Biochemical evidence of mild hepatic dysfunction identifies decompensated heart failure patients with reversible renal dysfunction

Meredith A. Brisco, Brian D. McCauley, Jennifer Chen, Chirag R. Parikh, Jeffrey M. Testani

Research output: Contribution to journalArticle

Abstract

Background Differentiation of HF-induced renal dysfunction (RD) from irreversible intrinsic kidney disease is challenging, likely related to the multifactorial pathophysiology underlying HF-induced RD. In contrast, HF-induced liver dysfunction results in characteristic laboratory abnormalities. Given that similar pathophysiologic factors are thought to underlie both conditions, and that the liver and kidneys share a common circulatory environment, patients with laboratory evidence of HF-induced liver dysfunction may also have a high incidence of potentially reversible HF-induced RD. Methods and Results Hospitalized patients with a discharge diagnosis of HF were reviewed (n = 823). Improvement in renal function (IRF) was defined as a 20% improvement in estimated glomerular filtration rate (eGFR). An elevated international normalized ratio (INR; odds ratio [OR] 2.8; P <001), bilirubin (BIL; OR 2.2; P <001), aspartate aminotransferase (AST; OR 1.8; P =.004), and alanine aminotransferase (ALT; OR 2.1; P =.001) were all significantly associated with IRF. Among patients with baseline RD (eGFR ≤45 mL min-1 1.73 m-2), associations between liver dysfunction and IRF were particularly strong (INR: OR 5.7 [P <001]; BIL: OR 5.1 [P <001]; AST: OR 2.9 [P =.005]; ALT: OR 4.8 [P <001]). Conclusions Biochemical evidence of mild liver dysfunction is associated with reversible RD in decompensated HF patients. In the absence of methodology to directly identify HF-induced RD, signs of HF-induced dysfunction of other organs may serve as an accessible method by which HF-induced RD is recognized.

Original languageEnglish (US)
Pages (from-to)739-745
Number of pages7
JournalJournal of cardiac failure
Volume19
Issue number11
DOIs
StatePublished - Nov 1 2013

Keywords

  • Cardiorenal syndrome
  • congestive hepatopathy
  • decompensated heart failure
  • improved renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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