Pathophysiology, Prevention, and Treatment of Severe Congestive Heart Failure Associated with Progressive Renal Failure

Abstract

Severe congestive heart failure (CHF) is progressive and almost invariably accompanied by varying degrees of renal failure. A common recommendation is to treat CHF with angiotensin converting enzyme inhibitor (ACEI) or a combination of ACEI and angiotensin receptor blocker (ARB). The result is progression of renal failure giving rise to decreased clearance of sodium and water and hence fluid overload, requiring repeated hospitalization for symptomatic relief. High doses of a combination of diuretics fail to induce adequate diuresis mainly due to very low systolic blood pressure caused by ACEI/ARB drugs. If avoidance of the use of ACEI/ARB drugs is not justifiable, approaches to afford symptomatic relief in a sustainable fashion will be diuretic infusion for 72 to 96 hours, which can be repeated as required. If diuretic response is not optimum, ultrafiltration by intermittent hemodialysis, intermittent peritoneal dialysis, or continuous ambulatory peritoneal dialysis must be initiated to provide symptomatic relief and reduce repeated hospitalization.