Characteristics of Patients With Improvement or Worsening in Renal Function During Treatment of Acute Decompensated Heart Failure

• Published in: The American journal of cardiology 2010-12, Vol.106 (12), p.1763-1769
• Main Authors: Testani, Jeffrey M., MD, McCauley, Brian D., BS, Kimmel, Stephen E., MD, MSCE, Shannon, Richard P., MD
• Format: Article
• Language: English
• Subjects: Acute Disease; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiotonic Agents - administration & dosage; Cardiovascular; Catheterization, Swan-Ganz - methods; Creatinine - blood; Disease Progression; Female; Follow-Up Studies; Glomerular Filtration Rate - physiology; Heart; Heart failure; Heart Failure - complications; Heart Failure - physiopathology; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hematology; Humans; Infusions, Intravenous; Kidneys; Male; Medical prognosis; Medical sciences; Medical treatment; Middle Aged; Prognosis; Pulmonary Wedge Pressure - physiology; Recovery of Function; Renal Insufficiency - blood; Renal Insufficiency - etiology; Renal Insufficiency - physiopathology; Retrospective Studies; Stroke Volume - physiology; Vasodilator Agents - administration & dosage
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2010.07.050

Worsening renal function (RF) and improved RF during the treatment of decompensated heart failure have traditionally been thought of as hemodynamically distinct events. We hypothesized that if the pulmonary artery catheter-derived measures are relevant in the evaluation of cardiorenal interactions, the comparison of patients with improved versus worsening RF should highlight any important hemodynamic differences. All subjects in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial limited data set with admission and discharge creatinine values available were included (n = 401). No differences were found in the baseline, final, or change in pulmonary artery catheter-derived hemodynamic variables, inotrope and intravenous vasodilator use, or survival between patients with improved versus worsening RF (p = NS for all). Both groups were equally likely to be in the bottom quartile of cardiac index (p = 0.32), have a 25% improvement in cardiac index (p = 0.97), or have any worsening in cardiac index (p = 0.90). When patients with any significant change in renal function (positive or negative) were compared to those with stable renal function, strong associations between variables such as a reduced cardiac index (odds ratio 2.2, p = 0.02), increased intravenous inotrope and vasodilator use (odds ratio 2.9, p