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

Tom D J Smilde; Kevin Damman; Pim van der Harst; Gerjan Navis; B Daan Westenbrink; Adriaan A Voors; Frans Boomsma; Dirk J van Veldhuisen; Hans L Hillege

doi:10.1007/s00392-008-0732-z

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

Tom D J Smilde, Kevin Damman, Pim van der Harst, Gerjan Navis, B Daan Westenbrink, Adriaan A Voors, Frans Boomsma, Dirk J van Veldhuisen, Hans L Hillege

Research output: Contribution to journal › Article › Academic › peer-review

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 (125)I-Iothalamate and (131)I-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). Urinary albumin excretion (UAE) was measured in 24 h urine. Mean GFR was 74+/-28 ml/min/1.73 m(2). GFR was strongly related to RBF (r=0.915, P<0.001), FF (r=0.546, P<0.001), but only weakly to endothelial function and PRA. In multivariate analysis, RBF (r=0.938, P < 0.001), FF (r=0.786, P < 0.001) and haemoglobin levels (r= -0.520, P<0.001) were independently associated with GFR. UAE was mainly dependent on RBF (r= -0.401, P < 0.001) and increased exponentially with decreasing RBF. RBF was mainly associated with NT-proBNP (r= -0.561, P<0.001) and PRA (r= -0.422, P<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.

Original language	English
Pages (from-to)	121-9
Number of pages	9
Journal	Clinical Research in Cardiology
Volume	98
Issue number	2
DOIs	https://doi.org/10.1007/s00392-008-0732-z
Publication status	Published - Feb 2009
Externally published	Yes

Keywords

Adult
Angiotensin II Type 1 Receptor Blockers/therapeutic use
Angiotensin-Converting Enzyme Inhibitors/therapeutic use
Biomarkers/blood
Chronic Disease
Endothelial Cells/metabolism
Female
Glomerular Filtration Rate
Heart Failure/drug therapy
Humans
Kidney/blood supply
Male
Middle Aged
Natriuretic Peptide, Brain/blood
Peptide Fragments/blood
Regression Analysis
Renal Circulation/drug effects
Renin/blood
Renin-Angiotensin System
Risk Factors

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@article{a3e08564667040ebaff338a4b61e809d,

title = "Differential associations between renal function and {"}modifiable{"} risk factors in patients with chronic heart failure",

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 (125)I-Iothalamate and (131)I-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). Urinary albumin excretion (UAE) was measured in 24 h urine. Mean GFR was 74+/-28 ml/min/1.73 m(2). GFR was strongly related to RBF (r=0.915, P<0.001), FF (r=0.546, P<0.001), but only weakly to endothelial function and PRA. In multivariate analysis, RBF (r=0.938, P < 0.001), FF (r=0.786, P < 0.001) and haemoglobin levels (r= -0.520, P<0.001) were independently associated with GFR. UAE was mainly dependent on RBF (r= -0.401, P < 0.001) and increased exponentially with decreasing RBF. RBF was mainly associated with NT-proBNP (r= -0.561, P<0.001) and PRA (r= -0.422, P<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.",

keywords = "Adult, Angiotensin II Type 1 Receptor Blockers/therapeutic use, Angiotensin-Converting Enzyme Inhibitors/therapeutic use, Biomarkers/blood, Chronic Disease, Endothelial Cells/metabolism, Female, Glomerular Filtration Rate, Heart Failure/drug therapy, Humans, Kidney/blood supply, Male, Middle Aged, Natriuretic Peptide, Brain/blood, Peptide Fragments/blood, Regression Analysis, Renal Circulation/drug effects, Renin/blood, Renin-Angiotensin System, Risk Factors",

author = "Smilde, {Tom D J} and Kevin Damman and {van der Harst}, Pim and Gerjan Navis and Westenbrink, {B Daan} and Voors, {Adriaan A} and Frans Boomsma and {van Veldhuisen}, {Dirk J} and Hillege, {Hans L}",

year = "2009",

month = feb,

doi = "10.1007/s00392-008-0732-z",

language = "English",

volume = "98",

pages = "121--9",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "D. Steinkopff-Verlag",

number = "2",

}

TY - JOUR

T1 - Differential associations between renal function and "modifiable" risk factors in patients with chronic heart failure

AU - Smilde, Tom D J

AU - Damman, Kevin

AU - van der Harst, Pim

AU - Navis, Gerjan

AU - Westenbrink, B Daan

AU - Voors, Adriaan A

AU - Boomsma, Frans

AU - van Veldhuisen, Dirk J

AU - Hillege, Hans L

PY - 2009/2

Y1 - 2009/2

N2 - 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 (125)I-Iothalamate and (131)I-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). Urinary albumin excretion (UAE) was measured in 24 h urine. Mean GFR was 74+/-28 ml/min/1.73 m(2). GFR was strongly related to RBF (r=0.915, P<0.001), FF (r=0.546, P<0.001), but only weakly to endothelial function and PRA. In multivariate analysis, RBF (r=0.938, P < 0.001), FF (r=0.786, P < 0.001) and haemoglobin levels (r= -0.520, P<0.001) were independently associated with GFR. UAE was mainly dependent on RBF (r= -0.401, P < 0.001) and increased exponentially with decreasing RBF. RBF was mainly associated with NT-proBNP (r= -0.561, P<0.001) and PRA (r= -0.422, P<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.

AB - 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 (125)I-Iothalamate and (131)I-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). Urinary albumin excretion (UAE) was measured in 24 h urine. Mean GFR was 74+/-28 ml/min/1.73 m(2). GFR was strongly related to RBF (r=0.915, P<0.001), FF (r=0.546, P<0.001), but only weakly to endothelial function and PRA. In multivariate analysis, RBF (r=0.938, P < 0.001), FF (r=0.786, P < 0.001) and haemoglobin levels (r= -0.520, P<0.001) were independently associated with GFR. UAE was mainly dependent on RBF (r= -0.401, P < 0.001) and increased exponentially with decreasing RBF. RBF was mainly associated with NT-proBNP (r= -0.561, P<0.001) and PRA (r= -0.422, P<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.

KW - Adult

KW - Angiotensin II Type 1 Receptor Blockers/therapeutic use

KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use

KW - Biomarkers/blood

KW - Chronic Disease

KW - Endothelial Cells/metabolism

KW - Female

KW - Glomerular Filtration Rate

KW - Heart Failure/drug therapy

KW - Humans

KW - Kidney/blood supply

KW - Male

KW - Middle Aged

KW - Natriuretic Peptide, Brain/blood

KW - Peptide Fragments/blood

KW - Regression Analysis

KW - Renal Circulation/drug effects

KW - Renin/blood

KW - Renin-Angiotensin System

KW - Risk Factors

U2 - 10.1007/s00392-008-0732-z

DO - 10.1007/s00392-008-0732-z

M3 - Article

C2 - 18979056

SN - 1861-0684

VL - 98

SP - 121

EP - 129

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

IS - 2

ER -

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

Abstract

Keywords

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