Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure

Jennifer S. Hanberg, Krishna Sury, F. Perry Wilson, Meredith A. Brisco, Tariq Ahmad, Jozine M. Ter Maaten, J. Samuel Broughton, Mahlet Assefa, W. H. Wilson Tang, Chirag Parikh, Jeffrey M. Testani

Research output: Contribution to journalArticle

Abstract

Background It is widely believed that a reduced cardiac index (CI) is a significant contributor to renal dysfunction in patients with heart failure (HF). However, recent data have challenged this paradigm. Objectives This study sought to determine the relationship between CI and renal function in a multicenter population of HF patients undergoing pulmonary artery catheterization (PAC). Methods Patients undergoing PAC in either the randomized or registry portions of the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial were included (n = 575). We evaluated associations between CI and renal function across multiple subgroups and assessed for nonlinear, threshold, and longitudinal relationships. Results There was a weak but significant inverse correlation between CI and estimated glomerular filtration rate (EGFR), such that higher CI was paradoxically associated with worse EGFR (r = -0.12; p = 0.02). CI was not associated with blood urea nitrogen (BUN) or the BUN to creatinine ratio. Similarly, no associations were observed between CI and better renal function across multiple subgroups defined by indications for PAC or hemodynamic, laboratory, or demographic parameters. A nonlinear or threshold effect could not be identified. In patients with serial assessments of renal function and CI, we were unable to find within-subject associations between change in CI and EGFR using linear mixed modeling. Neither CI nor change in CI was lower in patients developing worsening renal function (p ≥ 0.28). Conclusions These results reinforce evidence that reduced CI is not the primary driver for renal dysfunction in patients hospitalized for HF, irrespective of the degree of CI impairment or patient subgroup analyzed.

Original languageEnglish (US)
Pages (from-to)2199-2208
Number of pages10
JournalJournal of the American College of Cardiology
Volume67
Issue number19
DOIs
StatePublished - May 17 2016

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Swan-Ganz Catheterization
Heart Failure
Kidney
Glomerular Filtration Rate
Blood Urea Nitrogen
Registries
Creatinine
Hemodynamics
Demography
Population

Keywords

  • blood urea nitrogen
  • cardiorenal
  • creatinine
  • pulmonary artery catheterization
  • renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hanberg, J. S., Sury, K., Perry Wilson, F., Brisco, M. A., Ahmad, T., Ter Maaten, J. M., ... Testani, J. M. (2016). Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure. Journal of the American College of Cardiology, 67(19), 2199-2208. https://doi.org/10.1016/j.jacc.2016.02.058

Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure. / Hanberg, Jennifer S.; Sury, Krishna; Perry Wilson, F.; Brisco, Meredith A.; Ahmad, Tariq; Ter Maaten, Jozine M.; Samuel Broughton, J.; Assefa, Mahlet; Wilson Tang, W. H.; Parikh, Chirag; Testani, Jeffrey M.

In: Journal of the American College of Cardiology, Vol. 67, No. 19, 17.05.2016, p. 2199-2208.

Research output: Contribution to journalArticle

Hanberg, JS, Sury, K, Perry Wilson, F, Brisco, MA, Ahmad, T, Ter Maaten, JM, Samuel Broughton, J, Assefa, M, Wilson Tang, WH, Parikh, C & Testani, JM 2016, 'Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure', Journal of the American College of Cardiology, vol. 67, no. 19, pp. 2199-2208. https://doi.org/10.1016/j.jacc.2016.02.058
Hanberg, Jennifer S. ; Sury, Krishna ; Perry Wilson, F. ; Brisco, Meredith A. ; Ahmad, Tariq ; Ter Maaten, Jozine M. ; Samuel Broughton, J. ; Assefa, Mahlet ; Wilson Tang, W. H. ; Parikh, Chirag ; Testani, Jeffrey M. / Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure. In: Journal of the American College of Cardiology. 2016 ; Vol. 67, No. 19. pp. 2199-2208.
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abstract = "Background It is widely believed that a reduced cardiac index (CI) is a significant contributor to renal dysfunction in patients with heart failure (HF). However, recent data have challenged this paradigm. Objectives This study sought to determine the relationship between CI and renal function in a multicenter population of HF patients undergoing pulmonary artery catheterization (PAC). Methods Patients undergoing PAC in either the randomized or registry portions of the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial were included (n = 575). We evaluated associations between CI and renal function across multiple subgroups and assessed for nonlinear, threshold, and longitudinal relationships. Results There was a weak but significant inverse correlation between CI and estimated glomerular filtration rate (EGFR), such that higher CI was paradoxically associated with worse EGFR (r = -0.12; p = 0.02). CI was not associated with blood urea nitrogen (BUN) or the BUN to creatinine ratio. Similarly, no associations were observed between CI and better renal function across multiple subgroups defined by indications for PAC or hemodynamic, laboratory, or demographic parameters. A nonlinear or threshold effect could not be identified. In patients with serial assessments of renal function and CI, we were unable to find within-subject associations between change in CI and EGFR using linear mixed modeling. Neither CI nor change in CI was lower in patients developing worsening renal function (p ≥ 0.28). Conclusions These results reinforce evidence that reduced CI is not the primary driver for renal dysfunction in patients hospitalized for HF, irrespective of the degree of CI impairment or patient subgroup analyzed.",
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AU - Ter Maaten, Jozine M.

AU - Samuel Broughton, J.

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