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  1. Article ; Online: The War of Attrition on Diuretic Resistance: We Need to Open a Third Front.

    Kazory, Amir

    Cardiorenal medicine

    2023  Volume 13, Issue 1, Page(s) 259–262

    MeSH term(s) Humans ; Diuretics/pharmacology ; Diuretics/therapeutic use ; Heart Failure ; Cardio-Renal Syndrome
    Chemical Substances Diuretics
    Language English
    Publishing date 2023-08-28
    Publishing country Switzerland
    Document type Letter
    ZDB-ID 2595659-0
    ISSN 1664-5502 ; 1664-3828
    ISSN (online) 1664-5502
    ISSN 1664-3828
    DOI 10.1159/000533478
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Pregnancy in end-stage kidney disease: Great news that needs to be handled carefully.

    Kazory, Amir

    Hemodialysis international. International Symposium on Home Hemodialysis

    2023  Volume 27, Issue 2, Page(s) E29–E32

    Abstract: Compared to women with normal kidney function, women with end-stage kidney disease (ESKD) are much less likely to become pregnant, but more likely to have a complicated pregnancy. While renal transplantation remains the best option for women who desire ... ...

    Abstract Compared to women with normal kidney function, women with end-stage kidney disease (ESKD) are much less likely to become pregnant, but more likely to have a complicated pregnancy. While renal transplantation remains the best option for women who desire to have a child, pregnancy on dialysis should be considered an option for those who may not receive a transplant during their reproductive years. Many physicians do not encounter a pregnant patient with ESKD during their nephrology training, and may not feel prepared to provide care for such patients in a busy practice. In this paper, we briefly provide an overview of the most significant practical points related to management of a pregnant patient with ESKD through a real-life case with twin pregnancy. The two key elements in management of these patients would be an intensified hemodialysis regimen and a multidisciplinary team that can provide frequent, regular, and multifaceted assessments.
    MeSH term(s) Female ; Humans ; Pregnancy ; Kidney Failure, Chronic/therapy ; Kidney Failure, Chronic/etiology ; Kidney Transplantation/adverse effects ; Nephrology ; Renal Dialysis/adverse effects ; Transplants
    Language English
    Publishing date 2023-03-16
    Publishing country Canada
    Document type Case Reports
    ZDB-ID 2192458-2
    ISSN 1542-4758 ; 1492-7535
    ISSN (online) 1542-4758
    ISSN 1492-7535
    DOI 10.1111/hdi.13079
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Combination Diuretic Therapy to Counter Renal Sodium Avidity in Acute Heart Failure: Trials and Tribulations.

    Kazory, Amir

    Clinical journal of the American Society of Nephrology : CJASN

    2023  Volume 18, Issue 10, Page(s) 1372–1381

    Abstract: In contrast to significant advances in the management of patients with chronic heart failure over the past few years, there has been little change in how patients with acute heart failure are treated. Symptoms and signs of fluid overload are the primary ... ...

    Abstract In contrast to significant advances in the management of patients with chronic heart failure over the past few years, there has been little change in how patients with acute heart failure are treated. Symptoms and signs of fluid overload are the primary reason for hospitalization of patients who experience acute decompensation of heart failure. Intravenous loop diuretics remain the mainstay of therapy in this patient population, with a significant subset of them showing suboptimal response to these agents leading to incomplete decongestion at the time of discharge. Combination diuretic therapy, that is, using loop diuretics along with an add-on agent, is a widely applied strategy to counter renal sodium avidity through sequential blockade of sodium absorption within renal tubules. The choice of the second diuretic is affected by several factors, including the site of action, the anticipated secondary effects, and the available evidence on their efficacy and safety. While the current guidelines recommend combination diuretic therapy as a viable option to overcome suboptimal response to loop diuretics, it is also acknowledged that this strategy is not supported by strong evidence and remains an area of uncertainty. The recent publication of landmark studies has regenerated the interest in sequential nephron blockade. In this article, we provide an overview of the results of the key studies on combination diuretic therapy in the setting of acute heart failure and discuss their findings primarily with regard to the effect on renal sodium avidity and cardiorenal outcomes.
    MeSH term(s) Humans ; Diuretics/therapeutic use ; Heart Failure/drug therapy ; Kidney ; Sodium ; Sodium Potassium Chloride Symporter Inhibitors/therapeutic use
    Chemical Substances Diuretics ; Sodium (9NEZ333N27) ; Sodium Potassium Chloride Symporter Inhibitors
    Language English
    Publishing date 2023-04-27
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.0000000000000188
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Chloride and Cardiorenal Interactions in Heart Failure.

