title: Hemodynamic and neurochemical determinates of renal function in chronic heart failure.
abstract: Abnormal renal function is common in acute and chronic congestive heart failure (CHF) and is related to the severity of congestion. However, treatment of congestion often leads to worsening renal function. Our objective was to explore basal determinants of renal function and their response to hemodynamic interventions. Thirty-seven patients without CHF and 59 patients with chronic CHF (ejection fraction; 23 ± 8%) underwent right heart catheterization, measurements of glomerular filtration rate (GFR; inulin) and renal plasma flow (RPF; para-aminohippurate), and radiotracer estimates of renal sympathetic activity. A subset (26 without, 36 with CHF) underwent acute pharmacological intervention with dobutamine or nitroprusside. We explored the relationship between baseline and drug-induced hemodynamic changes and changes in renal function. In CHF, there was an inverse relationship among right atrial mean pressure (RAM) pressure, RPF, and GFR. By contrast, mean arterial pressure (MAP), cardiac index (CI), and measures of renal sympathetic activity were not significant predictors. In those with CHF there was also an inverse relationship among the drug-induced changes in RAM as well as pulmonary artery mean pressure and the change in GFR. Changes in MAP and CI did not predict the change in GFR in those with CHF. Baseline values and changes in RAM pressure did not correlate with GFR in those without CHF. In the CHF group there was a positive correlation between RAM pressure and renal sympathetic activity. There was also an inverse relationship among RAM pressure, GFR, and RPF in patients with chronic CHF. The observation that acute reductions in RAM pressure is associated with an increase in GFR in patients with CHF has important clinical implications.
authors.affiliation: Division of Cardiology and Nephrology, Mount Sinai Hospital and University Health Network Hospital, Toronto, Canada;
authors.forename: Cameron
authors.initials: C
authors.lastname: Gilbert
authors.affiliation: Division of Cardiology and Nephrology, Mount Sinai Hospital and University Health Network Hospital, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; and.
authors.forename: David Z I
authors.initials: DZ
authors.lastname: Cherney
authors.affiliation: Division of Cardiology and Nephrology, Mount Sinai Hospital and University Health Network Hospital, Toronto, Canada; john.parker@uhn.ca.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Parker
authors.affiliation: Division of Cardiology and Nephrology, Mount Sinai Hospital and University Health Network Hospital, Toronto, Canada;
authors.forename: Susanna
authors.initials: S
authors.lastname: Mak
authors.affiliation: Division of Cardiology and Nephrology, Mount Sinai Hospital and University Health Network Hospital, Toronto, Canada;
authors.forename: John S
authors.initials: JS
authors.lastname: Floras
authors.affiliation: Division of Cardiology, Saint Michael's Hospital, Toronto, Canada.
authors.forename: Abdul
authors.initials: A
authors.lastname: Al-Hesayen
authors.affiliation: Division of Cardiology and Nephrology, Mount Sinai Hospital and University Health Network Hospital, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; and.
authors.forename: John D
authors.identifier: http://orcid.org/0000-0003-1949-2669
authors.initials: JD
authors.lastname: Parker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D016280:Atrial Function, Right; D062185:Atrial Pressure; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D002908:Chronic Disease; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009599:Nitroprusside / Q000008:administration & dosage; D017595:Renal Plasma Flow; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology*; D013566:Sympathomimetics / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage; D016277:Ventricular Function, Left
chemical_list: D013566:Sympathomimetics; D014665:Vasodilator Agents; D009599:Nitroprusside; D004280:Dobutamine
keywords: heart failure; hemodynamics; renal function; sympathetic nervous system