Introduction
Decongestion is the primary therapeutic objective in most acute decompensated heart
failure (ADHF) hospitalizations. However, congestion itself commonly represents a
barrier to successful diuresis. Renal congestion results in increased renal tubular
pressures, reducing glomerular filtration and urine output. This is further aggravated
by loop diuretics, which also increase tubular pressures. Because each nephron is
a fluid filled column, renal negative pressure treatment (rNPT) applied to the urinary
collecting system should reduce tubular pressure, potentially improving kidney function
and diuresis.
Hypothesis
rNPT will improve diuresis, natriuresis, and renal function in a congestion predominate
heart failure (CHF) model.
Methods
Ten ∼80 kg pigs underwent thoracotomy with implantation of a pericardial, Swan Ganz,
& bilateral ureteral JuxtaFlow® catheters. High dose furosemide (400mg bolus, then
80mg/hr) was administered since HF clinical use of rNPT will be in conjunction with
loop diuretics. Each animal served as its own control with randomization of L vs.
R kidney to -30 mmHg rNPT or no rNPT. HF was induced via cardiac tamponade (∼200 ml
of pericardial 6% hydroxyethyl starch) and IV normal saline. Pericardial pressure
was maintained at 20-22.5 mmHg.
Results
Prior to HF induction, rNPT increased urine output (UOP) & creatinine clearance (CrCl)
compared to the control kidney during furosemide diuresis (p lt 0.001 for all, Figure).
HF induction achieved the target hemodynamic profile with stable cardiac output &
elevated filling pressures (Figure). UOP, sodium excretion, and CrCl decreased during
HF (p lt 0.001 for all, Figure), but were higher consistently in rNPT kidney vs. control
(p lt 0.05 for all, Figure). UOP (p=0.38) was the same in rNPT during HF as control
prior to HF (Figure).
Conclusions
rNPT with the JuxtaFlow® system resulted in significantly increased diuresis, natriuresis,
and creatinine clearance, both in the presence and absence of experimental HF. Notably,
rNPT rescued the congested cardio-renal phenotype with equivalent diuresis and natriuresis
during HF with rNPT as was observed in the non-HF period without rNPT. Additional
research into the efficacy of the JuxtaFlow® system in human ADHF is warranted.
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Copyright
© 2020 Published by Elsevier Inc.
