Renal and intraglomerular haemodynamics in chronic heart failure with preserved and reduced ejection fraction.

TLDR: In this article, the authors assess renal and intraglomerular haemodynamics by constant infusion input clearance technique in subjects with congestive heart failure (CHF) and compared with 31 healthy controls.

Abstract: AIMS Congestive heart failure (CHF) and impaired renal function are two often co-existing medical conditions and associated with adverse cardiovascular outcome The aim of the current study was to assess renal and intraglomerular haemodynamics by constant infusion input clearance technique in subjects with CHF METHODS AND RESULTS The group of subjects with CHF consisted of 27 individuals with HFpEF and 27 individuals with HFrEF and were compared with 31 healthy controls Subjects underwent renal clearance examination to measure glomerular filtration rate (GFR) and renal blood and plasma flow (RBF and RPF) and to calculate intraglomerular haemodynamics such as resistances of the afferent (RA ) and efferent arterioles (RE ) as well as intraglomerular pressure (Pglom ) Measured GFR was lower in CHF subjects (681 ± 101 mL/min/173 m2 ) compared with controls (836 ± 134 mL/min/173 m2 , Padj  < 0001) as was Pglom (Padj  < 0001) Total renal vascular resistance (RVR) was higher in CHF subjects (873 ± 201 vs 738 ± 171 dyn × s/cm5 , Padj  < 0001) mediated by an increased resistance at the afferent site (3201 ± 1084 vs 2181 ± 796 dyn × s/cm5 , Padj  < 0001) Comparing HFpEF and HFrEF subjects, RA was higher in HFrEF subjects The severity of CHF assessed by NT-proBNP revealed an inverse association with renal perfusion (RPF r = -0421, P = 0002, RBF r = -0414, P = 0002) and a positive relation with RVR (r = 0346, P = 0012) at the post-glomerular site (RE : r = 0318, P = 0022) CONCLUSIONS Renal function assessed by measured GFR is reduced and renal vascular resistance at the preglomerular, afferent site is increased in HFpEF and, to greater extent, in HFrEF Our data indicate a close cardiorenal interaction in CHF