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. 2022 Aug;9(4):2654-2663.
doi: 10.1002/ehf2.13990. Epub 2022 May 25.

Association between central haemodynamics and renal function in advanced heart failure: a nationwide study from Sweden

Emanuele Bobbio  1   2 , Entela Bollano  1   2 , Christian L Polte  2   3 , Jan Ekelund  4 , Göran Rådegran  5   6 , Jakob Lundgren  5   6 , Carl Haggård  5   6 , Grunde Gjesdal  5   6 , Oscar Braun  7 , Sven-Erik Bartfay  1   2 , Niklas Bergh  1   2 , Pia Dahlberg  1   2 , Clara Hjalmarsson  1   2 , Sorosh Esmaily  2 , Ida Haugen Löfman  8 , Aristomenis Manouras  8 , Michael Melin  8 , Göran Dellgren  2   9 , Kristjan Karason  1   2   9
Affiliations

Association between central haemodynamics and renal function in advanced heart failure: a nationwide study from Sweden

Emanuele Bobbio et al. ESC Heart Fail. 2022 Aug.

Abstract

Aims: Renal dysfunction in patients with heart failure (HF) has traditionally been attributed to declining cardiac output and renal hypoperfusion. However, other central haemodynamic aberrations may contribute to impaired kidney function. This study assessed the relationship between invasive central haemodynamic measurements from right-heart catheterizations and measured glomerular filtration rate (mGFR) in advanced HF.

Methods and results: All patients referred for heart transplantation work-up in Sweden between 1988 and 2019 were identified through the Scandiatransplant organ-exchange organization database. Invasive haemodynamic variables and mGFR were retrieved retrospectively. A total of 1001 subjects (49 ± 13 years; 24% female) were eligible for the study. Analysis of covariance adjusted for age, sex, and centre revealed that higher right atrial pressure (RAP) displayed the strongest relationship with impaired GFR [β coefficient -0.59; 95% confidence interval (CI) -0.69 to -0.48; P < 0.001], followed by lower mean arterial pressure (MAP) (β coefficient 0.29; 95% CI 0.14-0.37; P < 0.001), and finally reduced cardiac index (β coefficient 3.51; 95% CI 2.14-4.84; P < 0.003). A combination of high RAP and low MAP was associated with markedly worse mGFR than any other RAP/MAP profile, and high renal perfusion pressure (RPP, MAP minus RAP) was associated with superior renal function irrespective of the degree of cardiac output.

Conclusions: In patients with advanced HF, high RAP contributed more to impaired GFR than low MAP. A higher RPP was more closely related to GFR than was high cardiac index.

Keywords: Advanced heart failure; Glomerular filtration rate; Invasive haemodynamics; Renal perfusion pressure; Right atrial pressure.

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Conflict of interest statement

None of the authors have any conflicts of interest to declare for the present study.

Figures

Figure 1
Figure 1
Flow diagram depicting the selection of eligible study participants. HF, heart failure; re‐HTx, heart re‐transplantation; MCS, mechanical circulatory support; mGFR, measured glomerular filtration rate; RHC, right‐heart catheterization; RRT, renal replacement therapy.
Figure 2
Figure 2
Analysis of covariance with absolute standardized (dimensionless) coefficients enabling comparison of the impact of different haemodynamic variables on measured glomerular filtration rate. CI, cardiac index; HR, heart rate; MAP, mean arterial pressure; PAWP, pulmonary artery wedge pressure; RAP, right atrial pressure.
Figure 3
Figure 3
Effects of (A) high or low RAP (≥ or <10 mmHg) on mGFR in participants with high or low MAP (≥ or <73.5 mmHg) and (B) high or low RPP (≥ or <64 mmHg) on mGFR in participants with high or low CI (≥ or <1.9 L/min/m2). CI, cardiac index; MAP, mean arterial pressure; mGFR, measured glomerular filtration rate; RAP, right atrial pressure; RPP, renal perfusion pressure.
See this image and copyright information in PMC

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