title: Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure.
abstract: BACKGROUND
  In heart failure (HF), renal dysfunction is associated with an adverse prognosis. Impaired renal perfusion from left ventricular dysfunction is thought to be a principal underlying mechanism. Less is known about the influence of venous congestion, including the potential contribution of tricuspid regurgitation (TR).
  
  
  RESULTS
  Echocardiograms and a simultaneous (+/-1 day) blood sample from 196 HF patients were analyzed. Patients with at least moderate TR (n = 78) had larger right-sided cardiac cavities, higher right ventricular systolic pressure, lower estimated glomerular filtration rate (eGFR), higher serum urea nitrogen (SUN), and SUN/creatinine ratio than patients with less than moderate TR (n = 118). In multivariate linear regression analysis, TR severity (P = .003), older age (P < .001), and loop diuretic use (P = .008) were independently associated with lower eGFR, and use of inhibitors of the renin-angiotensin-aldosterone system was associated with higher eGFR (P = .001). TR severity (P < .001) and older age (P < .001) were independently associated with higher SUN. TR severity (P = .004) and smaller left ventricular end-diastolic diameter (P = .048) were independent predictors of a higher SUN/creatinine ratio (P = .004).
  
  
  CONCLUSIONS
  Although a causal relationship cannot be proven, we suggest that significant TR contributes to renal dysfunction in HF patients, probably by elevation of central and renal venous pressure.
authors.affiliation: Baker IDI Heart and Diabetes Institute and Heart Center Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Micha T
authors.initials: MT
authors.lastname: Maeder
authors.forename: Diane P
authors.initials: DP
authors.lastname: Holst
authors.forename: David M
authors.initials: DM
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D002496:Central Venous Pressure / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*