Clinical Research
Heart Failure
Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart Failure

https://doi.org/10.1016/j.jacc.2008.05.068Get rights and content
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Objectives

To determine whether venous congestion, rather than impairment of cardiac output, is primarily associated with the development of worsening renal function (WRF) in patients with advanced decompensated heart failure (ADHF).

Background

Reduced cardiac output is traditionally believed to be the main determinant of WRF in patients with ADHF.

Methods

A total of 145 consecutive patients admitted with ADHF treated with intensive medical therapy guided by pulmonary artery catheter were studied. We defined WRF as an increase of serum creatinine ≥0.3 mg/dl during hospitalization.

Results

In the study cohort (age 57 ± 14 years, cardiac index 1.9 ± 0.6 l/min/m2, left ventricular ejection fraction 20 ± 8%, serum creatinine 1.7 ± 0.9 mg/dl), 58 patients (40%) developed WRF. Patients who developed WRF had a greater central venous pressure (CVP) on admission (18 ± 7 mm Hg vs. 12 ± 6 mm Hg, p < 0.001) and after intensive medical therapy (11 ± 8 mm Hg vs. 8 ± 5 mm Hg, p = 0.04). The development of WRF occurred less frequently in patients who achieved a CVP <8 mm Hg (p = 0.01). Furthermore, the ability of CVP to stratify risk for development of WRF was apparent across the spectrum of systemic blood pressure, pulmonary capillary wedge pressure, cardiac index, and estimated glomerular filtration rates.

Conclusions

Venous congestion is the most important hemodynamic factor driving WRF in decompensated patients with advanced heart failure.

Key Words

worsening renal function
venous congestion
cardiac index
decompensated heart failure

Abbreviations and Acronyms

ADHF
advanced decompensated heart failure
CI
cardiac index
CVP
central venous pressure
GFR
glomerular filtration rate
PAC
pulmonary artery catheter
PCWP
pulmonary capillary wedge pressure
WRF
worsening renal function

Cited by (0)

Dr. Tang is supported in part by the National Institutes of Health, National Center for Research Resources, CTSA 1UL1RR024989, Cleveland, Ohio.