New renal haemodynamic indices can predict worsening of renal function in acute decompensated heart failure
Open Access
- 30 June 2020
- journal article
- research article
- Published by Wiley in ESC Heart Failure
- Vol. 7 (5), 2581-2588
- https://doi.org/10.1002/ehf2.12835
Abstract
Aims Worsening of renal function (WRF) is a common complication in patients with acute decompensated heart failure (ADHF). We aimed to evaluate the role of intrarenal Doppler ultrasound (IRD) in the early prediction of WRF in this patient group. Methods and results Among 90 patients (age: 57.5 ± 11.1 years; 62% male) hospitalized with ADHF, resistivity index (RI), acceleration time (AT), and pulsatility index (PI) were measured on admission and at 24 and 72 h. WRF was defined as increased serum creatinine ≥0.3 mg/dL from baseline. Adverse clinical outcomes were defined as the composite of death, use of vasopressors, and need for ultrafiltration for refractory oedema. WRF developed in 40% of patients. Mean values of renal AT, RI, and PI on admission were 59.7 ± 15, 0.717 ± 0.08, and 1.5 ± 0.48 ms, respectively. At 24 h, there was significant decrease in AT (to 56.7 ± 10 ms, P = 0.02) and renal RI (to 0.732 ± 0.07; P < 0.001); these changes were maintained up to 72 h. Renal PI showed no significant changes. Independent predictors of WRF were renal AT at 24 h and admission values of renal RI, left ventricular ejection fraction, and plasma cystatin C. Renal AT at 24 h ≥ 57.8 ms had 89% sensitivity and 70% specificity for the prediction of WRF. Independent predictors for adverse clinical outcomes were left ventricular end systolic dimension and WRF. Conclusions Among ADHF patients receiving diuretic therapy, measurement of renal AT and RI by IRD can help identify patients at increased risk for WRF.Keywords
This publication has 27 references indexed in Scilit:
- Renal resistive index as a marker of vascular damage in cardiovascular diseasesInternational Urology and Nephrology, 2013
- Incidence, clinical predictors, and prognostic impact of worsening renal function in elderly patients with chronic heart failure on intensive medical therapyAmerican Heart Journal, 2012
- Cystatin C as a Biomarker of Worsening Renal Function in Acute Heart Failure: Insights from the DOSE StudyJournal of Cardiac Failure, 2011
- Markers of renal function and acute kidney injury in acute heart failure: definitions and impact on outcomes of the cardiorenal syndromeEuropean Heart Journal, 2010
- Associations Between Renal Duplex Parameters and Adverse Cardiovascular Events in the Elderly: A Prospective Cohort StudyAmerican Journal of Kidney Diseases, 2010
- Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart FailureJournal of the American College of Cardiology, 2009
- Renal and carotid vascular resistance assessed with Doppler sonographyJournal of Clinical Ultrasound, 2007
- Role of Diminished Renal Function in Cardiovascular Mortality: Marker or Pathogenetic Factor?Journal of the American College of Cardiology, 2006
- Haemodynamic Impact of Diuretic Therapy in Chronic Heart FailureCardiology, 1994
- Prediction of Creatinine Clearance from Serum CreatinineNephron, 1976