In patients with acute heart failure, central venous pressure at presentation did not differ between those with and without in-hospital worsening renal function (12.6 vs 13.5 cmH2O, P=0.503).
Observational (n=140)
Does central venous pressure correlate with worsening renal function in patients with acute heart failure?
In acute heart failure, the relationship between central venous pressure and worsening renal function is complex, with low CVP associated with short-term worsening renal function and combined low SBP/high CVP associated with lower eGFR.
p-value: p=0.503
AIMS: To determine the relationship between central venous pressure (CVP) and renal function in patients with acute heart failure (AHF) presenting to the emergency department. METHODS AND RESULTS: Central venous pressure was determined non-invasively using compression sonography in 140 patients with AHF at presentation. Worsening renal function (WRF) was defined as an increase in serum creatinine ≥ 0.3 mg/dL during hospitalization. In the study cohort age 77 ± 12 years, B-type natriuretic peptide 1862 ± 1564 pg/mL, left ventricular ejection fraction 40 ± 15%, estimated glomerular filtration rate (eGFR) 58 ± 28 mL/min, and CVP 13.2 ± 6.9 cmH(2)O, 51 patients (36%) developed WRF. No significant association between CVP at presentation or discharge and concomitant eGFR (r = 0.005, P = 0.419 and r = 0.013, P = 0.313, respectively) was observed. However, in patients with systolic blood pressure (SBP) 15 cmH(2)O), eGFR was significantly lower at presentation and discharge (29 ± 17 vs. 47 ± 19 mL/min/1.73 m(2), P = 0.039 and 26 ± 10 vs. 53 ± 26 mL/min/1.73 m(2), P = 0.013, respectively). Central venous pressure at presentation and at discharge did not differ between patients with or without in-hospital WRF (12.6 ± 7.2 vs. 13.5 ± 6.7 cmH(2)O, P = 0.503 and 7.4 ± 6.5 vs. 7.7 ± 5.7 cmH(2)O, P = 0.799, respectively) (receiver-operating characteristic analysis 0.543, P = 0.401 and 0.531, P = 0.625, respectively). However, patients with CVP in the lowest tertile (15 cmH(2)O) (18 vs. 4%, P = 0.046). CONCLUSION: In AHF, combined low SBP and high CVP predispose to lower eGFR. However, lower CVP may also be associated with short-term WRF. The pathophysiology of WRF and the role of CVP seem to be more complex than previously thought.
Uthoff et al. (2010) conducted an observational in Acute heart failure (n=140). Central venous pressure measurement was evaluated on Worsening renal function (increase in serum creatinine ≥ 0.3 mg/dL during hospitalization) (p=0.503). In patients with acute heart failure, central venous pressure at presentation did not differ between those with and without in-hospital worsening renal function (12.6 vs 13.5 cmH2O, P=0.503).
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