MP295
RESPIRATORY VARIATION OF INFERIOR VENA CAVA DIAMETER AND ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

INTRODUCTION AND AIMS: Venous congestion strongly associated with increase inferior vena cava blood pressure and renal vena blood pressure. The size and shape of the inferior vena cava (IVC) is correlated with central venous pressure (CVP) and intravascular volume status. We assume that in patients with acute decompensated heart failure (ADHF) pulmonary congestion, is associated with decrease kidney function. Lung ultrasound with counting B-lines is a simple way to assess extravascular lung water. The aim of this study was to determine the interaction between the inferior vena cava collapse, count B-lines and the risk of acute kidney injury (AKI) in patients with ADHF.

METHODS: 62 patients (43 males, 19 females, mean age was 62±9 years) admitted to hospital with ADHF were studied. The main cause of ADHF was a combination of coronary artery disease and arterial hypertension - 36 (58%). AKI was diagnosed according to the KDIGO Guidelines, 2012. According to the ESC Guidelines, 2016 on pre-hospital and early hospital management of acute heart failure we carried out bedside thoracic ultrasound for counting B-lines and abdominal ultrasound for assessment of IVC diameter and IVC respiratory collapse.

RESULTS: Acute kidney injury was diagnosed in 33 (53%) patients with ADHF. 23 (70%) patients had stage 1, 9 (27%) - stage 2, and 1 (3%) - stage 3 of AKI. There were not patients needing replacement kidney therapy. Patients with ADHF and AKI during the first day of hospitalization had larger IVC diameter (18.9±5.4 mm vs. 14.7±5.3 mm, resp., p=0.04) and respiratory IVC collapse was significantly lower (7.2±4.7 mm vs. 12.4±4.7 mm, resp., p=0.01). Subsequently, during the 7th day of therapy in patients with AKI the value of collapse of IVC became lower compared with patients without AKI (5.5±5.3 mm vs. 13.1±9.2 mm, resp., p=0.04). Cutoff point for predicting AKI was 8.7 mm for IVC collapse (under the curves of 0.77; sensitivity 73%, specificity 69%). The study showed no interaction between the count of pulmonary B-lines and the risk of AKI.

CONCLUSIONS: Study showed that AKI affected 53% of patients with ADHF. Kidney dysfunction is associated with venous congestion. There was no interaction between the count of pulmonary B-lines and the risk of AKI in patients with ADHF, but increasing IVC diameter and reducing respiratory IVC collapse is associated with AKI development in patients with ADHF.