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CLINICAL RESEARCH: HEART FAILURE

Increased Central Venous Pressure Is Associated With Impaired Renal Function and Mortality in a Broad Spectrum of Patients With Cardiovascular Disease

Kevin Damman, MD^_*, Vincent M. van Deursen^_*, Gerjan Navis, MD, PhD, Adriaan A. Voors, MD, PhD^_*, Dirk J. van Veldhuisen, MD, PhD, FACC^_* and Hans L. Hillege, MD, PhD^_*,,_*

^_* Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

Manuscript received February 6, 2008; revised manuscript received August 12, 2008, accepted August 18, 2008.

^_* Reprint requests and correspondence to: Prof. Dr. Hans L. Hillege, Hanzeplein 1, 9700 RB Groningen, the Netherlands (Email: h.hillege{at}tcc.umcg.nl).

Objectives: We sought to investigate the relationship between increased central venous pressure (CVP), renal function, and mortality in a broad spectrum of cardiovascular patients.

Background: The pathophysiology of impaired renal function in cardiovascular disease is multifactorial. The relative importance of increased CVP has not been addressed previously.

Methods: A total of 2,557 patients who underwent right heart catheterization in the University Medical Center Groningen, the Netherlands, between January 1, 1989, and December 31, 2006, were identified, and their data were extracted from electronic databases. Estimated glomerular filtration rate (eGFR) was assessed with the simplified modification of diet in renal disease formula.

Results: Mean age was 59 ± 15 years, and 57% were men. Mean eGFR was 65 ± 24 ml/min/1.73 m², with a cardiac index of 2.9 ± 0.8 l/min/m² and CVP of 5.9 ± 4.3 mm Hg. We found that CVP was associated with cardiac index (r = –0.259, p < 0.0001) and eGFR (r = –0.147, p < 0.0001). Also, cardiac index was associated with eGFR (r = 0.123, p < 0.0001). In multivariate analysis CVP remained associated with eGFR (r = –0.108, p < 0.0001). In a median follow-up time of 10.7 years, 741 (29%) patients died. We found that CVP was an independent predictor of reduced survival (hazard ratio: 1.03 per mm Hg increase, 95% confidence interval: 1.01 to 1.05, p = 0.0032).

Conclusions: Increased CVP is associated with impaired renal function and independently related to all-cause mortality in a broad spectrum of patients with cardiovascular disease.

Key Words: renal function • central venous pressure • mortality • prognosis • heart catheterization

Abbreviations and Acronyms   CI = confidence interval   CVP = central venous pressure   eGFR = estimated glomerular filtration rate   HR = hazard ratio

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