April 27, 2026Journal of the American College of Cardiology

Cardiorenal Interactions

Q: What are the key findings of this study?

In patients with advanced decompensated HF, right atrial pressure correlated weakly with baseline serum creatinine (r=0.165, p=0.03), and PAC guidance did not prevent worsening renal function.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Advanced decompensated heart failure. Intervention: Pulmonary artery catheter (PAC) guidance vs. Clinical assessment alone. Primary outcome: Death and death or rehospitalization at 6 months.

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Key result

Pulmonary artery catheter guidance fails to prevent worsening renal function compared to clinical assessment alone.

p=0.03

Why the study?

Baseline renal insufficiency and worsening renal function during treatment of decompensated heart failure are associated with adverse outcomes, but their impact and pathophysiology require further understanding.

Does pulmonary artery catheter guidance prevent worsening renal function or improve outcomes compared to clinical assessment alone in patients hospitalized with advanced decompensated heart failure?

Population

Patients hospitalized with advanced decompensated heart failure from the ESCAPE database

Comparison

Pulmonary artery catheter guidance vs clinical assessment alone

Design

Randomized controlled trial

Follow-up

6 months

Authors

ANAnju NohriaCardio-Oncology VHVic HasselbladUniversity of North Carolina at Chapel Hill ASAmanda StebbinsCross-Cutting Cardiology

Discussion

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Implication

Should not yet change practice toward PAC-guided care to prevent WRF in HF; leaves open alternative explanations for cardiorenal interactions.**[[1]](https://pubmed.ncbi.nlm.nih.gov/18371557/)[[2]](https://www.sciencedirect.

Key Points

To examine the impact, pathophysiology, and hemodynamic correlates of baseline renal insufficiency and worsening renal function in patients hospitalized with advanced decompensated heart failure.
Analyzed the ESCAPE randomized trial database using Cox proportional hazards models to evaluate the association of baseline renal insufficiency (eGFR <60 ml/min) and worsening renal function (serum creatinine increase ≥0.3 mg/dl) with 6-month clinical outcomes.
Correlated renal indices with invasive hemodynamic measurements among patients randomized to pulmonary artery catheter (PAC) monitoring (n = 194) versus clinical assessment alone.
Baseline and discharge renal insufficiency, but not worsening renal function during hospitalization, were significantly associated with an increased risk of 6-month mortality and the composite of death or rehospitalization.
Right atrial pressure correlated weakly with baseline serum creatinine (r = 0.165, p = 0.03), while no baseline hemodynamics or hemodynamic shifts correlated with worsening renal function.
PAC-guided therapy led to a smaller average creatinine rise but did not reduce the incidence of worsening renal function during hospitalization or improve post-discharge renal function compared with clinical assessment alone.

Study Design

Type

RCT

Randomization

randomized

Structured PICO

Does pulmonary artery catheter guidance prevent worsening renal function or improve outcomes compared to clinical assessment alone in patients hospitalized with advanced decompensated heart failure?

Population

Patients hospitalized with advanced decompensated heart failure, followed for 6 months to evaluate the impact of renal dysfunction and PAC guidance.

Intervention

Pulmonary artery catheter (PAC) guidance

Comparator

Treatment based on clinical assessment alone

Outcome

6-month outcomes including death, composite of death or rehospitalization, and worsening renal function (WRF)composite

In patients with advanced decompensated heart failure, baseline renal insufficiency is a stronger predictor of adverse outcomes than worsening renal function, and PAC-guided therapy does not prevent worsening renal function.

Cite This Study

Nohria et al. (2008) conducted an RCT in Advanced decompensated heart failure. Pulmonary artery catheter (PAC) guidance vs. Clinical assessment alone was evaluated on Death and death or rehospitalization at 6 months. In patients with advanced decompensated HF, right atrial pressure correlated weakly with baseline serum creatinine (r=0.165, p=0.03), and PAC guidance did not prevent worsening renal function.

synapsesocial.com/papers/69eed5a16e8256fd0cf35781 https://doi.org/10.1016/j.jacc.2007.08.072

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Cardiorenal Interactions

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Cardiorenal Interactions

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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