|Principal Investigator: Adhish Agarwal|
|Keywords: Cardiorenal Syndrome , Sodium Excretion , Heart Failure , HFpEF , Furosemide||Department: Nephrology|
|IRB Number: 00112270||Co Investigator: Stavros Drakos|
|Specialty: Cardiology, Nephrology and Hypertension|
|Sub Specialties: Heart Failure,|
|Recruitment Status: Recruiting|
Heart failure (HF) affects 2-3% of the population, and is characterized by impaired sodium balance which results in fluid overload. Ejection fraction, a measure of systolic function, is reduced in only about half of all HF patients. Incidence of heart failure with preserved ejection fraction (HFpEF) has increased in the last 20 years making it a growing public health problem. Currently, most patients admitted to the hospital with heart failure have preserved rather than reduced ejection fractions. However, to date it remains unknown why patients with HFpEF retain salt and water. We hypothesize that patients with clinical HFpEF have an impaired renal response to salt loading, intravascular expansion and diuretics. Characterization of the salt and water excretory renal response to intravascular salt, fluid and diuretic load in patients with HFpEF will provide insight into the pathophysiology of HFpEF, and may help in the development of novel strategies to target renal sodium handling in patients with HFpEF. This characterization is the primary objective of this pilot project.
1. To explore baseline similarities and differences in renal tubular transporters (as measured by urinary exosomal protein expression) between patients with HFpEF and controls.
2. Create a biorepository of blood and urine samples obtained at baseline, after saline infusion, and after loop diuretic challenge from HFpEF patients and controls.
Inclusion Criteria for Study Subjects
1. Males or females aged 21-89 years old, and able to give informed written consent.
2. History of chronic (>6 months) heart failure with current New York Heart Association I, II, or III symptoms.
3. Left ventricular ejection fraction >50% obtained within 12 months.
4. Clinically compensated heart failure.
5. On constant medical therapy for heart failure; without changes in heart failure medication regimen (including diuretics) for previous 7 days before the next procedure.
1. Unable to comply with protocol or procedures.
2. Uncontrolled severe hypertension, SBP>160 mmHg
3. Significant renal impairment as defined by estimated glomerular filtration rate (eGFR)< 30ml/min/1.73m2 determined by CKD-EPI equation.
4. Significant proteinuria (>0.5g protein/daily protein or equivalent)
5. Body mass index (BMI) > 50 kg/m2
6. Acute coronary syndrome within last 4 weeks.
7. Coronary revascularization procedures (percutaneous coronary intervention or cardiac artery bypass graft) or valve surgery within 30 days of screening.
8. Cardiac resynchronization therapy, with or without implantable cardioverter defibrillator within 90 days of screening.
9. Clinically relevant cardiac valvular disease
10. Known history of hypertrophic or restrictive cardiomyopathy, constrictive pericarditis, active myocarditis, active endocarditis, or complex congenital heart disease.
11. Known history of cirrhosis of the liver
12. Known history of hydronephrosis
13. History of adrenal insufficiency