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

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Abstract

Background

Reduced glomerular filtration rate (GFR) is strongly associated with reduced survival in patients with chronic heart failure (CHF). Our aim was to determine different pathophysiologic markers that are associated with reduced renal function in CHF.

Methods and results

We studied 86 patients with CHF (58 ± 12 years, 78% male). GFR and renal blood flow (RBF) were determined by 125I-Iothalamate and 131I-Hippuran clearances. Filtration fraction (FF) was calculated. We determined haemoglobin levels, endothelial function, inflammatory status, plasma renin activity (PRA) and N-terminal pro brain natriuretic peptide (NT-proBNP). Urinay albumin excretion (UAE) was measured in 24 h urine. Mean GFR was 74 ± 28 ml/min/1.73 m2. GFR was strongly related to RBF (= 0.915, < 0.001), FF (= 0.546, < 0.001), but only weakly to endothelial function and PRA. In multivariate analysis, RBF (r = 0.938, P < 0.001), FF (r = 0.786, < 0.001) and haemoglobin levels (r = −0.520, P < 0.001) were independently associated with GFR. UAE was mainly dependent on RBF (= −0.401, P < 0.001) and increased exponentially with decreasing RBF. RBF was mainly associated with NT-proBNP (= −0.561, < 0.001) and PRA (= −0.422, < 0.001).

Conclusion

Reduced GFR is mainly dependent of decreased RBF in patients with CHF. Endothelial function and neurohormonal activation showed only mild associations with GFR. NT-proBNP showed a strong relationship with RBF, and may be used as a marker of reduced renal perfusion.

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Acknowledgments

K. Damman and P. van der Harst are supported by the Netherlands Heart Foundation (grants 2006B157 and 2006B003, respectively). A.A. Voors and D.J. van Veldhuisen are Clinical Established Investigators of the Netherlands Heart Foundation (grants 2006T37 and D97-017, respectively). P. van der Harst is a research fellow of the Interuniversitair Cardiologisch Instituut Nederland (ICIN).

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Correspondence to Hans L. Hillege MD, MSc, PhD.

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Smilde, T.D.J., Damman, K., van der Harst, P. et al. Differential associations between renal function and “modifiable” risk factors in patients with chronic heart failure. Clin Res Cardiol 98, 121–129 (2009). https://doi.org/10.1007/s00392-008-0732-z

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  • DOI: https://doi.org/10.1007/s00392-008-0732-z

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