a Department of Cardiology , Rigshopsitalet , Copenhagen , Denmark.
b Department of Cardiology , Herlev-Gentofte Hospital , Copenhagen , Denmark.
Scand J Clin Lab Invest. 2019 May;79(3):194-201. doi: 10.1080/00365513.2019.1576221. Epub 2019 Feb 20.
The interaction between hemodynamics and kidney function in heart failure (HF) is incompletely understood. We investigated the association between invasive hemodynamic parameters and measured glomerular filtration rate (mGFR) by plasma clearance of 51-chromium-labeled ethylenediamine tetra-acetic acid (Cr-EDTA) in patients with advanced HF and tested the hypothesis that patients with reduced mGFR have lower cardiac index (CI) and mean arterial pressure (MAP) as well as higher central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). We retrospectively studied 242 patients (mean age 50 ± 13 years) referred for evaluation for heart transplantation or implantation of a left ventricular assist device with a left ventricular ejection fraction < 45% on optimal medical therapy, who underwent right heart catheterization (RHC) and measurement of Cr-EDTA clearance. Mean mGFR was 63 ± 21 mL/min/1.73 m, CI was 2.3 ± 0.7 L/min/m, PCWP was 21 ± 9 mmHg, and CVP was 10.3 ± 5.2 mmHg. Univariate analysis demonstrated a significant correlation between mGFR and CI (r = 0.030, p = .007) and CVP (r = 0.017, p = .049) but not between mGFR and MAP or PCWP. In multivariate analyses, none of the hemodynamic variables remained significantly associated with mGFR. While CVP and CI were correlated with mGFR in univariate analysis the results of analyses adjusted for multiple covariates suggest that hemodynamics are only correlated to renal function in advanced HF to a modest degree challenging the hypothesis that renal dysfunction in HF mainly is a consequence of renal congestion.
心力衰竭（HF）中血流动力学和肾功能之间的相互作用尚不完全清楚。我们研究了先进 HF 患者中侵入性血流动力学参数与通过血浆清除 51-铬标记的乙二胺四乙酸（Cr-EDTA）测量的肾小球滤过率（mGFR）之间的关联，并检验了假设，即 mGFR 降低的患者具有较低的心脏指数（CI）和平均动脉压（MAP），以及较高的中心静脉压（CVP）和肺毛细血管楔压（PCWP）。我们回顾性研究了 242 名患者（平均年龄 50 ± 13 岁），这些患者在最佳药物治疗下左心室射血分数 < 45%，并接受了右心导管检查（RHC）和 Cr-EDTA 清除率测量，他们因心脏移植或左心室辅助设备植入而被转诊。平均 mGFR 为 63 ± 21 mL/min/1.73 m，CI 为 2.3 ± 0.7 L/min/m，PCWP 为 21 ± 9 mmHg，CVP 为 10.3 ± 5.2 mmHg。单因素分析表明 mGFR 与 CI（r = 0.030，p = 0.007）和 CVP（r = 0.017，p = 0.049）之间存在显著相关性，但与 MAP 或 PCWP 之间没有相关性。在多因素分析中，没有一个血流动力学变量与 mGFR 显著相关。虽然 CVP 和 CI 在单因素分析中与 mGFR 相关，但在调整了多个协变量的分析中，结果表明血流动力学与 HF 晚期肾功能仅存在适度相关性，这对肾功能障碍在 HF 中主要是由于肾充血的假设提出了挑战。
