In patients with heart failure (HF), baseline and follow-up changes in kidney venous flow (KVF) provide information on the risk of cardiorenal events, reports a study in the Journal of the American Heart Association.
The observational cohort study included 216 consecutive cardiology inpatients with HF who were referred for nephrology evaluation of diuretic resistance and abnormal kidney function. Sixty percent of patients were men; median age was 76 years. Approximately 69.4% of patients had advanced chronic kidney disease, with an estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m2; 66% were receiving combined diuretic therapy.
Patients underwent Doppler spectral kidney assessments at baseline and 25–35 days later to assess patterns of intra-KVF (IKVF) and kidney venous stasis index (KVSI). These values were analyzed for association with risk of cardiorenal events.
At up to 18 months' follow-up, 126 patients died or had worsening HF. Risk of these adverse outcomes was associated with baseline KVSI (hazard ratio [HR], 1.49 per 0.1-unit increase) and baseline IKVF pattern (HR, 2.47 per increase in severity from continuous to pulsatile to biphasic to monophasic).
On analysis of 92 patients, increases in both KVSI and IKVF pattern from the first to second Doppler examination were also associated with risk of worsening HF or death: HR, 3.00 and 6.73, respectively. Results were similar on analysis of individual cardiorenal outcomes, initiation of kidney replacement therapy, and decline in eGFR.
Many patients hospitalized for HF have residual congestion at discharge, which may lead to oliguria and worsening HF. Few studies have evaluated the impact of changes in Doppler-derived KVF in patients with HF.
The new findings suggest that initial and subsequent changes in Doppler-derived KVSI and IKVF are predictors of adverse cardiorenal events in hospitalized patients with HF. The researchers write, “Future studies should aim to assess and validate the prognostic ability of serial KVF assessments in HF management” [Husain-Syed F, et al. Changes in Doppler-derived kidney venous flow and adverse cardiorenal outcomes in patients with heart failure. J Am Heart Assoc 2023; 12:e030145. doi: 10.1161/JAHA.123.030145].