    Kazory, Amir

    Nephron

    2022  Volume 147, Issue 1, Page(s) 6–8

    Abstract: The cardiorenal literature has long been dominated by a sodium-centric view. However, mechanisms affecting sodium homeostasis in patients with heart failure (HF) commonly lead to concurrent changes in the serum levels of chloride as well. There is a ... ...

    Abstract The cardiorenal literature has long been dominated by a sodium-centric view. However, mechanisms affecting sodium homeostasis in patients with heart failure (HF) commonly lead to concurrent changes in the serum levels of chloride as well. There is a growing body of evidence on a strong link between low serum chloride levels and adverse outcomes in HF, which might be even more potent than that of sodium. Maladaptive neurohormonal activation and unresponsiveness to diuretics have been proposed as potential mechanisms to explain this phenomenon. In parallel with accumulating evidence on the predictive value of chloride in various HF populations, the limited available interventional studies that were aimed at increasing serum chloride levels have also shown promising results. Ongoing studies are designed to elucidate the role of chloride as a key cardiorenal connector and whether hypochloremia represents a modifiable risk factor (i.e., target of therapy) or a mere marker of disease severity and poor prognosis.
    MeSH term(s) Humans ; Chlorides ; Heart Failure/complications ; Diuretics ; Sodium ; Risk Factors
    Chemical Substances Chlorides ; Diuretics ; Sodium (9NEZ333N27)
    Language English
    Publishing date 2022-05-31
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 207121-6
    ISSN 2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
    ISSN (online) 2235-3186 ; 1423-0186
    ISSN 1660-8151 ; 0028-2766
    DOI 10.1159/000524987
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Advances in Cardiorenal Medicine: The Year 2023 in Review.

    Kazory, Amir / Ronco, Claudio

    Cardiorenal medicine

    2024  Volume 14, Issue 1, Page(s) 123–128

    MeSH term(s) Humans ; Cardio-Renal Syndrome/physiopathology ; Cardiology/trends ; Heart Failure/drug therapy ; Periodicals as Topic
    Language English
    Publishing date 2024-02-14
    Publishing country Switzerland
    Document type Editorial ; Letter
    ZDB-ID 2595659-0
    ISSN 1664-5502 ; 1664-3828
    ISSN (online) 1664-5502
    ISSN 1664-3828
    DOI 10.1159/000537785
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology.

    Koratala, Abhilash / Kazory, Amir

    World journal of nephrology

    2024  Volume 12, Issue 5, Page(s) 112–119

    Abstract: Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, ... ...

    Abstract Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.
    Language English
    Publishing date 2024-01-12
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2220-6124
    ISSN 2220-6124
    DOI 10.5527/wjn.v12.i5.112
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Nuances of POCUS in Nephrology: A Clarion Call for Deeper Understanding.

    Kazory, Amir / Olaoye, Olanrewaju A / Koratala, Abhilash

    Blood purification

    2024  

    Language English
    Publishing date 2024-04-15
    Publishing country Switzerland
    Document type Editorial
    ZDB-ID 605548-5
    ISSN 1421-9735 ; 0253-5068
    ISSN (online) 1421-9735
    ISSN 0253-5068
    DOI 10.1159/000538909
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Tackling Congestion in Acute Heart Failure: Is It the Primetime for "Combo Diuretic Therapy?"

    Kazory, Amir / Ronco, Claudio

    Cardiorenal medicine

    2023  Volume 13, Issue 1, Page(s) 184–188

    Abstract: Symptoms and signs of congestion are the primary reason for hospitalization of patients with acute heart failure. Efficient fluid and sodium removal remain the main goals of therapy, and loop diuretics are the recommended agents in this setting. However, ...

