Effect of estimated plasma volume reduction on renal function for acute heart failure differs between patients with preserved and reduced ejection fraction.
BACKGROUND
The prognostic relevance of plasma volume reduction (PVR) in acute heart failure patients remains unclear because of the confounding hemodynamic effect of left ventricular ejection fraction impairment on kidney function.


RESULTS
Subjects enrolled in the West Tokyo Heart Failure Registry were examined. The PV at admission and discharge was estimated from the subjects' body weight and its deviation from the ideal body weight. Patients in the top tertile of estimated PVR were classified as PVR+. Of the 381 patients with acute heart failure, 181 (47.5%) had heart failure with preserved ejection fraction (HFpEF). Estimated PVR was associated with worsening renal function in the HFpEF (odds ratio, 3.28; 95% confidence interval, 1.55-6.96; P=0.002) but not in the heart failure with reduced ejection fraction cohort (odds ratio, 1.22; 95% confidence interval, 0.61-2.42; P=0.57). This association in the HFpEF cohort remained significant after adjusting for a history of hypertension and diabetes mellitus and the estimated glomerular filtration rate (odds ratio, 3.34; 95% confidence interval, 1.52-7.33; P=0.003). The use of intravenous diuretics was a significant predictor of PVR in the HFpEF and heart failure with reduced ejection fraction groups.


CONCLUSIONS
The effect of estimated PVR differs by HF type, and the estimated PVR during hospitalization is a predictor of worsening renal function in patients with HFpEF but not in heart failure with reduced ejection fraction.


BACKGROUND
URL: http://www.umin.ac.jp/ctr/index-j.html. Unique identifier: UMIN000001549.
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Makoto
M
Takei
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.). kohsaka@cpnet.med.keio.ac.jp.
Shun
S
Kohsaka
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Yasuyuki
Y
Shiraishi
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Ayumi
A
Goda
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Yuki
Y
Izumi
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Mayuko
M
Yagawa
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Atsushi
A
Mizuno
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Mitsuaki
M
Sawano
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Taku
T
Inohara
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Takashi
T
Kohno
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Keiichi
K
Fukuda
From the Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan (M.T., S.K., Y.S., M.S., T.I., T.K., K.F.); Department of Cardiology, St. Luke's International Hospital, Chuouku, Tokyo, Japan (A.M.); Second Department of Internal Medicine, Division of Cardiology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan (A.G.); and Department of Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan (Y.I., M.Y., T.Y.).
Tsutomu
T
Yoshikawa
D000208:Acute Disease; D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D018450:Disease Progression; D004231:Diuresis / Q000187:drug effects*; D004232:Diuretics / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D056865:Ideal Body Weight; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010953:Plasma Volume / Q000187:drug effects*; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects*; D013997:Time Factors; D014041:Tokyo; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*
D004232:Diuretics
diuretics; heart failure; heart failure, diastolic; plasma