Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical and Imaging Parameters Associated With Impaired Kidney Function in Patients With Acute Decompensated Heart Failure With Reduced Ejection Fraction

  • In-Jeong Cho (Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine) ;
  • Sang-Eun Lee (Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine) ;
  • Dong-Hyeok Kim (Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine) ;
  • Wook Bum Pyun (Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine)
  • Received : 2023.01.05
  • Accepted : 2023.03.19
  • Published : 2023.10.27
Download PDF
⟨ Previous Next ⟩

Abstract

BACKGROUND: Acute worsening of cardiac function frequently leads to kidney dysfunction. This study aimed to identify clinical and imaging parameters associated with impaired kidney function in patients with acute decompensated heart failure with reduced ejection fraction (HFrEF). METHODS: Data from 131 patients hospitalized with acute decompensated HFrEF (left ventricular ejection fraction, < 40%) were analyzed. Patients were divided into two groups according to the glomerular filtration rate (GFR) at admission (those with preserved kidney function [GFR ≥ 60 mL/min/1.73 m2] and those with reduced kidney function [GFR < 60 mL/min/1.73 m2]). Various echocardiographic parameters and perirenal fat thicknesses were assessed by computed tomography. RESULTS: There were 71 patients with preserved kidney function and 60 patients with reduced kidney function. Increased age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.04-1.12; p = 0.005), increased log N-terminal pro b-type natriuretic peptide (OR, 1.74; 95% CI, 1.14-2.66; p = 0.010), and increased perirenal fat thickness (OR, 1.19; 95% CI, 1.10-1.29; p < 0.001) were independently associated with reduced kidney function, even after adjusting for variable clinical and echocardiographic parameters. The optimal average perirenal fat thickness cut-off value of > 12 mm had a sensitivity of 55% and specificity of 83% for kidney dysfunction prediction. CONCLUSIONS: Thick perirenal fat was independently associated with impaired kidney function in patients hospitalized for acute decompensated HFrEF. Measurement of perirenal fat thickness may be a promising imaging marker for the detection of HFrEF patients who are more susceptible to kidney dysfunction.

Keywords

Acknowledgement

This study was supported by a research grant of the Korean Society of Echocardiography (2017).

References

  1. Jiang HJ, Russo CA, Barrett ML. Nationwide Frequency and Costs of Potentially Preventable Hospitalizations, 2006. Rockville, MD: Agency for Healthcare Research and Quality (US); 2006. 
  2. Jong P, Vowinckel E, Liu PP, Gong Y, Tu JV. Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study. Arch Intern Med 2002;162:1689-94. https://doi.org/10.1001/archinte.162.15.1689
  3. Hernandez AF, Greiner MA, Fonarow GC, et al. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA 2010;303:1716-22. https://doi.org/10.1001/jama.2010.533
  4. Ljungman S, Laragh JH, Cody RJ. Role of the kidney in congestive heart failure. Relationship of cardiac index to kidney function. Drugs 1990;39 Suppl 4:10-21. https://doi.org/10.2165/00003495-199000394-00004
  5. Mullens W, Abrahams Z, Francis GS, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 2009;53:589-96. https://doi.org/10.1016/j.jacc.2008.05.068
  6. Damman K, van Deursen VM, Navis G, Voors AA, van Veldhuisen DJ, Hillege HL. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol 2009;53:582-8. https://doi.org/10.1016/j.jacc.2008.08.080
  7. Husain-Syed F, Grone HJ, Assmus B, et al. Congestive nephropathy: a neglected entity? Proposal for diagnostic criteria and future perspectives. ESC Heart Fail 2021;8:183-203. https://doi.org/10.1002/ehf2.13118
  8. Grigoras A, Balan RA, Caruntu ID, et al. Perirenal adipose tissue-current knowledge and future opportunities. J Clin Med 2021;10:1291.
  9. Geraci G, Zammuto MM, Mattina A, et al. Para-perirenal distribution of body fat is associated with reduced glomerular filtration rate regardless of other indices of adiposity in hypertensive patients. J Clin Hypertens (Greenwich) 2018;20:1438-46. https://doi.org/10.1111/jch.13366
  10. Liu BX, Sun W, Kong XQ. Perirenal fat: a unique fat pad and potential target for cardiovascular disease. Angiology 2019;70:584-93. https://doi.org/10.1177/0003319718799967
  11. D'Marco L, Salazar J, Cortez M, et al. Perirenal fat thickness is associated with metabolic risk factors in patients with chronic kidney disease. Kidney Res Clin Pract 2019;38:365-72. https://doi.org/10.23876/j.krcp.18.0155
  12. Boorsma EM, Ter Maaten JM, Voors AA, van Veldhuisen DJ. Renal compression in heart failure: the renal tamponade hypothesis. JACC Heart Fail 2022;10:175-83. https://doi.org/10.1016/j.jchf.2021.12.005
  13. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022;145:e895-1032. https://doi.org/10.1161/CIR.0000000000001073
  14. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137-47. https://doi.org/10.7326/0003-4819-139-2-200307150-00013
  15. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003
  16. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713. https://doi.org/10.1016/j.echo.2010.05.010
  17. Yao Y, Gong H, Pang Y, et al. Risk factors influencing the thickness and stranding of perinephric fat of mayo adhesive probability score in minimally invasive nephrectomy. Med Sci Monit 2019;25:3825-31. https://doi.org/10.12659/MSM.916359
  18. Cho IJ, Wi J, Lee SE, Kim DH, Pyun WB. Perirenal fat and kidney function deterioration in patients with acute decompensated heart failure. Int J Heart Fail 2023;5:36-47. https://doi.org/10.36628/ijhf.2022.0029
  19. Abe H, Kosugi S, Ozaki T, et al. Prognostic impact of echocardiographic congestion grade in HFpEF with and without atrial fibrillation. JACC Asia 2022;2:73-84. https://doi.org/10.1016/j.jacasi.2021.10.012
  20. Huang N, Mao EW, Hou NN, Liu YP, Han F, Sun XD. Novel insight into perirenal adipose tissue: a neglected adipose depot linking cardiovascular and chronic kidney disease. World J Diabetes 2020;11:115-25. https://doi.org/10.4239/wjd.v11.i4.115
  21. Favre G, Grangeon-Chapon C, Raffaelli C, Francois-Chalmin F, Iannelli A, Esnault V. Perirenal fat thickness measured with computed tomography is a reliable estimate of perirenal fat mass. PLoS One 2017;12:e0175561.
  22. Buliga-Finis ON, Ouatu A, Badescu MC, et al. Beyond the cardiorenal syndrome: pathophysiological approaches and biomarkers for renal and cardiac crosstalk. Diagnostics (Basel) 2022;12:773.
  23. Martin L, Seton G, Aldred B, et al. When body mass index fails to measure up: perinephric and periumbilical fat as predictors of operative risk. Am J Surg 2016;212:1039-46. https://doi.org/10.1016/j.amjsurg.2016.09.001
  24. Sun X, Han F, Miao W, Hou N, Cao Z, Zhang G. Sonographic evaluation of para- and perirenal fat thickness is an independent predictor of early kidney damage in obese patients. Int Urol Nephrol 2013;45:1589-95. https://doi.org/10.1007/s11255-013-0404-4