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Current management of heart failure includes intravenous or oral diuretic.
However, many times, diuretics caused severe increase of blood urea nitrogen (BUN) or creatinine level. These increases may require discontinuation of diuretics or even resumption of IV fluid. How to predict which HF patient will develop increase of BUN and creatinine or renal failure with diuretic?
Patients with HF were enrolled from the emergency room. They were divided in 2 groups. Group 1 had conventional treatment and group 2 had the new Expansibility of the Femoral Vein (EFV) of which the results were shown to the investigators. The EFV is a venous ultrasound exam of the femoral vein testing the expansibility of the femoral vein. If the size of the femoral vein is equal or slightly larger than the size of the femoral artery, above its bifurcation, the size of the femoral vein is considered normal. This is based on the presumption that the amount of blood entering the lower leg via the iliac artery should be the same amount which returns via the femoral vein. If the size of the femoral vein is 2 times larger than the size of the femoral artery, this result showed that the patient has fluid overload. Then the patients could be started on diuretics. If the patient had no enlarged femoral vein, diuretics were not given or given at very low amount.
25 patients with diagnosis of acute on chronic systolic HF were enrolled from December 2015 to May 2016. The EFV results showed that 20/25 patients had abnormal EFV test caused by enlarged femoral vein. The patient with abnormal EFV test were given liberal intravenous diuretics and 18/20 of these patients did not have increase BUN or creatinine. One patient had small femoral vein and only 20mg of furosemide brought his creatinine from 0.9mg to 2.0mg overnight.
The patients with HF should have the EFV early and its results helped to guide the use of diuretics without causing renal failure.