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Title: Determinants of dynamic changes in serum creatinine in acute decompensated heart failure: the importance of blood pressure reduction during treatment
Authors: DUPONT, Matthias 
MULLENS, Wilfried 
Finucan, Michael
Taylor, David O.
Starling, Randall C.
Tang, W.H. Wilson
Issue Date: 2013
Source: European journal of heart failure, 15 (4), p. 433-440
Abstract: Aims: ‘Worsening renal function’ (WRF) and ‘improvement in renal function’ (IRF) monitored by changes in serum creatinine are frequently encountered during treatment of acute decompensated heart failure (ADHF). We sought to establish the important haemodynamic determinants of alterations in serum creatinine. Methods and results: We reviewed data from 443 patients treated for ADHF with haemodynamic guidance in a single centre. WRF and IRF were defined as a 25% increase or decrease in estimated glomerular filtration rate (eGFR) from time of admission to pulmonary artery catheter removal, respectively. Of the 443 patients, 46 (10%) experienced WRF and 127 (29%) had IRF. Baseline eGFR was lower in patients with IRF when compared with stable patients or those with WRF (45 ± 25 vs. 63 ± 30 vs. 68 ± 27 mL/min/m2, respectively, P < 0.0001). In contrast, the relative decrease in mean blood pressure (BP) was more pronounced in patients with WRF when compared with stable patients or those with IRF (15 ± 15 vs. 9 ± 17 vs. 4 ± 15%, respectively, P = 0.003). With larger decreases in mean BP, there was greater likelihood of experiencing WRF (P = 0.04) but less likelihood of experiencing IRF (P = 0.01). In contrast, the degree of changes in right atrial pressure or cardiac index did not affect the propensity for developing WRF or IRF. There was no difference in adverse clinical outcomes (death, heart transplantation, LV assist device implantation, or readmission) between the three groups (P = 0.56). Conclusion: Blood pressure decrease, rather than alterations in cardiac output or central venous pressure, were associated with changes in serum creatinine during treatment of ADHF.
Notes: Reprint Address: Tang, WHW (reprint author) - Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH 44195 USA. E-mail
Keywords: acute heart failure; blood pressure; worsening renal function
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ISSN: 1388-9842
e-ISSN: 1879-0844
DOI: 10.1093/eurjhf/hfs209
ISI #: 000316955400011
Category: A1
Type: Journal Contribution
Validations: ecoom 2014
Appears in Collections:Research publications

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