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Updated: Sep 19, 2025
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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
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Association of Volume Overload With Kidney Function Outcomes Among Patients With Acute Decompensated Heart Failure.
Amanda I Moises1, Hocine Tighiouart2, Jeffrey M Testani3
1Tufts Medical Center MA, Boston, Massachusetts.
Summary
Volume overload in acute decompensated heart failure (ADHF) is linked to reduced kidney function and increased dialysis risk. However, fluctuating volume overload did not correlate with kidney function changes during follow-up.
Area of Science:
- Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Reduced kidney function, indicated by estimated glomerular filtration rate (eGFR), is a significant predictor of adverse outcomes in acute decompensated heart failure (ADHF).
- Previous research on volume overload as a risk factor for eGFR decline in ADHF patients has yielded inconsistent findings.
Purpose of the Study:
- To investigate the association between volume overload, assessed by central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP), and kidney function in adult patients with ADHF.
- To determine if volume overload predicts baseline eGFR, in-hospital eGFR slope, and the need for dialysis.
Main Methods:
- A retrospective observational study was conducted on 753 adult patients admitted with ADHF requiring right heart catheterization between 2015 and 2021.
- Statistical models, including restricted cubic splines, linear mixed models, and Cox proportional hazard regression, were used to analyze the relationship between CVP, PCWP, and kidney outcomes (eGFR, dialysis initiation).
- Sensitivity analyses were performed, considering death as a competing risk for dialysis initiation.
Main Results:
- Higher CVP and PCWP were significantly associated with lower baseline eGFR and a steeper decline in eGFR during hospitalization.
- Elevated CVP and PCWP were linked to an increased risk of requiring dialysis over a median follow-up of 33 months (adjusted HR for CVP: 1.49; for PCWP: 1.30).
- Changes in CVP and PCWP were not associated with concurrent changes in eGFR or the risk of dialysis.
Conclusions:
- Volume overload in ADHF patients is demonstrably associated with impaired baseline kidney function, accelerated eGFR decline, and a higher likelihood of initiating dialysis.
- The degree of volume overload fluctuations did not predict subsequent changes in eGFR or dialysis risk during the follow-up period.
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