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Cited by 51Heart Failure Treatment and ManagementCardiovascular Function and Risk FactorsChronic Kidney Disease and Diabetes

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

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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 +6 more·2020·Journal of Cardiac Failure
DOI 10.1016/j.cardfail.2019.09.015PMC PMC7036022
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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/m 2. 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/1.73m 2) 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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  • Among patients with established heart failure with preserved ejection fraction, those with the obesity phenotype have distinct clinical and hemodynamic features, including expanded plasma and stressed blood volume, reduced venous capacitance, elevations in exercise pulmonary wedge pressures, adverse hemodynamic response to diuresis, higher inflammatory markers, more pronounced hypertension, and m

    “Among patients with established heart failure with preserved ejection fraction, those with the obesity phenotype have distinct clinical and hemodynamic features, including expanded plasma and stressed blood volume, reduced venous capacitance, elevations in exercise pulmonary wedge pressures, adverse hemodynamic response to diuresis, higher inflammatory markers, and more pronounced”

    From Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity (2023) · cites this paper as [25]

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Authors
Reddy, Y. N. V., Obokata, M., Testani, J. M., Felker, G. M., Tang, W. H. W., Abou-Ezzeddine, O. F., Sun, J.-L., Chakrabothy, H., McNulty, S., Shah, S. J., Lewis, G. D., Stevenson, L. W., Redfield, M. M., & Borlaug, B. A.
Affiliations
  • Mayo Clinic (US)
  • Yale University (US)
  • Duke University (US)
  • Vanderbilt University (US)
Corresponding author
Borlaug, Barry A.
ORCID
Venue
Journal of Cardiac Failure
Publisher
Elsevier BV
Published
2020-02
Volume
26
Issue
2
Pages
101-107
ISSN
1071-9164 (ISSN-L)
DOI
10.1016/j.cardfail.2019.09.015
PMC
PMC7036022
OpenAlex
W2979864371
Cited by
51
References
32
Citations by year
2026: 5 · 2025: 12 · 2024: 8 · 2023: 8 · 2022: 6 · 2021: 4 · 2020: 7 · 2019: 1
FWCI
3.25
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Cardiac Failure (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
heart failure with preserved ejection fraction, obesity, decongestion, renal function, glomerular filtration rate, acute decompensated heart failure, creatinine, right ventricular remodeling, plasma expansion, weight loss
MeSH terms
Aged, Aged, 80 and over, Creatinine, Female, Glomerular Filtration Rate, Heart Failure, Humans, Kidney, Male, Middle Aged, Obesity, Peptide Fragments, Phenotype, Plasma Volume, Prospective Studies, Stroke Volume, Natriuretic Peptide, Brain

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