Renal Compression in Heart Failure: The Renal Tamponade Hypothesis

State-of-the-Art Review

Eva M. Boorsma, MD; Jozine M. ter Maaten, MD, PHD; Adriaan A. Voors, MD, PHD; Dirk J. van Veldhuisen, MD, PHD


JACC Heart Fail. 2022;10(3):175-183. 

In This Article

Increased Intra-abdominal Pressure

In patients with severe HF, intra-abdominal pressure (IAP) may increase because of ascites or increased fluid in the splanchnic system in the absence of ascites (Central Illustration).[32] The presence of ascites and its severity have been associated with impaired renal function in HF.[32] Reduction of IAP from decongestive therapies and mechanical removal of fluid restore renal function.[33] This indicates an indirect relationship between venous congestion and impaired renal function, a direct mass effect on the retroperitoneal kidneys from the weight of the fluid-filled peritoneum, or both (Central Illustration). In patients with (morbid) obesity, IAP is similarly increased and decreases after weight-reduction surgery.[34–36] Moreover, several studies indicate that weight-reduction surgery improves both renal and cardiovascular outcomes in morbidly obese patients.[34–38] Two studies from the same group indicate that renal venous compression, rather than parenchymal compression, is the main driver behind decreased GFR, increases in renin and aldosterone, and onset of proteinuria in patients with intra-abdominal hypertension.[39,40]