Renal and intraglomerular haemodynamics in chronic heart failure with preserved and reduced ejection fraction

Susanne Jung; Agnes Bosch; Julie Kolwelter; Kristina Striepe; Dennis Kannenkeril; Tizia Schuster; Christian Ott; Stephan Achenbach; Roland E Schmieder

doi:10.1002/ehf2.13257

Renal and intraglomerular haemodynamics in chronic heart failure with preserved and reduced ejection fraction

ESC Heart Fail. 2021 Apr;8(2):1562-1570. doi: 10.1002/ehf2.13257. Epub 2021 Feb 9.

Authors

Susanne Jung^{1

2}, Agnes Bosch¹, Julie Kolwelter^{1

2}, Kristina Striepe¹, Dennis Kannenkeril¹, Tizia Schuster¹, Christian Ott^{1

3}, Stephan Achenbach², Roland E Schmieder¹

Affiliations

¹ Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University, Ulmenweg 18, Erlangen-Nuremberg, 91054, Germany.
² Department of Cardiology and Angiology, University Hospital Erlangen, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany.
³ Paracelsus Medical School Nuremberg, Nuremberg, Germany.

Abstract

Aims: Congestive heart failure (CHF) and impaired renal function are two often co-existing medical conditions and associated with adverse cardiovascular outcome. The aim of the current study was to assess renal and intraglomerular haemodynamics by constant infusion input clearance technique in subjects with CHF.

Methods and results: The group of subjects with CHF consisted of 27 individuals with HFpEF and 27 individuals with HFrEF and were compared with 31 healthy controls. Subjects underwent renal clearance examination to measure glomerular filtration rate (GFR) and renal blood and plasma flow (RBF and RPF) and to calculate intraglomerular haemodynamics such as resistances of the afferent (R_A ) and efferent arterioles (R_E ) as well as intraglomerular pressure (P_glom ). Measured GFR was lower in CHF subjects (68.1 ± 10.1 mL/min/1.73 m² ) compared with controls (83.6 ± 13.4 mL/min/1.73 m² , P_adj < 0.001) as was P_glom (P_adj < 0.001). Total renal vascular resistance (RVR) was higher in CHF subjects (87.3 ± 20.1 vs. 73.8 ± 17.1 dyn × s/cm⁵ , P_adj < 0.001) mediated by an increased resistance at the afferent site (3201 ± 1084 vs. 2181 ± 796 dyn × s/cm⁵ , P_adj < 0.001). Comparing HFpEF and HFrEF subjects, R_A was higher in HFrEF subjects. The severity of CHF assessed by NT-proBNP revealed an inverse association with renal perfusion (RPF r = -0.421, P = 0.002, RBF r = -0.414, P = 0.002) and a positive relation with RVR (r = 0.346, P = 0.012) at the post-glomerular site (R_E : r = 0.318, P = 0.022).

Conclusions: Renal function assessed by measured GFR is reduced and renal vascular resistance at the preglomerular, afferent site is increased in HFpEF and, to greater extent, in HFrEF. Our data indicate a close cardiorenal interaction in CHF.

Trial registration: ClinicalTrials.gov NCT03672591.

Keywords: Cardiorenal interaction; Heart failure; Preserved ejection fraction; Reduced ejection fraction; Renal haemodynamics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Glomerular Filtration Rate
Heart Failure* / complications
Hemodynamics
Humans
Kidney
Stroke Volume

Associated data

ClinicalTrials.gov/NCT03672591