Department of Angiology, University Hospital, Basel, Switzerland.
Eur J Heart Fail. 2011 Apr;13(4):432-9. doi: 10.1093/eurjhf/hfq195. Epub 2010 Nov 18.
To determine the relationship between central venous pressure (CVP) and renal function in patients with acute heart failure (AHF) presenting to the emergency department.
Central venous pressure was determined non-invasively using compression sonography in 140 patients with AHF at presentation. Worsening renal function (WRF) was defined as an increase in serum creatinine ≥ 0.3 mg/dL during hospitalization. In the study cohort [age 77 ± 12 years, B-type natriuretic peptide 1862 ± 1564 pg/mL, left ventricular ejection fraction 40 ± 15%, estimated glomerular filtration rate (eGFR) 58 ± 28 mL/min, and CVP 13.2 ± 6.9 cmH(2)O], 51 patients (36%) developed WRF. No significant association between CVP at presentation or discharge and concomitant eGFR (r = 0.005, P = 0.419 and r = 0.013, P = 0.313, respectively) was observed. However, in patients with systolic blood pressure (SBP) <110 mmHg and concomitant high CVP (>15 cmH(2)O), eGFR was significantly lower at presentation and discharge (29 ± 17 vs. 47 ± 19 mL/min/1.73 m(2), P = 0.039 and 26 ± 10 vs. 53 ± 26 mL/min/1.73 m(2), P = 0.013, respectively). Central venous pressure at presentation and at discharge did not differ between patients with or without in-hospital WRF (12.6 ± 7.2 vs. 13.5 ± 6.7 cmH(2)O, P = 0.503 and 7.4 ± 6.5 vs. 7.7 ± 5.7 cmH(2)O, P = 0.799, respectively) (receiver-operating characteristic analysis 0.543, P = 0.401 and 0.531, P = 0.625, respectively). However, patients with CVP in the lowest tertile (<10 cmH(2)O) at presentation were more likely to develop WRF within the first 24 h than patients with CVP in the highest tertile (>15 cmH(2)O) (18 vs. 4%, P = 0.046).
In AHF, combined low SBP and high CVP predispose to lower eGFR. However, lower CVP may also be associated with short-term WRF. The pathophysiology of WRF and the role of CVP seem to be more complex than previously thought.
确定在因急性心力衰竭（AHF）就诊于急诊的患者中，中心静脉压（CVP）与肾功能之间的关系。
在 140 例 AHF 患者就诊时，使用压缩超声技术无创性地测定 CVP。住院期间血清肌酐升高≥0.3mg/dL 定义为肾功能恶化（WRF）。在研究队列中[年龄 77±12 岁，B 型利钠肽 1862±1564pg/mL，左心室射血分数 40±15%，估算肾小球滤过率（eGFR）58±28mL/min，CVP 13.2±6.9cmH2O]，51 例（36%）患者发生了 WRF。在就诊时或出院时 CVP 与同期 eGFR 之间未见显著相关性（r=0.005，P=0.419 和 r=0.013，P=0.313）。然而，在收缩压（SBP）<110mmHg 且 CVP 较高（>15cmH2O）的患者中，就诊时和出院时 eGFR 显著较低（29±17 vs. 47±19mL/min/1.73m2，P=0.039 和 26±10 vs. 53±26mL/min/1.73m2，P=0.013）。有或无院内 WRF 的患者之间就诊时和出院时的 CVP 无差异（12.6±7.2 vs. 13.5±6.7cmH2O，P=0.503 和 7.4±6.5 vs. 7.7±5.7cmH2O，P=0.799）（受试者工作特征分析 0.543，P=0.401 和 0.531，P=0.625）。然而，就诊时 CVP 处于最低三分位数（<10cmH2O）的患者比 CVP 处于最高三分位数（>15cmH2O）的患者在最初 24h 内发生 WRF 的可能性更高（18% vs. 4%，P=0.046）。
在 AHF 中，联合的低 SBP 和高 CVP 易导致 eGFR 降低。然而，较低的 CVP 也可能与短期 WRF 相关。WRF 的病理生理学和 CVP 的作用似乎比之前认为的更复杂。
