Body volume is the major determinant of worsening renal function in acutely decompensated heart failure with reduced left ventricular ejection fraction

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AIMS: Little is known about the relative importance of body volume and haemodynamic parameters in the development of worsening of renal function in acutely decompensated heart failure (ADHF). To study the relationship between haemodynamic parameters, body water content and worsening of renal function in patients with heart failure with reduced ejection fraction (HFrEF) hospitalised for ADHF.

METHODS AND RESULTS: This prospective observational study involved 51 consecutive patients with HFrEF (age: 73±14 years, male: 60%, left ventricular ejection fraction: 33.3%±9.9%) hospitalised for ADHF. Echocardiographic-determined haemodynamic parameters and body volume determined using a bioelectric impedance analyser were serially obtained. All patients received intravenous furosemide 160 mg/day for 3 days. There was a mean weight loss of 3.95±2.82 kg (p<0.01), and brain natriuretic peptide (BNP) reduced from 1380±901 pg/mL to 797±738 pg/mL (p<0.01). Nonetheless serum creatinine (SCr) increased from 134±46 μmol/L to 151±53 μmol/L (p<0.01), and 35% of patients developed worsening of renal function. The change in SCr was positively correlated with age (r=0.34, p=0.017); and negatively with the ratio of extracellular water to total body water, a parameter of body volume status (r=-0.58, p<0.001); E:E' ratio (r=-0.36, p=0.01); right ventricular systolic pressure (r=-0.40, p=0.009); and BNP (r=-0.40, p=0.004). Counterintuitively, no correlation was observed between SCr and cardiac output, or total peripheral vascular resistance. Regression analysis revealed that normal body volume and lower BNP independently predicted worsening of renal function.

CONCLUSIONS: Normal body volume and lower serum BNP on admission were associated with worsening of renal function in patients with HFrEF hospitalised for ADHF.

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:98

Enthalten in:

Postgraduate medical journal - 98(2022), 1159 vom: 15. Mai, Seite 333-340

Sprache:

Englisch

Beteiligte Personen:

Ho, Mei Han [VerfasserIn]
Huang, Duo [VerfasserIn]
Ho, Chi-Wai [VerfasserIn]
Zuo, Ming-Liang [VerfasserIn]
Luo, An-Guo [VerfasserIn]
Cheung, Emmanuel [VerfasserIn]
Zhou, Mi [VerfasserIn]
Cheng, Yangyang [VerfasserIn]
Liu, Mingya [VerfasserIn]
Yiu, Kai-Hang [VerfasserIn]
Lau, Chu Pak [VerfasserIn]
Yeung, Pauline [VerfasserIn]
Yue, Wen Sheng [VerfasserIn]
Yin, Li-Xue [VerfasserIn]
Tse, Hung Fat [VerfasserIn]
Jiang, Wei [VerfasserIn]
Lei, Zhen [VerfasserIn]
Li, Xin-Li [VerfasserIn]
Cowie, M [VerfasserIn]
Siu, Chung Wah [VerfasserIn]

Links:

Volltext

Themen:

114471-18-0
Acute renal failure
Heart failure
Ischaemic heart disease
Journal Article
Natriuretic Peptide, Brain
Observational Study

Anmerkungen:

Date Completed 25.04.2022

Date Revised 31.05.2022

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1136/postgradmedj-2020-139023

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM321528190