title: Cardiorenal interactions: insights from the ESCAPE trial.
abstract: OBJECTIVE
  We examined the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) database to understand the impact and pathophysiology of renal dysfunction in patients hospitalized with advanced decompensated heart failure (HF).
  
  
  BACKGROUND
  Baseline renal insufficiency (RI) (estimated glomerular filtration rate [eGFR] <60 ml/min) and worsening renal function (WRF) (upward arrow serum creatinine [SCr] >or=0.3 mg/dl) during treatment of decompensated HF are associated with adverse outcomes.
  
  
  METHODS
  We used a Cox proportional hazards model to evaluate the impact of renal function on 6-month outcomes. Renal parameters were correlated with hemodynamic measurements. The impact of a strategy using pulmonary artery catheter (PAC) guidance on WRF and outcomes in patients with baseline RI was compared with treatment based on clinical assessment alone.
  
  
  RESULTS
  Baseline and discharge RI, but not WRF, were associated with an increased risk of death and death or rehospitalization. Among the hemodynamic parameters measured in patients randomized to the PAC arm (n = 194), only right atrial pressure correlated weakly with baseline SCr (r = 0.165, p = 0.03). There was no correlation between baseline hemodynamics or change in hemodynamics and WRF. A PAC-guided strategy was associated with less average increase in creatinine but did not decrease the incidence of defined WRF during hospitalization or affect renal function after discharge relative to clinical assessment alone.
  
  
  CONCLUSIONS
  Among patients with advanced decompensated HF, baseline RI impacts outcomes more than WRF. Poor forward flow alone does not appear to account for the development of RI or WRF in these patients. The addition of hemodynamic monitoring to clinical assessment does not prevent WRF or improve renal function after discharge.
authors: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors: Anju
authors: A
authors: Nohria
authors: Vic
authors: V
authors: Hasselblad
authors: Amanda
authors: A
authors: Stebbins
authors: Daniel F
authors: DF
authors: Pauly
authors: Gregg C
authors: GC
authors: Fonarow
authors: Monica
authors: M
authors: Shah
authors: Clyde W
authors: CW
authors: Yancy
authors: Robert M
authors: RM
authors: Califf
authors: Lynne W
authors: LW
authors: Stevenson
authors: James A
authors: JA
authors: Hill
mesh_terms: D000208:Acute Disease; D002407:Catheterization, Swan-Ganz; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine