Related Experiment Videos

Differential associations between renal function and "modifiable" risk factors in patients with chronic heart failure

Tom D J Smilde1, Kevin Damman, Pim van der Harst

  • 1Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|November 4, 2008
PubMed

Insights

Reduced kidney function in chronic heart failure (CHF) is primarily linked to decreased renal blood flow (RBF). N-terminal pro brain natriuretic peptide (NT-proBNP) may indicate reduced renal perfusion in these patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • Reduced Glomerular Filtration Rate (GFR) is a significant predictor of mortality in patients with Chronic Heart Failure (CHF).
  • Understanding the pathophysiological markers associated with diminished renal function in CHF is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify and analyze the pathophysiological markers linked to reduced renal function in patients diagnosed with CHF.
  • To investigate the relationship between GFR, renal blood flow (RBF), and other clinical markers in CHF patients.

Main Methods:

  • The study included 86 patients with CHF, assessing GFR and RBF using clearances of (125)I-Iothalamate and (131)I-Hippuran, respectively.
  • Key parameters measured included filtration fraction (FF), hemoglobin levels, endothelial function, plasma renin activity (PRA), N-terminal pro brain natriuretic peptide (NT-proBNP), and urinary albumin excretion (UAE).

Main Results:

  • A strong correlation was observed between GFR and RBF (r=0.915, P<0.001) and FF (r=0.546, P<0.001).
  • Multivariate analysis revealed RBF (r=0.938, P<0.001), FF (r=0.786, P<0.001), and hemoglobin levels (r=-0.520, P<0.001) as independent predictors of GFR.
  • Urinary albumin excretion (UAE) was primarily dependent on RBF (r=-0.401, P<0.001) and increased with declining RBF.

Conclusions:

  • Decreased renal blood flow (RBF) is the primary determinant of reduced GFR in patients with CHF.
  • Endothelial function and neurohormonal activation exhibited only minor associations with GFR.
  • N-terminal pro brain natriuretic peptide (NT-proBNP) demonstrated a strong correlation with RBF, suggesting its potential utility as a marker for reduced renal perfusion in CHF.
Abstract

Related Concept Videos

Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
Factors Affecting Renal Clearance: Renal Impairment01:17

Factors Affecting Renal Clearance: Renal Impairment

Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Chronic Kidney Disease IV: Nursing Management01:18

Chronic Kidney Disease IV: Nursing Management

Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of fluid...