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Body volume is the major determinant of worsening renal function in acutely decompensated heart failure with reduced left ventricular ejection fraction
  1. Mei Han Ho1,
  2. Duo Huang1,
  3. Chi-Wai Ho1,
  4. Ming-Liang Zuo2,
  5. An-Guo Luo2,
  6. Emmanuel Cheung1,
  7. Mi Zhou1,
  8. Yangyang Cheng1,
  9. Mingya Liu3,
  10. Kai-Hang Yiu1,3,
  11. Chu Pak Lau1,
  12. Pauline Yeung4,
  13. Wen Sheng Yue5,
  14. Li-Xue Yin2,
  15. Hung Fat Tse1,
  16. Wei Jiang6,
  17. Zhen Lei6,
  18. Xin-Li Li7,
  19. M Cowie8,
  20. Chung Wah Siu1,3
  1. 1 Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
  2. 2 Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
  3. 3 Cardiology Division,Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
  4. 4 Respiratory Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  5. 5 Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
  6. 6 Department of medicine, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
  7. 7 Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, NanJing, China
  8. 8 Imperial College London, Royal Brompton Hospital, London, UK
  1. Correspondence to Professor Chung Wah Siu, Medicine, Hong Kong, China; cwdsiu{at}yahoo.com.hk

Abstract

Aims Little is known about the relative importance of body volume and haemodynamic parameters in the development of worsening of renal function in acutely decompensated heart failure (ADHF). To study the relationship between haemodynamic parameters, body water content and worsening of renal function in patients with heart failure with reduced ejection fraction (HFrEF) hospitalised for ADHF.

Methods and results This prospective observational study involved 51 consecutive patients with HFrEF (age: 73±14 years, male: 60%, left ventricular ejection fraction: 33.3%±9.9%) hospitalised for ADHF. Echocardiographic-determined haemodynamic parameters and body volume determined using a bioelectric impedance analyser were serially obtained. All patients received intravenous furosemide 160 mg/day for 3 days. There was a mean weight loss of 3.95±2.82 kg (p<0.01), and brain natriuretic peptide (BNP) reduced from 1380±901 pg/mL to 797±738 pg/mL (p<0.01). Nonetheless serum creatinine (SCr) increased from 134±46 μmol/L to 151±53 μmol/L (p<0.01), and 35% of patients developed worsening of renal function. The change in SCr was positively correlated with age (r=0.34, p=0.017); and negatively with the ratio of extracellular water to total body water, a parameter of body volume status (r=−0.58, p<0.001); E:E’ ratio (r=−0.36, p=0.01); right ventricular systolic pressure (r=−0.40, p=0.009); and BNP (r=−0.40, p=0.004). Counterintuitively, no correlation was observed between SCr and cardiac output, or total peripheral vascular resistance. Regression analysis revealed that normal body volume and lower BNP independently predicted worsening of renal function.

Conclusions Normal body volume and lower serum BNP on admission were associated with worsening of renal function in patients with HFrEF hospitalised for ADHF.

  • heart failure
  • ischaemic heart disease
  • acute renal failure

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Footnotes

  • MHH, DH, C-WH and M-LZ contributed equally.

  • Contributors M-HH: conception, design, patient recruitment and assessment, data analysis, manuscript drafting and review. DH: conception, design, echocardiographic assessment, data analysis, manuscript review. C-WH and EC: conception, design, patient recruitment and assessment, data analysis, manuscript review. M-LZ and A-GL: conception, design, echocardiographic assessment, data analysis, manuscript review. MZ and YC: echocardiographic assessment, data analysis, manuscript review. ML, K-HY, PY, WSY, L-XY, HFT, WJ, ZL, X-LL and MC: data review and manuscript review. CPL: conception, design, and manuscript review. CWS: conception, design, echocardiographic assessment, data analysis, manuscript review and final edition.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study complies with the principles outlined in the Declaration of Helsinki, that the local Institutional Review Board has approved the research protocol and that informed consent has been obtained from all participants.

  • Data availability statement Data are available from the corresponding author

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