© 2007 European Society of Cardiology
Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction
a Department of Cardiology, University Medical Center Groningen, University of Groningen Groningen, The Netherlands
b Department of Nephrology, University Medical Center Groningen, University of Groningen Groningen, The Netherlands
c Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen Groningen, The Netherlands
d Department of Epidemiology, University Medical Center Groningen, University of Groningen Groningen, The Netherlands
* Corresponding author. Hanzeplein 1, PO 30001, 9700 RB Groningen, The Netherlands. Tel.: +31503618066; fax: +31503618062. E-mail address: h.hillege{at}tcc.umcg.nl
 |
Abstract |
|---|
Background: Renal failure in heart failure is related to decreased cardiac output. However, little is known about its association with venous congestion.
Aims: To investigate the relationship between venous congestion and glomerular filtration rate (GFR) in patients with cardiac dysfunction.
Methods and results: Right atrial pressure (RAP) and cardiac index (CI) were determined by right heart catheterisation in 51 patients with cardiac dysfunction, secondary to pulmonary hypertension. GFR and renal blood flow (RBF) were measured as 125I-Iothalamate and 131I-Hippuran clearances, respectively. Mean age was 40±11 years and 69% of patients were female. GFR was 73±19 ml/min/1.73 m2 with a CI of 2.1±0.7 l/min/m2. In multivariate analysis, RBF (r=0.664, p<0.001) and RAP (r<0.367, p=0.020) were independently associated with GFR. In patients in the lower ranges of RBF, venous congestion was an important determinant of renal function.
Conclusion: RBF is the main factor determining GFR in patients with cardiac dysfunction. Venous congestion, characterised by an increased RAP, adjusted for RBF is also related to GFR. Treatment to preserve GFR should not only focus on improvement of renal perfusion, but also on decreasing venous congestion.
Key Words: Heart failure • Renal function • Kidney • Haemodynamics • Venous congestion
Received November 29, 2006; Revised April 2, 2007; Accepted May 16, 2007
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. van der Meer and D. J van Veldhuisen Anaemia and renal dysfunction in chronic heart failure Heart, November 1, 2009; 95(21): 1808 - 1812. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Cohen-Solal, D. Kotecha, D. J van Veldhuisen, D. Babalis, M. Bohm, A. J. Coats, M. Roughton, P. Poole-Wilson, L. Tavazzi, M. Flather, et al. Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial Eur J Heart Fail, September 1, 2009; 11(9): 872 - 880. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Damman, T. Jaarsma, A. A. Voors, G. Navis, H. L. Hillege, D. J. van Veldhuisen, and on behalf of the COACH investigators Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH) Eur J Heart Fail, September 1, 2009; 11(9): 847 - 854. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Mullens, G. S. Francis, R. C. Starling, D. O. Taylor, and W.H. W. Tang Reply J. Am. Coll. Cardiol., August 11, 2009; 54(7): 662 - 662. [Full Text] [PDF]
|
|
|
|
|
|
A Kazory and E A Ross Ultrafiltration for decompensated heart failure: renal implications Heart, July 1, 2009; 95(13): 1047 - 1051. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gheorghiade and P. S. Pang Acute heart failure syndromes. J. Am. Coll. Cardiol., February 17, 2009; 53(7): 557 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Damman, V. M. van Deursen, G. Navis, A. A. Voors, D. J. van Veldhuisen, and H. L. Hillege Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J. Am. Coll. Cardiol., February 17, 2009; 53(7): 582 - 588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Mullens, Z. Abrahams, G. S. Francis, G. Sokos, D. O. Taylor, R. C. Starling, J. B. Young, and W.H. W. Tang Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J. Am. Coll. Cardiol., February 17, 2009; 53(7): 589 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., November 11, 2008; 52(20): 1671 - 1678. [Full Text] [PDF]
|
|
|
|
|
|
K. Damman, D. J. van Veldhuisen, G. Navis, A. A. Voors, and H. L. Hillege Urinary neutrophil gelatinase associated lipocalin (NGAL), a marker of tubular damage, is increased in patients with chronic heart failure Eur J Heart Fail, October 1, 2008; 10(10): 997 - 1000. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Mullens, Z. Abrahams, H. N. Skouri, G. S. Francis, D. O. Taylor, R. C. Starling, E. Paganini, and W.H. W. Tang Elevated Intra-Abdominal Pressure in Acute Decompensated Heart Failure: A Potential Contributor to Worsening Renal Function? J. Am. Coll. Cardiol., January 22, 2008; 51(3): 300 - 306. [Abstract] [Full Text] [PDF]
|
|