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New renal hemodynamic indices can predict worsening of renal function in acute decompensated heart failure
M Abdelhamid1
,
K Said1
,
W Ammar1
,
A El Taweel2
,
A Mostafa1
,
1Cardiology Department , Cairo University - Cairo - Egypt
,
2Cairo University, Clinical pathology - Cairo - Egypt
,
Topic(s): Acute Heart Failure: Diagnostic Methods, Other
Background: Combined disorders of heart and kidney are classified as cardiorenal syndromes (CRS). CRS type 1 includes acute heart disorder leading to acute kidney injury (AKI) and occurs in ~25% of patients admitted with acute decompensated heart failure (ADHF). The development of duplex ultrasound has enabled the evaluation of changes in intra-renal blood flow.
Objectives: To evaluate the role of intra-renal duplex parameters in predicting worsening of renal functions (WRF) in hospitalized patients with ADHF.
Methods: Among 90 patients hospitalized with ADHF, intra-renal duplex parameters (resistivity index (RRI), pulsitility index (PI) and acceleration time (AT)) were assessed on admission, after 24 and 72 hours. WRF was defined as rise of the serum creatinine level =0.3 mg/dL from the baseline. Diuretic efficiency was defined as net daily urine output normalized for the amount of Furosemide received in mg. Adverse in-hospital outcomes were defined as the composite outcome of death, use of vasopressors and need for ultrafiltration.
Results: The mean age of the patients was 57.5±11.1 years with 62% of them males. WRF developed in 40% of the patients. The Mean value of RRI on admission was 0.717 ± 0.08 and it showed significant increase at 24 and 72 hours follow up (p= 0.001 for both). The independent predictors of WRF by multivariate regression analysis were AT at 24 hours follow up, urea on admission, RRI on admission, LVEF and plasma cystatin C on admission. Patients with lower diuretic response had higher levels of admission RRI and higher levels of PASP on admission. The independent predictors of development of the composite outcome were LVESD, WRF and E/e’.
Conclusions: The intra-renal duplex parameters RRI and AT are independent predictors of WRF in hospitalized patients with ADHF on diuretic therapy. Higher admission RRI is associated with lower diuretic response. WRF is among the independent predictors of adverse outcome in hospitalized patients with ADHF.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
