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
. 2021 Dec;8(6):4944-4954.
doi: 10.1002/ehf2.13534. Epub 2021 Sep 14.

Haemodynamic parameters associated with renal function prior to and following heart transplantation

Guillaume Baudry  1   2 , Laurent Sebbag  1 , Juliette Bourdin  1 , Elisabeth Hugon-Vallet  1 , Antoine Jobbe Duval  1 , Nathan Mewton  3 , Matteo Pozzi  4 , Patrick Rossignol  2 , Nicolas Girerd  2
Affiliations

Haemodynamic parameters associated with renal function prior to and following heart transplantation

Guillaume Baudry et al. ESC Heart Fail. 2021 Dec.

Abstract

Aims: Abnormal renal function is a common feature in patients on heart transplant waiting lists. This study aimed to identify the haemodynamic parameters associated with decreased estimated glomerular filtration rate (eGFR) in patients listed for heart transplantation (HT) and renal function improvement following HT.

Methods and results: A total of 176 adults (52 years old, 81% men) with available right heart catheterization (RHC) listed in our centre for HT between 2014 and 2019 were studied. Cardiac catheterization measurements were obtained at time of HT listing evaluation. Changes in renal function were assessed between RHC and 6 months after HT. Median eGFR was 63 mL/min/1.73 m2 at time of RHC. Central venous pressure > 10 mmHg was associated with a two-fold increase in the likelihood of eGFR < 60 mL/min/1.73 m2 at time of RHC (adjusted odd ratio, 2.2; 95% confidence interval, 1.1-4.7; P = 0.04). In the 134 patients (76%) who underwent HT during follow-up, eGFR decreased by 7.9 ± 29.7 mL/min/1.73 m2 from RHC to 6 months after HT. In these patients, low cardiac index (<2.1 L/min/m2 ) at initial RHC was associated with a (adjusted) 6 month post-HT eGFR improvement of 12.2 mL/min/1.73 m2 (P = 0.018). Patients with eGFR < 60 mL/min/1.73 m2 and low cardiac index at time of RHC exhibited the greatest eGFR improvement (delta eGFR = 18.3 mL/min/1.73 m2 ) while patients with eGFR ≥ 60 mL/min/1.73 m2 and normal cardiac index had a marked decrease in eGFR (delta eGFR = -27.7 mL/min/1.73 m2 , P < 0.001).

Conclusions: Central venous pressure is the main haemodynamic parameter associated with eGFR < 60 mL/min/1.73 m2 in patients listed for HT. Low cardiac index prior to HT is associated with post-transplant renal function recovery.

Keywords: Cardiac index; Cardiac oedema; Cardiorenal syndrome; Cardiovascular diseases; Heart failure; Heart transplantation; Renal function.

PubMed Disclaimer

Conflict of interest statement

G.B. reports personal fees from AstraZeneca, Boehringer Ingelheim, and Abbott, outside the submitted work. L.S. reports personal fees from Novartis Pharma, AstraZeneca, and Vifor Pharma, outside the submitted work. J.B. has nothing to disclose. E.H.V. has nothing to disclose. A.J.D. reports personal fees from Boehringer Ingelheim, Novartis, Sanofi Genzyme, and Amicus. N.M. reports grants and personal fees from Novartis, personal fees from Bayer, grants from AstraZeneca, and personal fees from Vifor Pharma, outside the submitted work. M.P. has nothing to disclose. P.R. reports consulting fees from Bayer, G3P (stocks), Idorsia, and KBP; honoraria from Ablative Solutions, AstraZeneca, Bayer, Boehringer Ingelheim, Corvidia, CVRx, Fresenius, Grunenthal, Novartis, Novo Nordisk, Vifor Pharma, Inc., Sanofi, Sequana Medical, Servier, Stealth Peptides, and Vifor Fresenius Medical Care Renal Pharma; and cofounder: CardioRenal. N.G. reports personal fees from AstraZeneca, Bayer, Boehringer, Novartis, and Vifor.

Figures

Figure 1
Figure 1
Correlation between CVP, CI, SBP, PCWP, and eGFR at right heart catheterization. CI, cardiac index; CVP, central venous pressure; eGFR, estimated glomerular filtration rate; HR, heart rate; PCWP, pulmonary capillary wedge pressure; SBP, systolic blood pressure.
Figure 2
Figure 2
Prevalence of eGFR < 60 mL/min/1.73 m2 according to central venous pressure at right heart catheterization (Panel A) and mean delta eGFR between right heart catheterization and 6 months after heart transplantation according to eGFR and cardiac index at right heart catheterization (Panel B). CI, cardiac index; CVP, central venous pressure; eGFR, estimated glomerular filtration rate; HT, heart transplantation; RHC, right heart catheterization.
See this image and copyright information in PMC

References

    1. Rossignol P, Hernandez AF, Solomon SD, Zannad F. Heart failure drug treatment. Lancet 2019; 393: 1034–1044. - PubMed
    1. Zannad F, Rossignol P. Cardiorenal syndrome revisited. Circulation 2018; 138: 929–944. - PubMed
    1. Carubelli V, Metra M, Lund LH. Negotiating renal dysfunction when treating patients with heart failure. Expert Rev Cardiovasc Ther 2018; 16: 113–122. - PubMed
    1. Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 2009; 53: 582–588. - PubMed
    1. Damman K, Navis G, Smilde TDJ, Voors AA, van der Bij W, van Veldhuisen DJ, Hillege HL. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction. Eur J Heart Fail 2007; 9: 872–878. - PubMed

Publication types