Abstract 16019: Worsening Renal Function During Intensive Volume Removal is Driven by Renin-Angiotensin-Aldosterone System Activation

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A16019-A16019
• Main Authors: Griffin, Matthew, Ivey-Miranda, Juan, Rao, Veena, Fleming, James, Gomez, Nicole, Barnett, Joslyn, Pattoli, Megan, Wycallis, Emily, Mahoney, Devin, Thomas, Anvin, Struyk, Griffin, Testani, Jeffrey M
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.16019

IntroductionWorsening renal function (WRF) in the setting of aggressive diuresis may carry a neutral or even beneficial prognosis for patients with acute decompensated heart failure (ADHF). Prior research supports that the primary mediator of this effect is not tubular injury but may instead be hemodynamic. Renin-angiotensin-aldosterone system (RAAS) activation is known to worsen in the setting of volume removal, potentially negatively influencing renal perfusion. Our objective was to test whether changes in estimated glomerular filtration rate (eGFR) could be explained by changes in RAAS activation.MethodsWe performed a post-hoc analysis of CARRESS-HF; 165 patients had complete PRA, aldosterone and eGFR data during the period of intensive volume removal (randomization to day 4), and 100 had complete data during the renal recovery period (day 4 to day 60). WRF was defined as an increase > 20% in eGFR. Higher RAAS activation was defined as increases in aldosterone and PRA above the median.ResultsIn patients with higher RAAS activation during intensive volume removal, the odds ratio of experiencing WRF were 7.4 (95% CI 2.9-19.0, p