunction. This chapter explores diagnostic, therapeutic, and prognostic options that can be employed when dealing with this often overlooked patient population. Although there are well-established guidelines for managing heart failure and kidney disease alone, the lack of significant randomized clinical trials guiding management of their copresentation in the emergency department and short-stay unit has slowed development of evidence-based treatment guidelines. This chapter will mainly focus on the additional management of patients with heart failure and concomitant kidney disease in the short-stay unit. New York Heart Association heart failure class IV and end-stage renal disease will not be considered in this presentation.