Khibar Salah1, Wouter E Kok1, Luc W Eurlings2, Paulo Bettencourt3, Joana M Pimenta3, Marco Metra4, Valerio Verdiani5, Jan G Tijssen1, Yigal M Pinto6. 1. Heart Failure Research Center and Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 2. Department of Cardiology, University Hospital Maastricht, Maastricht, the Netherlands. 3. Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal. 4. Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy. 5. Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy. 6. Heart Failure Research Center and Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: y.pinto@amc.uva.nl.
Abstract
OBJECTIVES: The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF). BACKGROUND: Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters. METHODS: This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge. RESULTS: A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables. CONCLUSIONS: When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe WRF is a measure of prognosis, but is of lesser value than, and independent of the prognostic changes induced by adequate NT-proBNP reduction. This suggests that in ADHF patients it may be warranted to strive for an optimal decrease in NT-proBNP, even if this induces WRF.
OBJECTIVES: The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF). BACKGROUND: Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters. METHODS: This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge. RESULTS: A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables. CONCLUSIONS: When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe WRF is a measure of prognosis, but is of lesser value than, and independent of the prognostic changes induced by adequate NT-proBNP reduction. This suggests that in ADHF patients it may be warranted to strive for an optimal decrease in NT-proBNP, even if this induces WRF.
Authors: Agata Bielecka-Dabrowa; Breno Godoy; Joerg C Schefold; Michael Koziolek; Maciej Banach; Stephan von Haehling Journal: Curr Heart Fail Rep Date: 2018-08
Authors: Jonathan S Chávez-Iñiguez; Miguel Ibarra-Estrada; Sergio Sánchez-Villaseca; