Intra-abdominal pressure and its relationship with markers of congestion in patients admitted for acute decompensated heart failure

Abstract

Background: Systemic congestion is one of the mechanisms involved in acute decompensated heart failure (ADHF). Increased intraabdominal pressure (IAP), elicited by abdominal congestion, has been related to acute kidney injury and prognosis. Nonetheless, the link between diuretic response, surrogate markers of congestion and renal function remains poorly understood. Methods and results:We measured IAP in 43 patients from a non-interventional, exploratory, prospective, single center study carried out in patients admitted for ADHF. IAP was measured with an calibrated electronic manometer through a catheter inserted in the bladder. Normal IAP was defined as < 12 mmHg. At baseline, median IAP was 15 mmHg, with a reduction over the next 72 hours to a median of 12 mmHg. A higher IAP at admission was associated with higher baseline blood urea (83 mg/dL [62 -138] vs. 50 mg/dL [35 -65]; p=0.007) and creatinine (1.30 mg/dL vs 0.95 mg/dL; p=0.027), and with poorer diuretic response 72 hours after admission, either measured by diuresis (14.4 mL/mg vs. 21.6 mL/mg; [p = 0.005]) or natriuresis (1.2 mEqNa/mg vs. 2.0 mEqNa/mg; [p = 0.008]). A higher incidence for one-year all-cause mortality (45.0% vs 16.7%; log-rank test = 0.041) was observed among those patients with IAP>12mmHg at 72 hours. Conclusions:In patients with ADHF, higher IAP at admission is associated with poorer baseline renal function and impaired diuretic response. The persistence of IAP at 72 hours above 12 mm Hg associates to longer length of hospital stay and higher one-year all-cause mortality.

Congestive nephropathy: a neglected entity? Proposal for diagnostic criteria and future perspectives

“…65 Another study reported a similar association between increased IAP (≥12 mmHg) and renal dysfunction in patients with acute HF with mid-range ejection fraction and preserved ejection fraction. 66 Furthermore, in that study, a persistent increase in IAP at 72 h was associated with a longer length of hospital stay and 1 year mortality. 66 Microcirculatory disturbance occurs when IAP reaches 10-15 mmHg.…”

“…66 Furthermore, in that study, a persistent increase in IAP at 72 h was associated with a longer length of hospital stay and 1 year mortality. 66 Microcirculatory disturbance occurs when IAP reaches 10-15 mmHg. 61 In animal models, renal dysfunction commences at IAP of 10 mmHg, 67,68 and anuria occurs at IAP of 30 mmHg.…”

“…Furthermore, a strong correlation ( r = 0.77; P < 0.001) was observed between reduction in IAP at baseline and improvement in renal function, independent of haemodynamic changes 65 . Another study reported a similar association between increased IAP (≥12 mmHg) and renal dysfunction in patients with acute HF with mid‐range ejection fraction and preserved ejection fraction 66 . Furthermore, in that study, a persistent increase in IAP at 72 h was associated with a longer length of hospital stay and 1 year mortality 66 …”

“…CRS is commonly associated with increased IAP, especially when ascites is present. The impact of increased IAP on renal dysfunction in acute HF has been described in small studies 64–66 . In a seminal study involving patients with acute HF with reduced ejection fraction, an elevated IAP (≥8 mmHg) at admission was present in 60% of the study population ( n = 40) and was associated with renal dysfunction 65 .…”

Pathophysiology of Cardiorenal Syndrome and Use of Diuretics and Ultrafiltration as Volume Control

“… 27) 28) In patients with acute decompensated HF, increased intraabdominal pressure was also prevalent and correlated with the serum creatinine level in patients who had HF with reduced left ventricular ejection fraction. 29) Another study reported that a persistent increase in intraabdominal pressure at 72 hours was associated with 1-year mortality and a longer length of hospital stay in patients who had acute HF with reduced ejection fraction and preserved ejection fraction. Furthermore, a strong correlation was observed between a reduction in the intraabdominal pressure at baseline and improvement in renal function, independent of hemodynamic changes.…”