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Kidney dysfunction is a major prognostic variable in patients admitted for acute heart failure (AHF).
Adenosine, through its action on type 1 receptors, causes afferent glomerular arteriole constriction in response to increased sodium delivery, as after loop diuretics administration. Adenosine type 1 receptor antagonists are a new class of agents for the treatment of AHF and cardio-renal syndrome. These agents have been shown to improve renal blood flow and glomerular filtration rate in patients with AHF and fluid overload.
In a pilot study , the adenosine type 1 receptor antagonist rolofylline has improved symptoms and outcomes in 182 patients with AHF.
This hypothesis has now been tested in a large multicenter trial (PROTECT) in 2000 patients with AHF, fluid overload, mild to moderate renal dysfunction, and high BNP/ NT-proBNP levels whose results will be available by the end of this year.
Teaching objective of the lecture:
Show the pathophysiologic basis and current evidence of the effects of adenosine type 1 receptor antagonists on renal function, symptoms and outcomes in the patients with acute heart failure, renal dysfunction and fluid overload.
Take home messages:
- Role of kidney dysfunction in the prognosis of patients with acute heart failure
- Results with adenosine type 1 receptor antagonists in patients with acute heart failure
- Ongoing trials with adenosine type 1 receptor antagonists in heart failure.