    Abstract Symptoms and signs of congestion are the primary reason for hospitalization of patients with acute heart failure. Efficient fluid and sodium removal remain the main goals of therapy, and loop diuretics are the recommended agents in this setting. However, the therapeutic response to these medications is known to be variable, and a significant subset of patients is discharged from the hospital with residual fluid overload. Therefore, sequential blockade of the nephron has been proposed as a more effective decongestive strategy. Pilot studies have suggested significant increase in diuresis and natriuresis with combination diuretic therapy. Recently, two groups of investigators examined this hypothesis on a larger scale in randomized placebo-controlled trials; one targeted the proximal tubules upstream of the loop of Henle (Acetazolamide in Decompensated Heart Failure with Volume Overload - ADVOR), while the other one blocked sodium-chloride cotransporters in the distal convoluted tubules (Combination of Loop with Thiazide Diuretics for Decompensated Heart Failure - CLOROTIC). Herein, we discuss the results of these two trials with special focus on their impact on extraction of sodium, i.e., the main determinant of extracellular volume, and put them in the context of previous studies of combination diuretic therapy as well as extracorporeal ultrafiltration.
    MeSH term(s) Humans ; Diuretics/therapeutic use ; Heart Failure/complications ; Heart Failure/drug therapy ; Acetazolamide/therapeutic use ; Drug Therapy, Combination ; Sodium
    Chemical Substances Diuretics ; Acetazolamide (O3FX965V0I) ; Sodium (9NEZ333N27)
    Language English
    Publishing date 2023-02-14
    Publishing country Switzerland
    Document type Letter
    ZDB-ID 2595659-0
    ISSN 1664-5502 ; 1664-3828
    ISSN (online) 1664-5502
    ISSN 1664-3828
    DOI 10.1159/000529646
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Hepato-Cardio-Renal Syndrome.

    Koratala, Abhilash / Verbrugge, Frederik / Kazory, Amir

    Advances in kidney disease and health

    2024  Volume 31, Issue 2, Page(s) 127–132

    Abstract: Hepatorenal syndrome has conventionally been regarded as a multisystem syndrome in which pathophysiologic pathways that link cirrhosis with impairment in kidney function are followed by dysfunction of several organs such as the heart. The advances in ... ...

    Abstract Hepatorenal syndrome has conventionally been regarded as a multisystem syndrome in which pathophysiologic pathways that link cirrhosis with impairment in kidney function are followed by dysfunction of several organs such as the heart. The advances in cardiac studies have helped diagnose more subtle cardiac abnormalities that would have otherwise remained unnoticed in a significant subset of patients with advanced liver disease and cirrhosis. Accumulating data suggests that in many instances, the cardiac dysfunction precedes and predicts development of kidney disease in such patients. These observations point to the heart as a key player in hepatorenal syndrome and challenge the notion that the cardiac abnormalities are either the consequence of aberrancies in hepatorenal interactions or have only minor effects. As such, the disturbances traditionally bundled within hepatorenal syndrome may indeed represent a hepatic form of cardiorenal syndrome whereby the liver affects the kidney in part through cardiorenal pathways (that is, hepato-cardio-renal syndrome).
    Language English
    Publishing date 2024-04-22
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 3156601-7
    ISSN 2949-8139
    ISSN (online) 2949-8139
    DOI 10.1053/j.akdh.2023.07.002
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The Congestion-Creatinine Interplay in Acute Heart Failure: Time to Move Up to the Next Level.

    Kazory, Amir

    The American journal of medicine

    2019  Volume 133, Issue 3, Page(s) 259–260

    MeSH term(s) Creatinine ; Heart Failure ; Humans ; Natriuretic Peptide, Brain ; Patient Readmission ; Peptide Fragments
    Chemical Substances Peptide Fragments ; pro-brain natriuretic peptide (1-76) ; Natriuretic Peptide, Brain (114471-18-0) ; Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2019-08-23
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2019.07.052
    Database MEDical Literature Analysis and Retrieval System OnLINE

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