In patients with cardiac dysfunction, preserving renal function requires addressing both renal perfusion and venous congestion.
RBF is the main factor determining GFR in patients with cardiac dysfunction. Venous congestion, characterised by an increased RAP, adjusted for RBF is also related to GFR. Treatment to preserve GFR should not only focus on improvement of renal perfusion, but also on decreasing venous congestion.
Damman et al. (Sat,) studied this question.