Pulsatile arterial haemodynamic effect on renal outcomes in patients with acute heart failure.

IF 2.9 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
François Croset, Pau Llàcer, Jorge Campos, Marina García-Melero, Carlos Pérez, Alberto Pérez-Nieva, Raúl Ruiz, Daniel Useros, Cristina Fernández, María Pumares, Almudena Vázquez, Esteban Pérez-Pisón, Martín Fabregate, Luis Manzano
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Abstract

Aims: Haemodynamic changes in acute heart failure (AHF) are closely linked to renal function alterations. Pulse pressure (PP) may offer insights beyond mean arterial pressure (MAP) in identifying patients with vulnerable renal function during AHF episodes. This study aimed to investigate the association between PP and renal function parameters, including urinary albumin creatinine ratio (UACR) and changes in creatinine, in patients hospitalized for AHF.

Methods and results: We conducted a retrospective observational study involving 695 patients admitted for AHF between June 2020 and April 2023. PP was calculated at admission, and renal function parameters were assessed over the first 48 hours. A multivariable linear regression assessed the association between PP and UACR and creatinine changes, adjusting for possible confounders. Patients in the highest tertile of PP exhibited a significantly higher incidence of worsening renal function (WRF) (p=0.048) and a lower incidence of improved renal function (IRF) (p=0.001). Multivariable analysis identified PP as an independent predictor of changes in creatinine (p=0.010) and UACR (p=0.037). The findings suggest that elevated PP may indicate impaired renal autoregulation and an increased risk of renal deterioration during AHF.

Conclusion: In patients hospitalized for AHF pulse pressure showed a positive and linear association with UACR values and changes in creatinine during the first 48 hours of intravenous furosemide treatment. Pulse pressure may help identifying patients with kidneys more susceptible to haemodynamic changes during hospitalization for AHF.

搏动动脉血流动力学对急性心力衰竭患者肾脏预后的影响。
目的:急性心力衰竭(AHF)的血流动力学改变与肾功能改变密切相关。在AHF发作期间,脉压(PP)可能提供比平均动脉压(MAP)更深入的见解,以识别肾功能易损的患者。本研究旨在探讨住院AHF患者PP与肾功能参数(包括尿白蛋白肌酐比(UACR)和肌酐变化)的关系。方法和结果:我们进行了一项回顾性观察性研究,涉及2020年6月至2023年4月期间入院的695例AHF患者。入院时计算PP,并评估前48小时的肾功能参数。多变量线性回归评估了PP、UACR和肌酐变化之间的关系,并对可能的混杂因素进行了调整。PP最高分位数的患者肾功能恶化(WRF)发生率显著高于对照组(p=0.048),而肾功能改善(IRF)发生率显著低于对照组(p=0.001)。多变量分析发现PP是肌酐(p=0.010)和UACR (p=0.037)变化的独立预测因子。研究结果表明,PP升高可能表明AHF期间肾脏自身调节功能受损,肾脏恶化的风险增加。结论:因AHF住院患者脉压与静脉速尿治疗前48小时UACR值和肌酐变化呈线性正相关。脉压可能有助于鉴别因AHF住院期间肾脏更易发生血流动力学变化的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cardiorenal Medicine
Cardiorenal Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-UROLOGY & NEPHROLOGY
CiteScore
5.40
自引率
2.60%
发文量
25
审稿时长
>12 weeks
期刊介绍: The journal ''Cardiorenal Medicine'' explores the mechanisms by which obesity and other metabolic abnormalities promote the pathogenesis and progression of heart and kidney disease (cardiorenal metabolic syndrome). It provides an interdisciplinary platform for the advancement of research and clinical practice, focussing on translational issues.
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