Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease.
OBJECTIVE
We sought to investigate the relationship between increased central venous pressure (CVP), renal function, and mortality in a broad spectrum of cardiovascular patients.


BACKGROUND
The pathophysiology of impaired renal function in cardiovascular disease is multifactorial. The relative importance of increased CVP has not been addressed previously.


METHODS
A total of 2,557 patients who underwent right heart catheterization in the University Medical Center Groningen, the Netherlands, between January 1, 1989, and December 31, 2006, were identified, and their data were extracted from electronic databases. Estimated glomerular filtration rate (eGFR) was assessed with the simplified modification of diet in renal disease formula.


RESULTS
Mean age was 59 +/- 15 years, and 57% were men. Mean eGFR was 65 +/- 24 ml/min/1.73 m(2), with a cardiac index of 2.9 +/- 0.8 l/min/m(2) and CVP of 5.9 +/- 4.3 mm Hg. We found that CVP was associated with cardiac index (r = -0.259, p < 0.0001) and eGFR (r = -0.147, p < 0.0001). Also, cardiac index was associated with eGFR (r = 0.123, p < 0.0001). In multivariate analysis CVP remained associated with eGFR (r = -0.108, p < 0.0001). In a median follow-up time of 10.7 years, 741 (29%) patients died. We found that CVP was an independent predictor of reduced survival (hazard ratio: 1.03 per mm Hg increase, 95% confidence interval: 1.01 to 1.05, p = 0.0032).


CONCLUSIONS
Increased CVP is associated with impaired renal function and independently related to all-cause mortality in a broad spectrum of patients with cardiovascular disease.
Damman
Kevin
K
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
van Deursen
Vincent M
VM
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Navis
Gerjan
G
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Voors
Adriaan A
AA
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
van Veldhuisen
Dirk J
DJ
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Hillege
Hans L
HL
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: h.hillege@tcc.umcg.nl.
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D002496:Central Venous Pressure; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051437:Renal Insufficiency / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate
D003404:Creatinine