Association between Central Hemodynamics and Glomerular Filtration Rate in Patients with Advanced Heart Failure

Abstract

Purpose The cardiorenal syndrome is common in patients with advanced heart failure (HF). It has been suggested that deteriorating central hemodynamics may contribute to impaired renal function but this relationship is not well defined. We studied the association between invasive hemodynamic measurements and glomerular filtration rate (GFR) in patients undergoing evaluation for heart transplantation (HTx). Methods A total of 220 consecutive patients undergoing evaluation for HTx (mean age 48,6 years ± SD 12,9 years; 73,6 % male) at Sahlgrenska University Hospital during 1988 and 2018 were included in the study. Patients underwent right sided cardiac catheterization with measurements of central hemodynamics and GFR was measured with 51chrome-EDTA clearance. Results GFR showed a significant positive correlation with mean arterial pressure (MAP), heart rate (HR) and mixed venous oxygen saturation (SvO2) and a significant negative correlation with right atrial pressure (RAP); but no correlation with pulmonary artery wedge pressure (PCWP) or cardiac output (CO). In a stepwise multivariate regression analysis adjusted for age and sex, GFR was independently associated with MAP (β-estimate 0.27; p= 0.017), RAP (β-estimate -0.55; p= 0.018), and tended to be related to HR (β-estimate 0.13; p= 0.061). Conclusion Impaired GFR in patients with advanced HF is independently related to decreasing MAP and increasing RAP, probably reflecting a poor renal perfusion pressure.