Congestion and renal function in patients with chronic heart failure

Cardiac and renal dysfunction often conspire to cause water and salt retention. We assessed the relation between renal function and congestion, both clinically and by ultrasound, in chronic heart failure (CHF).

At a routine clinic visit, patients with CHF were classified as clinically congested if they had a raised jugular venous pressure, pulmonary congestion, or peripheral oedema, regardless of severity, blind to a subsequent ultrasound assessment of congestion, including 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.

Of 342 patients, eGFR was <30 in 9%, 30-44 in 18%, 45-59 in 26%, and ≥60 ml/min/1.73 m2 in 47% of the patients. Many patients had both clinical and ultrasound evidence of congestion, especially when eGFR was low (for each eGFR group, respectively: 51%, 30%, 39%, and 25%). Isolated ultrasound congestion was also common (19%, 29%, 34%, and 26%), but isolated clinical congestion was less so (11%, 11%, 4%, and 9%).Congestion, especially when detected by both methods, was associated with higher NT-proBNP concentrations and a greater probability of heart failure (HF) hospitalization or death (adjusted HR: 2.16, 95% CI [1.25, 3.75]; P = .006 vs no congestion).

Patients with CHF often have clinical evidence of congestion, confirmed by ultrasound, which is associated with a poor prognosis. Patients with a low eGFR are more likely to be congested. Whether ultrasound assessment of congestion can improve the management of patients with CHF requires more attention.