Effect on Kidney Function Recovery Guiding Decongestion with Venus Evaluation by Ultrasound System (VExUS) in Patients with Cardiorenal Syndrome 1, A Randomized Control Trial

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Background: In cardiorenal syndrome type 1 (CRS1) vascular congestion is a common complication, the Venus Evaluation by Ultrasound System (VExUS) could guide decongestion with diuretics effectively and thereby improve renal function and outcomes. Methods: In this double-blind randomized clinical trial, patients with CRS1 were randomized to guide decongestion with VExUS compared to usual clinical evaluation. The primary and secondary endpoint was to assess kidney function recovery (KFR), days of hospitalization, mortality, changes in brain natriuretic peptide (BNP) and CA-125. Protocol register number is HCG/CEI-0836/22. Results: During the period from March 2022 to February 2023, a total of 140 patients were randomized, 70 in the VExUS group and 70 in the Control group. KFR in the VExUS group, compared to Control, no significant difference was found. VExUS improve in more than twice the speed (in days) with which decongestion is achieved (OR 2.6, CI 1.9-3.0, p=0.01). With VExUS is two-fold more likely to reach a decrease of BNP >30% (OR = 2.4; CI 1.3-4.1, p = 0.01). Survival at 90 days was similar between groups. Recongestion, CA125 and mortality were similar between groups. Conclusions: In patients with CRS1, we observed that VExUS guided decongestion, compared to clinical evaluation, did not improve the probability of KFR, but decongestion could be achieved more efficiently in fewer days.

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