{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T15:31:58Z","timestamp":1774452718501,"version":"3.50.1"},"reference-count":79,"publisher":"BMJ","issue":"1","funder":[{"name":"Novartis France"},{"name":"Novartis France"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,11,1]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Cardiorenal syndrome (CRS) is the combination of acute heart failure syndrome (AHF) and renal dysfunction (creatinine clearance (CrCl) \u226460\u2009mL\/min). Real-life data were used to compare the management and outcome of AHF with and without renal dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective, multicentre.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Twenty-six academic, community and regional hospitals in France.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>507 patients with AHF were assessed in two groups according to renal function: group 1 (patients with CRS (CrCl \u226460\u2009mL\/min): n=335) and group 2 (patients with AHF with normal renal function (CrCl &gt;60\u2009mL\/min): n=172).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Differences were observed (group 1 vs group 2) at admission for the incidence of chronic heart failure (56.42% vs 47.67%), use of furosemide (60.9% vs 52.91%), insulin (15.52% vs 9.3%) and amiodarone (14.33% vs 4.65%); additionally, more patients in group 1 carried a defibrillator (4.78% vs 0%), had \u22652 hospitalisations in the last year (15.52% vs 5.81%) and were under the care of a cardiologist (72.24% vs 61.63%). Clinical signs were broadly similar in each group. Brain-type natriuretic peptide (BNP) and BNP prohormone were higher in group 1 than group 2 (1157.5 vs 534\u2009ng\/L and 5120 vs 2513\u2009ng\/mL), and more patients in group 1 were positive for troponin (58.2% vs 44.19%), had cardiomegaly (51.04% vs 37.21%) and interstitial opacities (60.3% vs 47.67%). The only difference in emergency treatment was the use of nitrates, (higher in group 1 (21.9% vs 12.21%)). In-hospital mortality and the percentage of patients still hospitalised after 30 days were similar between groups, but the median stay was longer in group 1 (8 days vs 6 days).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Renal impairment in AHF should not limit the use of loop diuretics and\/or vasodilators, but early assessment of pulmonary congestion and close monitoring of the efficacy of conventional therapies is encouraged to allow rapid and appropriate implementation of alternative therapies if necessary.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022776","type":"journal-article","created":{"date-parts":[[2019,1,15]],"date-time":"2019-01-15T14:47:04Z","timestamp":1547563624000},"page":"e022776","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of renal dysfunction on the management and outcome of acute heart failure: results from the French prospective, 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