
    could not enroll patients
  
['cardiorenal syndrome']
['milrinone', 'dobutamine']

        Inclusion Criteria:

          1. Age >18 years

          2. Admitted to the hospital with a primary diagnosis of Decompensated Heart Failure

          3. Onset of cardio-renal syndrome (increasing creatinine>0.3mg/dl) after or before
             hospitalization. After hospitalization within 7 days of from the time of admission
             after receiving intravenous diuretics and heart failure medication optimization.
             Before hospitalization in the setting of escalating doses of outpatient loop diuretics
             and heart failure medication optimization

          4. Persistent volume overload- For patients with a pulmonary artery catheter, peristent
             volume overload will include :

             Pulmonary capillary wedge pressure >22mm Hg and one of the following clinical signs
             :2+ peripheral edema and/or pulmonary edema or pleural effusion on chest Xray. For
             patients without a pulmonary artery catheter- persistent volume overload will include
             atleast 2 of the following: 2+ peripheral edema , jugular venous pressure >10 mm Hg
             and pulmonary edema or pleural effusion on chest Xray

          5. BNP>400

          6. Cr-1.2-3.0

        Exclusion Criteria:

          1. Intravascular volume depletion

          2. Acute coronary syndrome within 4 weeks

          3. Indication for hemodialysis

          4. Systolic Blood pressure <90mm Hg or MAP<60mm Hg at the time of enrollment

          5. Alternate explanation for worsening renal function , such as obstructive nephropathy ,
             contrast induced nephropathy , ATN

          6. Clinical instability likely to require the addition of intravenous vasoactive drugs
             including vasodilators and/or inotropic drugs

          7. The use of iodinated radio-contrast material in the past 72 hours or anticipated use
             of intravenous contrast during the current hospitalization

          8. Underlying rhythm disorder
      