Importance of venous congestion for worsening of renal function in advanced decompensated heart failure.
نویسندگان
چکیده
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/m(2), 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.
منابع مشابه
Cardiorenal syndrome in decompensated heart failure.
Worsening renal function during treatment of acute decompensated heart failure (ADHF) often complicates the treatment course of heart failure. Furthermore, the development of worsening renal function is a strong independent predictor of long-term adverse outcomes. Sometimes referred to as 'cardiorenal syndrome,' the definition varies widely, and the overall understanding of pathogenesis is limi...
متن کاملFocus on renal congestion in heart failure
Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are impor...
متن کاملImpact of chronic kidney disease on the diuretic response of tolvaptan in acute decompensated heart failure
AIM This study investigated the relationship between the initial diuretic response to tolvaptan and clinical predictors for tolvaptan responders in patients with acute decompensated heart failure (ADHF). METHODS AND RESULTS Patients (153) with ADHF (clinical scenario 2 or 3 with signs of fluid retention) who were administered tolvaptan were enrolled. Tolvaptan (15 or 7.5 mg) was administered ...
متن کاملWorsening kidney function in decompensated heart failure: treat the heart, don't mind the kidney.
In a post-hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST), Blair and co-workers found that worsening kidney function shortly after hospitalization and in the early post-discharge period independently predicted cardiovascular mortality and re-hospitalizations because of heart failure (HF). These findings confirmed previous evidence t...
متن کاملIntensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure.
BACKGROUND Worsening renal function in heart failure may be related to increased venous congestion, decreased cardiac output, or both. Diuretics are universally used in acute decompensated heart failure, but they may be ineffective and may lead to azotemia. We aimed to compare the decongestive properties of a urine output-guided diuretic adjustment and standard therapy for the management of car...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Journal of the American College of Cardiology
دوره 53 7 شماره
صفحات -
تاریخ انتشار 2009