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

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.