title: Renal dysfunction in heart failure is due to congestion but not low output.
abstract: BACKGROUND
  Renal dysfunction in heart failure is thought to be due to poor perfusion of the kidney.
  
  
  OBJECTIVE
  We tested the hypothesis that passive congestion is more important than poor perfusion.
  
  
  METHODS
  We retrospectively studied the data on 178 patients who underwent right heart catheterization for evaluation of heart failure and had serum creatinine (Cr) measured on the same day.
  
  
  RESULTS
  Serum Cr and glomerular filtration rate (GFR) correlated with central venous pressure (r = 0.22, P = 0.001 and r = -0.55, P < 0.0001, respectively) and renal perfusion pressure (r = 0.21, P = 0.001 and r = 0.27, P = 0.015, respectively). Neither correlated with cardiac index or left ventricular ejection fraction. Serum Cr was significantly higher and GFR was significantly lower in the upper tertile of central venous pressure, pulmonary capillary wedge pressure as well as in the lower tertile of renal perfusion pressure.
  
  
  CONCLUSIONS
  Renal dysfunction in heart failure is determined more by passive congestion than by low perfusion.
authors.affiliation: Department of Medicine, University of South Florida, Tampa, FL 33620, USA. mguglin@gmail.com
authors.forename: Maya
authors.initials: M
authors.lastname: Guglin
authors.forename: Abel
authors.initials: A
authors.lastname: Rivero
authors.forename: Fadi
authors.initials: F
authors.lastname: Matar
authors.forename: Marcos
authors.initials: M
authors.lastname: Garcia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D051437:Renal Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D013223:Statistics as Topic; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D003404:Creatinine