TY - JOUR
T1 - Differential associations between renal function and "modifiable" risk factors in patients with chronic heart failure
AU - Smilde, Tom D. J.
AU - Damman, Kevin
AU - van der Harst, Pim
AU - Navis, Gerjan
AU - Westenbrink, B. Daan
AU - Voors, Adriaan A.
AU - Boomsma, Frans
AU - van Veldhuisen, Dirk J.
AU - Hillege, Hans L.
PY - 2009/2
Y1 - 2009/2
N2 - Reduced glomerular filtration rate (GFR) is strongly associated with reduced survival in patients with chronic heart failure (CHF). Our aim was to determine different pathophysiologic markers that are associated with reduced renal function in CHF.We studied 86 patients with CHF (58 +/- A 12 years, 78% male). GFR and renal blood flow (RBF) were determined by (125)I-Iothalamate and (131)I-Hippuran clearances. Filtration fraction (FF) was calculated. We determined haemoglobin levels, endothelial function, inflammatory status, plasma renin activity (PRA) and N-terminal pro brain natriuretic peptide (NT-proBNP). Urinay albumin excretion (UAE) was measured in 24 h urine. Mean GFR was 74 +/- A 28 ml/min/1.73 m(2). GFR was strongly related to RBF (r = 0.915, P <0.001), FF (r = 0.546, P <0.001), but only weakly to endothelial function and PRA. In multivariate analysis, RBF (r = 0.938, P <0.001), FF (r = 0.786, P <0.001) and haemoglobin levels (r = -0.520, P <0.001) were independently associated with GFR. UAE was mainly dependent on RBF (r = -0.401, P <0.001) and increased exponentially with decreasing RBF. RBF was mainly associated with NT-proBNP (r = -0.561, P <0.001) and PRA (r = -0.422, P <0.001).Reduced GFR is mainly dependent of decreased RBF in patients with CHF. Endothelial function and neurohormonal activation showed only mild associations with GFR. NT-proBNP showed a strong relationship with RBF, and may be used as a marker of reduced renal perfusion.
AB - Reduced glomerular filtration rate (GFR) is strongly associated with reduced survival in patients with chronic heart failure (CHF). Our aim was to determine different pathophysiologic markers that are associated with reduced renal function in CHF.We studied 86 patients with CHF (58 +/- A 12 years, 78% male). GFR and renal blood flow (RBF) were determined by (125)I-Iothalamate and (131)I-Hippuran clearances. Filtration fraction (FF) was calculated. We determined haemoglobin levels, endothelial function, inflammatory status, plasma renin activity (PRA) and N-terminal pro brain natriuretic peptide (NT-proBNP). Urinay albumin excretion (UAE) was measured in 24 h urine. Mean GFR was 74 +/- A 28 ml/min/1.73 m(2). GFR was strongly related to RBF (r = 0.915, P <0.001), FF (r = 0.546, P <0.001), but only weakly to endothelial function and PRA. In multivariate analysis, RBF (r = 0.938, P <0.001), FF (r = 0.786, P <0.001) and haemoglobin levels (r = -0.520, P <0.001) were independently associated with GFR. UAE was mainly dependent on RBF (r = -0.401, P <0.001) and increased exponentially with decreasing RBF. RBF was mainly associated with NT-proBNP (r = -0.561, P <0.001) and PRA (r = -0.422, P <0.001).Reduced GFR is mainly dependent of decreased RBF in patients with CHF. Endothelial function and neurohormonal activation showed only mild associations with GFR. NT-proBNP showed a strong relationship with RBF, and may be used as a marker of reduced renal perfusion.
KW - chronic heart failure
KW - renal function
KW - microalbuminuria
KW - renal blood flow
KW - plasma renin activity
KW - NT-proBNP
KW - BRAIN NATRIURETIC PEPTIDE
KW - LEFT-VENTRICULAR DYSFUNCTION
KW - GLOMERULAR-FILTRATION RATE
KW - CARDIOVASCULAR MORTALITY
KW - ANGIOTENSIN-II
KW - ACE-INHIBITION
KW - ELDERLY-MEN
KW - PLASMA-FLOW
KW - BLOOD-FLOW
KW - IMPAIRMENT
U2 - 10.1007/s00392-008-0732-z
DO - 10.1007/s00392-008-0732-z
M3 - Article
VL - 98
SP - 121
EP - 129
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
SN - 1861-0684
IS - 2
ER -