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

Wilfried Mullens, Zuheir Abrahams, Gary S. Francis, George Sokos, David O. Taylor, Randall C. Starling, James B. Young, W. H Wilson Tang

Research output: Contribution to journalArticlepeer-review

842 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)589-596
Number of pages8
JournalJournal of the American College of Cardiology
Volume53
Issue number7
DOIs
StatePublished - Feb 17 2009

Keywords

  • cardiac index
  • decompensated heart failure
  • venous congestion
  • worsening renal function

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