The Association between Renal Congestion on Admission and Clinical Course in Acute Decompensated Heart Failure

Objectives: To investigate the relationship between renal congestion, body weight loss, and worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF). Methods: We studied 110 patients (mean age, 78 ± 10 yrs; 72 [65%] men) with ADHF who underwent intrarenal Doppler ultrasonography (IRD) to evaluate intrarenal venous flow (IRVF) within 24 h after admission. Doppler waveforms of IRVF were divided into 3 patterns: continuous, biphasic discontinuous, and monophasic discontinuous. We defined the discontinuous (biphasic and monophasic) IRVF patterns as the surrogate of renal congestion. WRF was defined as a >0.3 mg/dl increase in creatinine from baseline to discharge. Results: IRVF patterns were continuous (n = 21), biphasic (n = 50), and monophasic pattern (n = 39). Baseline creatinine level was highest in the monophasic pattern (1.2 ± 0.5 vs 1.2 ± 0.4 vs 1.6 ± 0.6 mg/dl, P < .05), while baseline body mass index was lowest in the continuous pattern (22.1 ± 2.8 vs 24.1 ± 3.4 vs 25.1 ± 4.5 kg/m², P < .05) among the 3 patterns. Patients with continuous pattern had milder BW loss during hospital stay (−3.0plusmn;3.0 kg vs −5.0 ± 3.0 kg vs −6.4 ± 4.3 kg, P < .05) and higher frequency of WRF (33% vs 6% vs 13%, P = .02) than the other patterns during the hospitalization. Conclusions: Renal congestion evaluated by IRD on admission could predict the extent of body weight loss and WRF in ADHF.