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Abstract: FR-PO280

Liver Stiffness Reflecting Renal Congestion Predicts Renal Outcome in Patients with Congestive Heart Failure

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Oka, Tatsufumi, Osaka University Graduate School of Medicine, Suita, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, Japan
  • Yamaguchi, Satoshi, Osaka University Graduate School of Medicine, Suita, Japan
  • Doi, Yohei, Osaka University Graduate School of Medicine, Suita, Japan
  • Sakaguchi, Yusuke, Osaka University Graduate School of Medicine, Suita, Japan
  • Matsui, Isao, Osaka University Graduate School of Medicine, Suita, Japan
  • Isaka, Yoshitaka, Osaka University Graduate School of Medicine, Suita, Japan
Background

Renal congestion is one of the underlying mechanisms for acute kidney injury in congestive heart failure (CHF). Reportedly, ultrasonographic liver stiffness (LS), originally developed for assessment of liver cirrhosis, reflects right atrial pressure (RAP) with great accuracy in CHF without liver cirrhosis. However, its association with renal congestion and its clinical relevance remain uncertain.

Methods

In this prospective cohort study (JACC Cardiovasc Imaging 2018), we enrolled inhospital patients with acute heart failure in an educational hospital. LS was evaluated in all participants. Using longitudinal inhospital data, we investigated the association between time-dependent LS and kidney length. High-LS was defined as ≥9 kPa (75 percentile, corresponding to RAP of ≥8.9 mmHg). Exposures were LS levels at discharge and changes in its levels during hospitalization. An outcome was eGFR change over time after discharge. We employed a multivariable mixed effects model with time-dependent eGFR as a dependent variable. In sensitivity analyses, we used coarsened exact matching to balance the baseline clinical characteristics.

Results

Among the 251 patients, median eGFR, BNP, LS at discharge, and follow-up were 54.7 mL/min/1.73m2, 188.7 pg/mL, 6.3 kPa, and 12.0 months, respectively. During hospitalization, in patients with eGFR>30 mL/min/1.73m2, LS decrease was observed in parallel with decrease in kidney length (P=0.01), suggesting a rationale to use LS as a proxy of renal congestion. After adjustment for 16 factors including BNP, ejection fraction, and blood pressure, patients with high-LS at discharge had lower eGFR over time than the rest of the patients (P=0.03) (Figure 1). In patients with LS improvement from high- to normal-LS during hospitalization, eGFR trajectory was higher than that in patients without improvement (P<0.01) and comparable to that in patients with normal-LS on admission (P=0.81) (Figure 2).

Conclusion

LS reflecting renal congestion predicts worse renal outcome in CHF. Renal function should be followed up carefully in patients with a high LS value at discharge.