We propose the renal tamponade hypothesis to explain the disproportionate impairment in renal function when central venous pressures increase in patients with HF. The renal capsule surrounding the kidney is very rigid and will not allow expansion when pressures rise. Increased central venous pressures lead to increased renal interstitial pressures, compressing renal structures such as the tubules, intrarenal veins, and glomeruli in the encapsulated kidney. Future research is warranted to further elucidate the relationship between HF, congestion, obesity, and impaired renal function. Whereas decreased renal perfusion may be difficult to influence, and indeed, attempts to improve renal perfusion have shown not to be associated with improved outcome, intrarenal congestion may possibly be a treatment target. Ultimately, renal decompression therapies may be a novel therapeutic field to explore in decreasing the incidence of worsening renal function and worsening HF.
Funding Support and Author Disclosures
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Abbreviations and Acronyms
GFR = glomerular filtration rate; HF = heart failure; IAP = intra-abdominal pressure; KIM-1 = kidney injury marker 1; RAAS = renin-angiotensin-aldosterone system; TNF-α = tumor necrosis factor-α
JACC Heart Fail. 2022;10(3):175-183. © 2022 American College of Cardiology Foundation