Tricuspid Regurgitation Contributes to Renal Dysfunction in Patients With Heart Failure

Abstract. Background.  In heart failure (HF), renal dysfunction is associated with an adverse prognosis. Impaired renal perfusion from left ventricular dysfunction is thought to be a principal underlying mechanism. Less is known about the influence of venous congestion, including the potential contribution of tricuspid regurgitation (TR). Methods and Results.   Echocardiograms and a simultaneous (±1 day) blood sample from 196 HF patients were analyzed. Patients with at least moderate TR (n=78) had larger right-sided cardiac cavities, higher right ventricular systolic pressure, lower estimated glomerular filtration rate (eGFR), higher serum urea nitrogen (SUN) level, and SUN/creatinine ratio than patients with less than moderate TR (n=118). In multivariate linear regression analysis, TR severity (P=.003), older age (P<.001), and loop diuretic use (P=.008) were independently associated with lower eGFR, and use of inhibitors of the renin-angiotensin-aldosterone system was associated with higher eGFR (P=.001). TR severity (P<.001) and older age (P<.001) were independently associated with higher SUN value. TR severity (P=.004) and smaller left ventricular end-diastolic diameter (P=.048) were independent predictors of a higher SUN/creatinine ratio (P=.004). Conclusions.  Although a causal relationship cannot be proven, we suggest that significant TR contributes to renal dysfunction in HF patients, probably by elevation of central and renal venous pressure.—Maeder MT, Holst DP, Kaye DM. Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure. J Card Fail. 2008;14:824–830.