HF is associated with decreased renal blood flow and RAAS activation, which may be aggravated in the presence of T2D. The renal arterial-venous gradient for RAAS markers has not been previously reported in HF patients. Our aim was to characterize renal hemodynamic function and renal arterial-venous gradient for RAAS markers in patients with: (1) HF with T2D, (2) HF without T2D, and (3) controls without HF or T2D.

In this post hoc analysis, GFRinulin, ERPFPAH, plasma angiotensin converting enzyme (ACE), ACE2, aldosterone, angiotensinogen, plasma renin activity (PRA) and ACE activity were measured in renal artery and vein samples from 20 HF with T2D, 28 HF without T2D and 24 controls. RAAS inhibitors were used in 90% of HF and 63% of controls.

GFR and ERPF were higher in controls vs. HF with and without T2D (p<0.05). There was a larger renal arterial-venous gradient for PRA and ACE levels in HF patients, regardless of T2D status, compared to controls (p<0.01). There were no arterial-venous differences in HF with T2D vs. HF without T2D (Figure 1).

HF patients exhibited lower renal perfusion vs. non-HF patients regardless of T2D status. A larger renal arterial-venous gradient for the RAAS markers suggests a renal origin for neurohormonal activation in HF patients. T2D status did not impact renal hemodynamics or RAAS markers in patients with HF, highlighting the need to broadly target neurohormonal abnormalities in these patients.


Y. Lytvyn: None. K.D. Burns: None. A. Lytvyn: None. J.P. Ambinathan: None. O. Osuntokun: None. L.C. Godoy: None. D. Cherney: Other Relationship; Self; AbbVie Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Mitsubishi Tanabe Pharma Corporation, Prometic Life Sciences Inc., Sanofi. J.D. Parker: Research Support; Self; Ironwood Pharmaceuticals, Inc., Luitpold Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Theracos, Inc. Other Relationship; Self; Novartis Pharmaceuticals Corporation, Servier, Theracos, Inc.

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