24 Cardiorenal Interaction Figure 1. Cardiorenal interaction and stage classification in the initiation and progression of chronic kidney disease and heart failure  and . CVD, cardiovascular disease; HF, heart failure; GFR, glomerular filtration rate.Figure 1. Cardiorenal interaction and stage classification in the initiation and progression of chronic kidney disease and heart failure  and . CVD, cardiovascular disease; HF, heart failure; GFR, glomerular filtration rate.
33 A Prospective, Blinded Study of Bioimpedance Vector Analysis and Biomarker Testing for the Prediction of Worsening Renal Function in Consecutive Patients with Acutely Decompensated Heart Failure: Primary Results of the Biomonitoring and Cardiorenal Syndrome in Heart Failure (BIONICS-HF) Trial
34 Independent role of high central venous pressure in predicting worsening of renal function in chronic heart failure outpatients
37 Potential Effects of Digoxin on Long-Term Renal and Clinical Outcomes in Chronic Heart Failure
38 Fig. 2. Adjusted survival curves grouped by randomization to digoxin or placebo and subsequent improved renal function (IRF) status, in patients with a serum digoxin level #0.8 ng/mL. IRF defined as $20% improvement in estimated glomerular filtration rate (eGFR) from randomization to 1 year. Covariates adjusted for: age, race, ejection fraction, heart rate, systolic blood pressure, New York Heart Association functional class, diabetes, baseline use of digoxin, hydralazine, nitrates, diuretics, or angiotensin-converting enzyme inhibitors, physical examination findings, cardiothoracic ratio, and baseline eGFR. Overall between-group differences: P Comparisons of the Yes IRF/Yes Digoxin (n 5 58) and the No IRF/No Digoxin group (n 5 409; P ), No IRF/Yes Digoxin (n 5 213; P ), and Yes IRF/No Digoxin (n 5 60; P ) groups were all statistically significant.
42 UltrafiltrationFigure 1. Water and solute transport in IU. Water molecules cross semipermeable membranes by UF, that is, a fluid shift driven by a hydrostatic pressure difference (TMP), according to the formula: Hourly fluid removal in IU=TMP×KUFwhere KUF is the UF coefficient of the filter, that is, the intrinsic permeability of the membrane. It represents the theoretical amount of plasma water transported in the unit of time per unit of TMP applied across the membrane (mL/mm Hg per hour). For example, given a filter KUF of 10 mL/mm Hg per hour, if TMP is 150 mm Hg, the maximum ultrafiltrate volume in 1 hour (hourly UF rate) will be 150 × 10 = 1.5 L. Hourly UF rate is directly set on the machine that modulates TMP according to the programmed weight loss. Solutes are dragged along with plasma water across the membrane (solvent drag: solutes with molecular size lower than membrane pores are transported with the solvent) (B). Urea (60 D) or electrolytes (sodium 23 D and potassium 35 D) will be moved easily; on the contrary, high-molecular-weight solutes (eg, albumin D) will not undergo the solvent drag effect. TMP, Transmembrane pressure; D, Daltons.
44 Nesiritide奈西立肽 recombinant human B-type natriuretic peptide (BNP), acts at the natriuretic peptide A receptor (NPR-A)to decrease preload, afterload, and PCWP,increase CO, increase urine output, and improve diastolic function.Adverse effects include headache andhypotension.
46 Carperitide 卡培立肽 Carperitide, or A-type natriuretic peptide (ANP), acts as a stronger agonist than BNP at NPR-A. Itshemodynamic effects are similar to those of nesiritide,Although it has more robust natriuretic and diuretic effects that are more pronounced in healthy subjects than in patients with HF.It increases and decreases MAP and PCWP, and its most common adverse effect is hypotension.
47 Urodilatin肾钠素 Ularitide, the product of differential processing of the pro-ANP precursor in the kidney, acts onNPR-A in the collecting ductthereby increasing excretion of water and sodium.it decreased PCWP, decreasedMAP, and increased CI, while down-regulating the RAAS and improving renal sodium excretion in healthy volunteers.The most common adverse effect is dosedependent hypotension.
48 CD-NP CD-NP (or ‘‘cenderitide’’) is a chimeric NP synthesized from C-type natriuretic peptide (CNP) and Dendroaspis natriuretic peptide (DNP).CNP originates from endothelial cells and activates NPR-B, resulting predominately in venodilationDNP was isolated from the green mamba snake and activates NPR-A, with effects similar to those of ANP and BNPBy fusing the DNP tail to CNP, an NP is created that acts as a partial agonist of NPR-A and an agonist of NPR-BCD-NP decreases PCWP and causes natriuresis and diuresis without a significant decrease in MAP in animal modelsIt significantly decreases Cr compared with furosemide in patients with stableto cause a dose-dependent decrease in SBP
49 Soluble Guanylyl Cyclase Agents Cinaciguat. Cinaciguat (or BAY ) is an NO independent sGC activator that is effectiveCinaciguat decreases diastolic blood pressure compared with placebo without significantly decreasing SBP, and in patientswith ADHFit decreases PCWP and MAP and increasesCO without significantly changing Cr.Dose-dependent hypotension is the most common adverse effect.
50 RAAS-Modifying Agents Aliskiren阿利吉仑. Aliskiren is an oral direct renin inhibitorthat blocks formation of angiotensin I and II without affecting kinin metabolism.decrease SVR and PCWP in patients with decompensated HF,Decreased N-terminal prohormone of BNP (NT-proBNP),plasma renin activity, and urinary aldosterone.Hyperkalemia,hypotension, and decreased renal function have been reported as adverse effects.
51 Relaxin松弛素 Relaxin, the hormone responsible for many of the maternal hemodynamic changes in pregnancy, acts as a systemic, renal, and coronary vasodilator in animalmodelsdecreasing afterload, increasing CO, anddecreasing the risk of infarction during periods of myocardial ischemia.In humans with HF, relaxin levels wereincreased and correlated with disease severityit increased CI and decreased PCWP, NT-proBNP, and Cr. No adverse effects have been reported.
52 Hydralazine肼苯哒嗪 Hydralazine is a direct vasodilator with an unknown mechanism of action that decreases afterload and improves stroke volume, increases renal blood flowand has a moderate direct inotropic effect.Adverse effectsinclude hypotension, nausea, headache, and tachycardia.