Castillo-Martínez L|Orea-Tejeda A|Valdespino-Trejo A|Colín-Ramírez E|Sánchez A|Pineda JÁ|Navarro A|Carrasco O|Sánchez R
Presented as Abstract at ESPEN Congress, Nice, France. September 2010
OBJECTIVE: Patients hospitalized for decompensated heart failure frequently experience worsening of renal function that leads to diuretic resistance and volume overload.
SUBJECTS/METHODS: We investigate whether albumin concentrations and whole-body impedance ratio, as an indicator of water distribution, are associated worsening of renal function (WRF) in decompensated heart failure (DHF).
In a longitudinal study 80 patients hospitalized for DHF were consecutively included. Worsening renal function was defined as a rise ≥ 0.3 mg/ dl or 25% of baseline serum creatinine. Clinical and echocardiographic characteristics were assessed at baseline and during hospitalization. Whole-body bioelectrical impedance was measured using tetrapolar and multiple-frequencies equipment BodyStat QuadScan 4000 to obtain impedance ratio at 200 kHz to that at 5 kHz (Z200/Z5).
Also at baseline serum albumin concentrations were evaluated. Baseline characteristics were compared between patients that worsening or not renal function with a t-test or chi-square and after that a logistic regression analysis was performed to obtain the independent variables associated to WRF.
RESULTS: Incidence of WRF during hospitalization was 26%. Independent risk factors associated with WRF were serum albumin (RR 0.11, p= 0.04); impedance ratio >0.85 (RR 5.3, p= 0.05), systolic blood pressure >160 mmHg (RR 12, p= 0.02), and maximum dose of furosemide>80 mg/ day during hospitalization (RR 5.7, p=0.015).
CONCLUSION: WRF is frequent in patients with DHF and is a consequence of the inability to effectively regulate volume status, because hypoalbuminemia induce that water not be in the vascular space (high impedance ratio), and high diuretic doses result in lowering of the circulatory volumes, reduction in renal blood flow, with the consequent fall of the renal filtration function.