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Renal Dysfunction Determinants in Advanced Heart Failure Patients: Pulmonary Artery Catheterization Study
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  • Emre Demir,
  • Aytaç Candemir,
  • Yeşim B. Candemir,
  • Rıza O. Öztürk,
  • * Bilgehan,
  • Mehdi Zoghi,
  • Cemil Gürgün,
  • Sanem Nalbantgil
Emre Demir
Duke University Division of Cardiology

Corresponding Author:emre.demir.ege@gmail.com

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Aytaç Candemir
Duke University Division of Cardiology
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Yeşim B. Candemir
Duke University Division of Cardiology
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Rıza O. Öztürk
Duke University Division of Cardiology
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* Bilgehan
Duke University Division of Cardiology
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Mehdi Zoghi
Duke University Division of Cardiology
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Cemil Gürgün
Duke University Division of Cardiology
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Sanem Nalbantgil
Duke University Division of Cardiology
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Abstract

Introduction: Renal dysfunction in heart failure (HF) patients is associated with poor outcomes. Reduced cardiac index (CI) and right atrial pressure (RAP) are postulated to be a contributor the renal dysfunction. This study aimed to investigate the relationship between the estimated glomerular filtration rate (eGFR) and the pulmonary artery catheterization (PAC) results. Patients and Method: Hospitalized advanced HF patients, between 2016-2020 PAC performed included in the study. Renal dysfunction was defined as eGFR<60 ml/min/1.73 m 2. We evaluated the correlation and the linear regression models of hemodynamics with eGFR. Results: 181 patients were included in the study, and the mean left ventricular ejection fraction (LVEF) was 20.9±3.7%, the mean eGFR was 79.8±25.4 ml/min/1.73 m 2, and 22.7% of patients had eGFR lower than 60 ml/min/1.73 m 2. CI (1.85±0.72; 1.84±0.64; p=0.47, respectively) and RAP (13.1±6.6; 13.7±6.8; p=0.61,respectively) was not significantly associated with renal dysfunction in HF patients. In the multivariable model, smoking history, AF, body mass index (BMI) revealed negative relation with eGFR, continuing ACEi or ARB therapy, and pulmonary artery capacitance index(PAC-i) were positively related variables with eGFR (p<0.0001). eGFR was not significantly different in distinct tricuspid regurgitation severities (p=0.67); however, eGFR was non-significantly higher in patients with moderate tricuspid regurgitation. In patients with moderate tricuspid regurgitation, eGFR had an inverse relationship with the RVSW-i and TRVP-i. Conclusion: These results indicate that CI or RAP is not the primary driver for eGFR. PAC-i and continuing ACEi or ARB positively, AF, smoking history, and BMI were negatively related factors for reduced eGFR.