Adverse Renal Response to Decongestion in the Obese Phenotype of Heart Failure With Preserved Ejection Fraction

Yogesh N.V. Reddy, Masaru Obokata, Jeffrey M. Testani, G. Michael Felker, W. H.Wilson Tang, Omar F. Abou-Ezzeddine, Jie Lena Sun, Hrishikesh Chakrabothy, Steven McNulty, Sanjiv J. Shah, Gregory D. Lewis, Lynne W. Stevenson, Margaret M. Redfield, Barry A. Borlaug

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Patients with heart failure (HF) with preserved ejection fraction (HFpEF) and obesity display a number of pathophysiologic features that may render them more or less vulnerable to negative effects of decongestion on renal function, including greater right ventricular remodeling, plasma volume expansion and pericardial restraint. We aimed to contrast the renal response to decongestion in obese compared to nonobese patients with HFpEF Methods and Results: National Institutes of Health heart failure network studies that enrolled patients with acute decompensated HFpEF (EF ≥ 50%) were included (DOSE, CARRESS, ROSE, and ATHENA). Obese HFpEF was defined as a body mass index ≥ 30 kg/m2. Compared to nonobese HFpEF (n = 118), patients with obese HFpEF (n = 214) were an average of 9 years younger (71 vs 80 years,< 0.001), were more likely to have diabetes (64% vs 31%, P< 0.001) but had less atrial fibrillation (56% vs 75%, P< 0.001). Renal dysfunction (glomerular filtration rate < 60 mL/min/1.73m2) was present in 82% of patients, and there was no difference at baseline between obese and nonobese patients. Despite similar weight loss through decongestive therapies, obese patients with HFpEF demonstrated greater rise in creatinine (Cr) and decline in glomerular filtration rate, with a 2-fold higher incidence of mild worsening renal function (rise in Cr ≥ 0.3 mg/dL) (28 vs 14%, P = 0.008) and a substantially greater increase in severe worsening of renal function (rise in Cr > 0.5 mg/dL) (9 vs 0%, P = 0.002). Conclusions: Despite being nearly a decade younger, obese patients with HFpEF experience greater deterioration in renal function during decongestion than do nonobese patients with HFpEF. Further study to elucidate the complex relationships between volume distribution, cardiorenal hemodynamics and adiposity in HFpEF is needed.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Heart Failure
Phenotype
Kidney
Ventricular Remodeling
Plasma Volume
Adiposity
National Institutes of Health (U.S.)
Body Mass Index
Obesity
Hemodynamics

Keywords

  • Heart failure
  • HFpEF
  • hospitalization
  • obesity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Adverse Renal Response to Decongestion in the Obese Phenotype of Heart Failure With Preserved Ejection Fraction. / Reddy, Yogesh N.V.; Obokata, Masaru; Testani, Jeffrey M.; Felker, G. Michael; Tang, W. H.Wilson; Abou-Ezzeddine, Omar F.; Sun, Jie Lena; Chakrabothy, Hrishikesh; McNulty, Steven; Shah, Sanjiv J.; Lewis, Gregory D.; Stevenson, Lynne W.; Redfield, Margaret M.; Borlaug, Barry A.

In: Journal of Cardiac Failure, 01.01.2019.

Research output: Contribution to journalArticle

Reddy, YNV, Obokata, M, Testani, JM, Felker, GM, Tang, WHW, Abou-Ezzeddine, OF, Sun, JL, Chakrabothy, H, McNulty, S, Shah, SJ, Lewis, GD, Stevenson, LW, Redfield, MM & Borlaug, BA 2019, 'Adverse Renal Response to Decongestion in the Obese Phenotype of Heart Failure With Preserved Ejection Fraction', Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2019.09.015
Reddy, Yogesh N.V. ; Obokata, Masaru ; Testani, Jeffrey M. ; Felker, G. Michael ; Tang, W. H.Wilson ; Abou-Ezzeddine, Omar F. ; Sun, Jie Lena ; Chakrabothy, Hrishikesh ; McNulty, Steven ; Shah, Sanjiv J. ; Lewis, Gregory D. ; Stevenson, Lynne W. ; Redfield, Margaret M. ; Borlaug, Barry A. / Adverse Renal Response to Decongestion in the Obese Phenotype of Heart Failure With Preserved Ejection Fraction. In: Journal of Cardiac Failure. 2019.
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AU - Obokata, Masaru

AU - Testani, Jeffrey M.

