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

By W. Mullens, Z. Abrahams, Gary S. Francis, G. Sokos, David O. Taylor, Randall C. Starling, James B. Young, W. Tang. Journal of the American College of Cardiology, 2008

1,575 citations recorded by the source corpus.

Background Reduced cardiac output is traditionally believed to be the main determinant of worsening renal function (WRF) in advanced decompensated heart failure (ADHF). Objective To determine if venous congestion, rather than impairment of cardiac output, is primarily associated with the development of WRF in ADHF. Methods A total of 145 consecutive patients admitted with ADHF treated with intensive medical therapy guided by pulmonary artery catheter were studied. WRF was defined 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/kg.m2, LVEF 20 ±8%, serum creatinine 1.7 ±0.9 mg/dl), 58 patients (40%) developed WRF. Patients who developed WRF had a higher central venous pressure on admission (CVP, 18 ±7 versus 12 ±6 mmHg, p<0.001) and after intensive medical therapy (11 ±8 versus 8 ±5 mmHg, p=0.04). The development of WRF occurred less frequently in patients that achieved a CVP <8 mmHg (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.

Subfields: Cardiology and Cardiovascular Medicine, Nephrology, Surgery

View Paper: https://www.semanticscholar.org/paper/82db01c0460d426336153c5edf6c643105bd4057

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Cardiology and Cardiovascular Medicine

1. S. Anker

In Nephrology

1. Sean M. Bagshaw
2. Claudio Ronco
3. R. Bellomo
4. John A. Kellum

In Surgery

1. Claudio Ronco
2. R. Bellomo
3. Sean M. Bagshaw

Citations in the corpus

• Prognostic Value of Elevated Levels of Intestinal Microbe-Generated Metabolite Trimethylamine-N-oxide in Patients with Heart Failure: Refining the Gut Hypothesis (2014, neutral): “Meanwhile, progressive venous congestion in subsets of patients with significant congestive signs and symptoms may lead to unwanted consequences of abdominal congestion, including adverse impact on drug absorption and pharmacokinetics (5,6), and renal glomerular and tubular dysfunction resulting fro”
• Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative (2009, background): “In both ADHF and ACS, the development of WRF/AKI has been associated with greater short- and long-term all-cause and cardiovascular mortality, prolonged duration of hospitalization,9,15,21 – 23 increased readmission rates,24,25 accelerated progression to CKD stages 4–5,17 and higher healthcare costs”