Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure.

Abstract:

BACKGROUND:It is widely believed that a reduced cardiac index (CI) is a significant contributor to renal dysfunction in patients with heart failure (HF). However, recent data have challenged this paradigm. OBJECTIVES:This study sought to determine the relationship between CI and renal function in a multicenter population of HF patients undergoing pulmonary artery catheterization (PAC). METHODS:Patients undergoing PAC in either the randomized or registry portions of the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial were included (n = 575). We evaluated associations between CI and renal function across multiple subgroups and assessed for nonlinear, threshold, and longitudinal relationships. RESULTS:There was a weak but significant inverse correlation between CI and estimated glomerular filtration rate (eGFR), such that higher CI was paradoxically associated with worse eGFR (r = -0.12; p = 0.02). CI was not associated with blood urea nitrogen (BUN) or the BUN to creatinine ratio. Similarly, no associations were observed between CI and better renal function across multiple subgroups defined by indications for PAC or hemodynamic, laboratory, or demographic parameters. A nonlinear or threshold effect could not be identified. In patients with serial assessments of renal function and CI, we were unable to find within-subject associations between change in CI and eGFR using linear mixed modeling. Neither CI nor change in CI was lower in patients developing worsening renal function (p ≥ 0.28). CONCLUSIONS:These results reinforce evidence that reduced CI is not the primary driver for renal dysfunction in patients hospitalized for HF, irrespective of the degree of CI impairment or patient subgroup analyzed.

journal_name

J Am Coll Cardiol

authors

Hanberg JS,Sury K,Wilson FP,Brisco MA,Ahmad T,Ter Maaten JM,Broughton JS,Assefa M,Tang WHW,Parikh CR,Testani JM

doi

10.1016/j.jacc.2016.02.058

subject

Has Abstract

pub_date

2016-05-17 00:00:00

pages

2199-2208

issue

19

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(16)01529-1

journal_volume

67

pub_type

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