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

• Published in: Journal of cardiac failure Vol. 14; no. 6; pp. 508 - 514
• Main Authors: Mullens, Wilfried, MD, Abrahams, Zuheir, MD, PhD, Francis, Gary S., MD, Taylor, David O., MD, Starling, Randall C., MD, MPH, Tang, W.H. Wilson, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2008
• Subjects: Abdominal Cavity - physiology; Abdominal Cavity - surgery; Adult; Advanced decompensated heart failure; Aged; Ascites - complications; Ascites - physiopathology; Ascites - surgery; Ascitic Fluid - physiology; cardiorenal syndrome; Cardiovascular; Female; Heart Failure - complications; Heart Failure - physiopathology; Heart Failure - surgery; Humans; intra-abdominal pressure; Male; Middle Aged; Pressure - adverse effects; Prospective Studies; Renal Insufficiency - complications; Renal Insufficiency - physiopathology; Renal Insufficiency - surgery; Suction - methods; intra-abdominal pressure; Advanced decompensated heart failure; cardiorenal syndrome
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2008.02.010

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.