Venous Congestion & Kidney Function
Historically, acute kidney injury (AKI) in patients with heart failure has been simplified to a model of reduced cardiac output from a failing left ventricle resulting in decreased renal blood flow. However, recent research has highlighted the critical role of venous congestion in kidney dysfunction.
Venous congestion has garnered increased attention due to its consistent association with worsening kidney function, leading to efforts at decongestion emerging as a central tenet in the management of hospitalized patients with acute decompensated heart failure.
Traditional Model
Venous Congestion Model
Knowledge Check
Question: What is the primary mechanism by which venous congestion affects kidney function?
Key References
Damman K, et al. Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease. J Am Coll Cardiol. 2009;53(7):582-588.
Mullens W, et al. Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol. 2008;51(3):300-306.
Hanberg JS, et al. Reduced cardiac index is not the dominant driver of renal dysfunction in heart failure. J Am Coll Cardiol. 2016;67(19):2199-2208.