AU - Felker, G. Michael

AU - Tang, W. H.Wilson

AU - Abou-Ezzeddine, Omar F.

AU - Sun, Jie Lena

AU - Chakrabothy, Hrishikesh

AU - McNulty, Steven

AU - Shah, Sanjiv J.

AU - Lewis, Gregory D.

AU - Stevenson, Lynne W.

AU - Redfield, Margaret M.

AU - Borlaug, Barry A.

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N2 - Background: Patients with heart failure (HF) with preserved ejection fraction (HFpEF) and obesity display a number of pathophysiologic features that may render them more or less vulnerable to negative effects of decongestion on renal function, including greater right ventricular remodeling, plasma volume expansion and pericardial restraint. We aimed to contrast the renal response to decongestion in obese compared to nonobese patients with HFpEF Methods and Results: National Institutes of Health heart failure network studies that enrolled patients with acute decompensated HFpEF (EF ≥ 50%) were included (DOSE, CARRESS, ROSE, and ATHENA). Obese HFpEF was defined as a body mass index ≥ 30 kg/m2. Compared to nonobese HFpEF (n = 118), patients with obese HFpEF (n = 214) were an average of 9 years younger (71 vs 80 years,< 0.001), were more likely to have diabetes (64% vs 31%, P< 0.001) but had less atrial fibrillation (56% vs 75%, P< 0.001). Renal dysfunction (glomerular filtration rate < 60 mL/min/1.73m2) was present in 82% of patients, and there was no difference at baseline between obese and nonobese patients. Despite similar weight loss through decongestive therapies, obese patients with HFpEF demonstrated greater rise in creatinine (Cr) and decline in glomerular filtration rate, with a 2-fold higher incidence of mild worsening renal function (rise in Cr ≥ 0.3 mg/dL) (28 vs 14%, P = 0.008) and a substantially greater increase in severe worsening of renal function (rise in Cr > 0.5 mg/dL) (9 vs 0%, P = 0.002). Conclusions: Despite being nearly a decade younger, obese patients with HFpEF experience greater deterioration in renal function during decongestion than do nonobese patients with HFpEF. Further study to elucidate the complex relationships between volume distribution, cardiorenal hemodynamics and adiposity in HFpEF is needed.

AB - Background: Patients with heart failure (HF) with preserved ejection fraction (HFpEF) and obesity display a number of pathophysiologic features that may render them more or less vulnerable to negative effects of decongestion on renal function, including greater right ventricular remodeling, plasma volume expansion and pericardial restraint. We aimed to contrast the renal response to decongestion in obese compared to nonobese patients with HFpEF Methods and Results: National Institutes of Health heart failure network studies that enrolled patients with acute decompensated HFpEF (EF ≥ 50%) were included (DOSE, CARRESS, ROSE, and ATHENA). Obese HFpEF was defined as a body mass index ≥ 30 kg/m2. Compared to nonobese HFpEF (n = 118), patients with obese HFpEF (n = 214) were an average of 9 years younger (71 vs 80 years,< 0.001), were more likely to have diabetes (64% vs 31%, P< 0.001) but had less atrial fibrillation (56% vs 75%, P< 0.001). Renal dysfunction (glomerular filtration rate < 60 mL/min/1.73m2) was present in 82% of patients, and there was no difference at baseline between obese and nonobese patients. Despite similar weight loss through decongestive therapies, obese patients with HFpEF demonstrated greater rise in creatinine (Cr) and decline in glomerular filtration rate, with a 2-fold higher incidence of mild worsening renal function (rise in Cr ≥ 0.3 mg/dL) (28 vs 14%, P = 0.008) and a substantially greater increase in severe worsening of renal function (rise in Cr > 0.5 mg/dL) (9 vs 0%, P = 0.002). Conclusions: Despite being nearly a decade younger, obese patients with HFpEF experience greater deterioration in renal function during decongestion than do nonobese patients with HFpEF. Further study to elucidate the complex relationships between volume distribution, cardiorenal hemodynamics and adiposity in HFpEF is needed.

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