Renal Dysfunction Determinants in Advanced Heart Failure Patients:
Pulmonary Artery Catheterization Study
Abstract
Introduction: Renal dysfunction in heart failure (HF) patients
is associated with poor outcomes. Reduced cardiac index (CI) and right
atrial pressure (RAP) are postulated to be a contributor the renal
dysfunction. This study aimed to investigate the relationship between
the estimated glomerular filtration rate (eGFR) and the pulmonary artery
catheterization (PAC) results. Patients and Method:
Hospitalized advanced HF patients, between 2016-2020 PAC performed
included in the study. Renal dysfunction was defined as
eGFR<60 ml/min/1.73 m 2. We evaluated the
correlation and the linear regression models of hemodynamics with eGFR.
Results: 181 patients were included in the study, and the mean
left ventricular ejection fraction (LVEF) was 20.9±3.7%, the mean eGFR
was 79.8±25.4 ml/min/1.73 m 2, and 22.7% of patients
had eGFR lower than 60 ml/min/1.73 m 2. CI (1.85±0.72;
1.84±0.64; p=0.47, respectively) and RAP (13.1±6.6; 13.7±6.8;
p=0.61,respectively) was not significantly associated with renal
dysfunction in HF patients. In the multivariable model, smoking history,
AF, body mass index (BMI) revealed negative relation with eGFR,
continuing ACEi or ARB therapy, and pulmonary artery capacitance
index(PAC-i) were positively related variables with eGFR
(p<0.0001). eGFR was not significantly different in distinct
tricuspid regurgitation severities (p=0.67); however, eGFR was
non-significantly higher in patients with moderate tricuspid
regurgitation. In patients with moderate tricuspid regurgitation, eGFR
had an inverse relationship with the RVSW-i and TRVP-i.
Conclusion: These results indicate that CI or RAP is not the
primary driver for eGFR. PAC-i and continuing ACEi or ARB positively,
AF, smoking history, and BMI were negatively related factors for reduced
eGFR.