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CLINICAL STUDIES

Renal circulatory effects of adenosine in patients with chronic heart failure

^a Division of Cardiology, Department of Medicine, University of Southern California School of Medicine, Los Angeles, California, USA

Manuscript received October 27, 1997; revised manuscript received March 17, 1998, accepted March 18, 1998.

Address for correspondence: Dr. Uri Elkayam, University of Southern California School of Medicine, Division of Cardiology, 2025 Zonal Avenue, Los Angeles, California 90033
elkayam{at}hsc.usc.edu

Objectives. We sought to study the renal circulatory effects of adenosine in patients with chronic congestive heart failure (CHF).

Background. Renal blood flow (RBF) is often reduced in patients with chronic CHF and may lead to decreased renal function. The cause of reduced RBF is multifactorial and involves systemic as well as local vasoregulatory mechanisms. Stimulation of renal adenosine A₁ receptors in animal models has resulted in a significant vasoconstriction of afferent and efferent glomerular arterioles and deterioration of renal function. Although adenosine serum levels have been shown to be elevated in patients with CHF, their effect on the renal circulation in this patient population has not been studied.

Methods. Nine patients with CHF from left ventricular systolic dysfunction were studied. The effects of adenosine at a dose of 10^–5 mol/liter infused directly into the main renal artery on heart rate, renal artery blood pressure, renal artery cross-sectional area (measured by intravascular ultrasound), renal Doppler blood flow velocity (measured by a Doppler flow wire in the renal artery), RBF and renal vascular resistance (RVR) were evaluated.

Results. Infusion of adenosine resulted in no significant effect on heart rate or renal artery blood pressure but caused a substantial increase in RVR (11,204 ± 1,469 to 31,494 ± 3,911 dynes·s·cm^–5, p = 0.0005), which led to a marked fall in RBF in every patient (mean values 376 ± 36 to 146 ± 22 ml/m², p = 0.0002). These changes in RVR and RBF were associated with no significant change in renal artery cross-sectional area (0.389 ± 0.040 to 0.375 ± 0.033 cm², p = 0.3).

Conclusions. Stimulation of renal adenosine receptors in patients with CHF results in marked renal vasoconstriction that leads to an important reduction in RBF. Lack of change in renal artery cross-sectional area suggests that adenosine affects intrarenal resistance blood vessels rather than large conductance vessels. These results may indicate a rationale for investigation of renal adenosine receptor blockade for enhancement of RBF and improvement of renal function in patients with chronic CHF.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AMP = adenosine monophosphate   CHF = congestive heart failure   LV = left ventricular   RBF = renal blood flow   RVR = renal vascular resistance

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