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Long-term changes in renal function and perfusion in heart failure patients with reduced ejection fraction
Nicolas F Schroten1, Kevin Damman2, Mattia A E Valente2
1Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands. nicolasschroten@gmail.com.
Summary
Renal function in heart failure with reduced ejection fraction (HFREF) patients shows a small average decline in glomerular filtration rate (GFR) over time. This decline is linked to age and changes in renal perfusion.
Area of Science:
- Nephrology
- Cardiology
- Renal Physiology
Background:
- Natural course of renal function in heart failure with reduced ejection fraction (HFREF) is poorly understood.
- Renal hemodynamics play a critical role in HFREF progression and patient outcomes.
Purpose of the Study:
- To prospectively investigate the natural course of renal function and hemodynamics in HFREF patients.
- To identify factors associated with changes in glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) over time.
Main Methods:
- Prospective study of 73 HFREF patients.
- Measurement of GFR and ERPF using (125)I-iothalamate/(131)I-hippuran clearances over a mean follow-up of 34.6 months.
- Analysis of baseline variables and changes in renal function, N-terminal pro-brain natriuretic peptide, and renovascular resistance.
Main Results:
- Average GFR decline was 0.6 mL/min/1.73 m(2) per year; average ERPF decline was 4.3 mL/min/1.73 m(2) per year.
- Older age was associated with GFR decline.
- Changes in GFR were strongly correlated with changes in ERPF, indicating the importance of renal perfusion.
Conclusions:
- Stable chronic HFREF patients exhibit a modest annual decline in GFR.
- Age and baseline GFR influence GFR decline.
- Changes in renal perfusion, specifically ERPF, are a primary driver of GFR changes in HFREF.
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