Kidney Week

Abstract: FR-PO0066

Association of Changes in Transrenal Perfusion Pressure with eGFR Slope in Patients with Acute Heart Failure

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Lee, Ki Jung, Tufts Medical Center, Boston, Massachusetts, United States

Ki Jung Lee, MD

• Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart, MS

• Tuttle, Marcelle, Tufts Medical Center, Boston, Massachusetts, United States

Marcelle Tuttle, MD

• Oka, Tatsufumi, Osaka Daigaku, Suita, Osaka Prefecture, Japan

Tatsufumi Oka, MD, PhD

• Sarnak, Hannah Leigh, Colgate University, Hamilton, New York, United States

Hannah Leigh Sarnak

• Moises, Amanda I., Tufts Medical Center, Boston, Massachusetts, United States

Amanda I. Moises

• Testani, Jeffrey M., Yale University, New Haven, Connecticut, United States

Jeffrey M. Testani, MD

• Kiernan, Michael S., Tufts Medical Center, Boston, Massachusetts, United States

Michael S. Kiernan, MD

• Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak, MD, MS

• McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States

Wendy I. McCallum, MD, MS

Background

Among patients with acute heart failure (AHF), high central venous pressure (CVP) has been associated with lower estimated glomerular filtration rate (eGFR) in cross-sectional studies. We sought to examine whether changes in the CVP, changes in the mean arterial pressure (MAP) or change when considering both in a composite metric, called the transrenal perfusion pressure (TRPP) defined as the (MAP – CVP)/MAP, would be associated with change in eGFR among patients admitted for AHF.

Methods

Patients admitted for a primary diagnosis of AHF requiring placement of a pulmonary artery catheter (PAC) were identified from 2015-2021. Those requiring mechanical circulatory support or dialysis prior to PAC placement were excluded. The primary exposures of interest included changes in TRPP and its components, CVP and MAP. Change was calculated as the percent change from the first to the last available hemodynamic value. The outcomes of interest were eGFR slope between the first and last hemodynamic value, as well as development of ≥30% eGFR decline.

Results

Among 543 patients, the mean (SD) age was 60.5 (13.9) years, 159 (29.3%) were women and mean eGFR at the time of PAC placement was 57.8 (27.2) ml/min/1.73m2. Initial and final mean hemodynamics included TRPP (SD) of 82.9 (8.3) and 86.4 (7.0) mmHg, CVP of 13.9 (6.4) and 10.5 (5.0) mmHg, MAP of 82.7 (11.4) and 79.0 (10.6) mmHg, respectively, over median [IQR] 4 [2, 7] days’ duration. A greater percent increase in TRPP was associated with lower odds of 30% eGFR decline (aOR: 0.62, 95% CI 0.42, 0.93 per SD increase in % change TRPP) and higher eGFR slope (Table). A greater percent increase in MAP was also associated with lower odds of 30% eGFR decline (aOR: 0.51, 95% CI 0.31, 0.85) and higher eGFR slope (Table). However, the increase in CVP was not related to either outcome.

Conclusion

Among patients admitted for AHF requiring invasive hemodynamic monitoring, higher increases in both TRPP and MAP were associated with significantly lower odds of eGFR decline and higher eGFR slope. In contrast, changes in CVP alone were not associated with changes in eGFR.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025d2e8kmhm