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Oscar Braun

Physician

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Association between central haemodynamics and renal function in advanced heart failure : a nationwide study from Sweden

Author

  • Emanuele Bobbio
  • Entela Bollano
  • Christian L. Polte
  • Jan Ekelund
  • Göran Rådegran
  • Jakob Lundgren
  • Carl Haggård
  • Grunde Gjesdal
  • Oscar Braun
  • Sven Erik Bartfay
  • Niklas Bergh
  • Pia Dahlberg
  • Clara Hjalmarsson
  • Sorosh Esmaily
  • Ida Haugen Löfman
  • Aristomenis Manouras
  • Michael Melin
  • Göran Dellgren
  • Kristjan Karason

Summary, in English

Aims: Renal dysfunction in patients with heart failure (HF) has traditionally been attributed to declining cardiac output and renal hypoperfusion. However, other central haemodynamic aberrations may contribute to impaired kidney function. This study assessed the relationship between invasive central haemodynamic measurements from right-heart catheterizations and measured glomerular filtration rate (mGFR) in advanced HF. Methods and results: All patients referred for heart transplantation work-up in Sweden between 1988 and 2019 were identified through the Scandiatransplant organ-exchange organization database. Invasive haemodynamic variables and mGFR were retrieved retrospectively. A total of 1001 subjects (49 ± 13 years; 24% female) were eligible for the study. Analysis of covariance adjusted for age, sex, and centre revealed that higher right atrial pressure (RAP) displayed the strongest relationship with impaired GFR [β coefficient −0.59; 95% confidence interval (CI) –0.69 to −0.48; P < 0.001], followed by lower mean arterial pressure (MAP) (β coefficient 0.29; 95% CI 0.14–0.37; P < 0.001), and finally reduced cardiac index (β coefficient 3.51; 95% CI 2.14–4.84; P < 0.003). A combination of high RAP and low MAP was associated with markedly worse mGFR than any other RAP/MAP profile, and high renal perfusion pressure (RPP, MAP minus RAP) was associated with superior renal function irrespective of the degree of cardiac output. Conclusions: In patients with advanced HF, high RAP contributed more to impaired GFR than low MAP. A higher RPP was more closely related to GFR than was high cardiac index.

Department/s

  • Lund Hemodynamic Lab
  • Cardiopulmonary disease - information, support and reception
  • Cardiology
  • Heart Failure and Mechanical Support
  • Molecular Epidemiology and Cardiology

Publishing year

2022-08

Language

English

Pages

2654-2663

Publication/Series

ESC Heart Failure

Volume

9

Issue

4

Document type

Journal article

Publisher

John Wiley & Sons Inc.

Topic

  • Cardiac and Cardiovascular Systems

Keywords

  • Advanced heart failure
  • Glomerular filtration rate
  • Invasive haemodynamics
  • Renal perfusion pressure
  • Right atrial pressure

Status

Published

Research group

  • Lund Hemodynamic Lab
  • Cardiopulmonary disease - information, support and reception
  • Heart Failure and Mechanical Support
  • Molecular Epidemiology and Cardiology

ISBN/ISSN/Other

  • ISSN: 2055-5822