Damman Kevin, Navis Gerjan, Smilde Tom D J, Voors Adriaan A, van der Bij Wim, van Veldhuisen Dirk J, Hillege Hans L
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Heart Fail. 2007 Sep;9(9):872-8. doi: 10.1016/j.ejheart.2007.05.010. Epub 2007 Jun 22.
Renal failure in heart failure is related to decreased cardiac output. However, little is known about its association with venous congestion.
To investigate the relationship between venous congestion and glomerular filtration rate (GFR) in patients with cardiac dysfunction.
Right atrial pressure (RAP) and cardiac index (CI) were determined by right heart catheterisation in 51 patients with cardiac dysfunction, secondary to pulmonary hypertension. GFR and renal blood flow (RBF) were measured as (125)I-Iothalamate and (131)I-Hippuran clearances, respectively. Mean age was 40+/-11 years and 69% of patients were female. GFR was 73+/-19 ml/min/1.73 m2 with a CI of 2.1+/-0.7 l/min/m2. In multivariate analysis, RBF (r=0.664, p<0.001) and RAP (r=- 0.367, p=0.020) were independently associated with GFR. In patients in the lower ranges of RBF, venous congestion was an important determinant of renal function.
RBF is the main factor determining GFR in patients with cardiac dysfunction. Venous congestion, characterised by an increased RAP, adjusted for RBF is also related to GFR. Treatment to preserve GFR should not only focus on improvement of renal perfusion, but also on decreasing venous congestion.
心力衰竭中的肾衰竭与心输出量降低有关。然而，关于其与静脉淤血的关联知之甚少。
研究心功能不全患者静脉淤血与肾小球滤过率（GFR）之间的关系。
对51例继发于肺动脉高压的心功能不全患者进行右心导管检查，测定右心房压力（RAP）和心脏指数（CI）。分别以（125）I-碘肽酸盐和（131）I-马尿酸盐清除率测量GFR和肾血流量（RBF）。平均年龄为40±11岁，69%的患者为女性。GFR为73±19 ml/min/1.73 m2，CI为2.1±0.7 l/min/m2。在多变量分析中，RBF（r = 0.664，p < 0.001）和RAP（r = -0.367，p = 0.020）与GFR独立相关。在RBF处于较低范围的患者中，静脉淤血是肾功能的重要决定因素。
RBF是决定心功能不全患者GFR 的主要因素。以RAP升高为特征的静脉淤血，在调整RBF后也与GFR相关。保护GFR的治疗不仅应侧重于改善肾灌注，还应侧重于减轻静脉淤血。
