Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2010 Jul 20;122(3):265-72.
doi: 10.1161/CIRCULATIONAHA.109.933275. Epub 2010 Jul 6.

Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival

Jeffrey M Testani  1 , Jennifer Chen, Brian D McCauley, Stephen E Kimmel, Richard P Shannon
Affiliations
Randomized Controlled Trial

Potential effects of aggressive decongestion during the treatment of decompensated heart failure on renal function and survival

Jeffrey M Testani et al. Circulation. .

Abstract

Background: Overly aggressive diuresis leading to intravascular volume depletion has been proposed as a cause for worsening renal function during the treatment of decompensated heart failure. If diuresis occurs at a rate greater than extravascular fluid can refill the intravascular space, the concentration of such intravascular substances as hemoglobin and plasma proteins increases. We hypothesized that hemoconcentration would be associated with worsening renal function and possibly would provide insight into the relationship between aggressive decongestion and outcomes.

Methods and results: Subjects in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial limited data set with a baseline/discharge pair of hematocrit, albumin, or total protein values were included (336 patients). Baseline-to-discharge increases in these parameters were evaluated, and patients with >or=2 in the top tertile were considered to have evidence of hemoconcentration. The group experiencing hemoconcentration received higher doses of loop diuretics, lost more weight/fluid, and had greater reductions in filling pressures (P<0.05 for all). Hemoconcentration was strongly associated with worsening renal function (odds ratio, 5.3; P<0.001), whereas changes in right atrial pressure (P=0.36) and pulmonary capillary wedge pressure (P=0.53) were not. Patients with hemoconcentration had significantly lower 180-day mortality (hazard ratio, 0.31; P=0.013). This relationship persisted after adjustment for baseline characteristics (hazard ratio, 0.16; P=0.001).

Conclusions: Hemoconcentration is significantly associated with measures of aggressive fluid removal and deterioration in renal function. Despite this relationship, hemoconcentration is associated with substantially improved survival. These observations raise the question of whether aggressive decongestion, even in the setting of worsening renal function, can positively affect survival.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Admission to discharge percentage change in glomerular filtration rate grouped by presence or absence of hemoconcentration. GFR: Glomerular filtration rate.
Figure 2
Figure 2
Survival curves grouped by presence or absence of hemoconcentration after adjustment for baseline characteristics.
See this image and copyright information in PMC

Comment in

References

    1. Butler J, Forman DE, Abraham WT, Gottlieb SS, Loh E, Massie BM, O'Connor CM, Rich MW, Stevenson LW, Wang Y, Young JB, Krumholz HM. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am.Heart J. 2004;147:331–338. - PubMed
    1. Cowie MR, Komajda M, Murray-Thomas T, Underwood J, Ticho B, POSH Investigators Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur.Heart J. 2006;27:1216–1222. - PubMed
    1. Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, van Veldhuisen DJ, Hillege HL. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J.Card.Fail. 2007;13:599–608. - PubMed
    1. Forman DE, Butler J, Wang Y, Abraham WT, O'Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW, Young JB, Krumholz HM. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J.Am.Coll.Cardiol. 2004;43:61–67. - PubMed
    1. Mullens W, Abrahams Z, Francis GS, Skouri HN, Starling RC, Young JB, Taylor DO, Tang WH. Sodium nitroprusside for advanced low-output heart failure. J.Am.Coll.Cardiol. 2008;52:200–207. - PubMed

Publication types

MeSH terms

Substances