Prompt Reduction in Intra-Abdominal Pressure Following Large-Volume Mechanical Fluid Removal Improves Renal Insufficiency in Refractory Decompensated Heart Failure

Abstract 

Background

Our group recently reported that elevated intra-abdominal pressure (IAP, defined as ≥ 8 mm Hg) can be associated with renal dysfunction in patients with advanced decompensated heart failure (ADHF). We hypothesize that in the setting of persistently elevated IAP and progressive renal insufficiency refractory to intensive medical therapy, mechanical fluid removal can be associated with improvements in IAP and renal function.

Methods and Results

The renal and hemodynamic profiles of 9 consecutive, volume-overloaded subjects with ADHF and elevated IAP, refractory to intensive medical therapy, were prospectively collected. All subjects experienced progressive elevation of serum creatinine and IAP in response to intravenous loop diuretics. Within 12 hours after mechanical fluid removal via paracentesis (n = 5, mean volume removed 3187 ± 1772 mL) or ultrafiltration (n = 4, mean volume removed 1800 ± 690 mL), there was a significant reduction in IAP (from 13 ± 4 mm Hg to 7 ± 2 mm Hg, P = .001), with corresponding improvement in renal function (serum creatinine from 3.4 ± 1.4 mg/dL to 2.4 ± 1.1 mg/dL, P = .01) without significantly altering any hemodynamic measurement.

Conclusion

In volume-overloaded patients admitted with ADHF refractory to intensive medical therapy, we observed a reduction of otherwise persistently elevated IAP with corresponding improvement in renal function after mechanical fluid removal.

Key Words: Advanced decompensated heart failure, cardiorenal syndrome, intra-abdominal pressure