Congestion and renal function in patients with chronic heart failure

Area of Science:

• Cardiology
• Nephrology
• Medical Imaging

Background:

• Cardiac and renal dysfunction frequently coexist, leading to fluid and salt retention.
• Assessing the interplay between renal function and congestion in chronic heart failure (CHF) is crucial.

Purpose of the Study:

• To evaluate the relationship between renal function (eGFR) and congestion in CHF patients.
• To compare clinical and ultrasound assessments of congestion.

Main Methods:

• Patients with CHF were assessed for clinical congestion (elevated jugular venous pressure, pulmonary or peripheral edema).
• Ultrasound evaluated congestion via inferior vena cava (IVC) diameter, jugular vein diameter Valsalva/rest ratio (JVD-ratio), and lung B-lines.
• Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 equation.

Main Results:

• Lower eGFR correlated with a higher prevalence of both clinical and ultrasound-detected congestion.
• Congestion, particularly when identified by both methods, was associated with elevated NT-proBNP levels.
• Congestion significantly increased the risk of heart failure hospitalization or death (adjusted HR: 2.16).

Conclusions:

• Congestion is common in CHF patients, often confirmed by ultrasound, and indicates a poor prognosis.
• Reduced renal function (low eGFR) is a significant risk factor for congestion in CHF.
• Further research is needed to determine if ultrasound-guided congestion assessment can enhance CHF management.