Prompt reduction in intra-abdominal pressure following large-volume mechanical fluid removal improves renal insufficiency in refractory decompensated heart failure

Background: Our group recently reported that elevated intra-abdominal pressure (TAP. defined as ! 8 mm Hg) call be associated with renal dysfunction in patients with advanced decompensated heart failure (ADHF). We hypothesize that in the setting of persistently elevated TAP and progressive renal insufficiency refractory to intensive medical therapy, mechanical fluid removal can be associated with improvements in TAP and renal function. Methods and Results: The renal and hemodynamic profiles of 9 consecutive. volume-overloaded subjects with ADHF and elevated TAP, refractory to intensive medical therapy, were prospectively collected. All subjects experienced progressive elevation of serum creatinine and TAP in response to intravenous loop diuretics. Within 12 hours after mechanical fluid removal via paracentesis (n = 5. mean volume removed 3187 +/- 1772 mL) or ultrafiltration (n = 4, mean volume removed 1800 +/- 690 mL), there was a significant reduction in TAP (from 13 +/- 4 mm Ho to 7 +/- 2 turn Hg, P=.001), with corresponding improvement in renal function (serum creatinine from 3.4 +/- 1.4 mg/dL to 2.4 +/- 1.1 mg/dL. P =.01) without significantly altering any hemodynamic measurement. Conclusion: In volume-overloaded patients admitted with ADHF refractory to intensive medical therapy, we observed a reduction of otherwise persistently elevated TAP with corresponding improvement in renal function after mechanical fluid removal.