Effect of Estimated Plasma Volume Reduction on Renal Function for Acute Heart Failure Differs Between Patients With Preserved and Reduced Ejection Fraction

Abstract

Background-The prognostic relevance of plasma volume reduction (PVR) in acute heart failure patients remains unclear because of the confounding hemodynamic effect of left ventricular ejection fraction impairment on kidney function. Methods and Results-Subjects enrolled in the West Tokyo Heart Failure Registry were examined. The PV at admission and discharge was estimated from the subjects' body weight and its deviation from the ideal body weight. Patients in the top tertile of estimated PVR were classified as PVR+. Of the 381 patients with acute heart failure, 181 (47.5%) had heart failure with preserved ejection fraction (HFpEF). Estimated PVR was associated with worsening renal function in the HFpEF (odds ratio, 3.28; 95% confidence interval, 1.55-6.96; P=0.002) but not in the heart failure with reduced ejection fraction cohort (odds ratio, 1.22; 95% confidence interval, 0.61-2.42; P=0.57). This association in the HFpEF cohort remained significant after adjusting for a history of hypertension and diabetes mellitus and the estimated glomerular filtration rate (odds ratio, 3.34; 95% confidence interval, 1.52-7.33; P=0.003). The use of intravenous diuretics was a significant predictor of PVR in the HFpEF and heart failure with reduced ejection fraction groups. Conclusions-The effect of estimated PVR differs by HF type, and the estimated PVR during hospitalization is a predictor of worsening renal function in patients with HFpEF but not in heart failure with reduced ejection fraction. Clinical Trial Registration

Tolvaptan Reduces the Risk of Worsening Renal Function in Patients With Acute Decompensated Heart Failure and Preserved Left Ventricular Ejection Fraction ― Prospective Randomized Controlled Study ―

“…16 Furthermore, a previous report showed that, unlike furosemide, tolvaptan results in fluid loss without adversely affecting renal hemodynamics. 18 Given that renal function in ADHF patients with HFpEF is thought to be especially sensitive to a reduction in renal perfusion, 10 it is tempting to speculate that the efficacy of tolvaptan therapy on the prevention of WRF might be higher in ADHF patients …”

“…18 In addition, a recent study has shown that aggressive fluid removal by diuretic therapy causes WRF, especially in ADHF patients with HFpEF compared with those with HFrEF. 10 Presumably, this is related to a susceptibility to a reduction in renal blood flow in ADHF patients with HFpEF. 10 Therefore, we decided to elucidate the therapeutic effect of tolvaptan on WRF in ADHF patients with HFpEF.…”

“…10 Presumably, this is related to a susceptibility to a reduction in renal blood flow in ADHF patients with HFpEF. 10 Therefore, we decided to elucidate the therapeutic effect of tolvaptan on WRF in ADHF patients with HFpEF.…”

“…10, 13 Therefore, it is expected that WRF caused by a reduction in renal perfusion can easily occur, especially in ADHF patients with HFpEF, in the course of diuretic therapy. 10 A cute decompensated heart failure (ADHF) is one of the leading causes of hospitalization worldwide, 1 and relief of congestion is an important therapeutic goal in patients admitted with ADHF. Although intravenous loop diuretics have been mainly used for the purpose of decongestion, 2 their use has been shown to be associated with an increased risk of worsening renal function (WRF).…”

“…Among several causes of WRF in ADHF, a reduction in renal perfusion caused by overdiuresis is thought to be the main underlying mechanism. 9, 10 Approximately half of all patients with HF have preserved left ventricular ejection fraction (LVEF), and this is termed HF with preserved EF (HFpEF). The survival of patients with HFpEF is similar to that of patients with Editorial p 642 …”