Recurrent Episodes of Fluid Retention in a Patient with Heart Failure and Chronic Kidney Disease: The Additional Value of Implantable Monitoring Systems

Table 1

Clinical characteristics, lab results, medical therapy, and echocardiographic and device parameters. NYHA: New York Heart Association class; ABPsyst: systolic arterial blood pressure; ABPdiast diastolic arterial blood pressure; Creat: creatinine; MDRD: modified diet renal disease; EF: ejection fraction; MR: mitral regurgitation; TR: tricuspid regurgitation; VCI: inferior caval vein; RV: right ventricular; BiV: biventricular; Na: not available; JVP: jugular venous pressure.

	Implant	1 month postimplant	AE1: bronchitis		AE2: AHF	AE3: dialysis
			Onset	Resolved		Start dialysis	2-month dialysis
Clinical exam
NYHA	3	1	4	2	3	4	1
Body weight (kg)	70	67	68	67	71	73	67
Heart rate (beats/min)	60	70	80	70	70	70	70
ABPsyst (mmHg)	110	120	100	130	120	120	110
ABPdiast (mmHg)	70	80	70	70	70	70	60
JVP	Elevated	No	No	No	Elevated	Elevated	No
Leg edema	Present	No	No	No	Present	Present	No
Lung sounds/rales	Present	No	No	No	Present	Present	No
Lab results
Creat (mg/ml)	4.50	3.80	5.25	3.53	4.50	6.00	Na
MDRD (ml/min/1.73 m^2)	13	18	10	20	13	8	Na
Nt-proBNP (pg/ml)	8070	2509	32404	6732	29574	/	Na
Medical therapy
Carvedilol	6.25 mg twice	6.25 mg twice	Stop	6.25 mg twice	6.25 mg twice	6.25 mg twice	6.25 mg twice
Bumetanide	2 mg	2 mg	2 mg	1.5 mg	2 mg	Dialysis	Dialysis
Echocardiography
EF (%)	15	15	15	15	15	15	18
MR (grade)	3	2	2	2	3	3	2
TR (grade)	3	2	3	3	3	2	1
VCI	Dilated	Not dilated	Not dilated	Not dilated	Dilated	Dilated	Not dilated
RV systolic pressure (mmHg)	60	38	57	36	65	58	37
	18	9	12	12	18	20	10
Device parameters
% BiV pacing	/	99	93	94	96	97	94
ePAD (mmHg)	25	12	18	14	35	26	15
Impedance (Ohm)	/	60	56	62	53	46	63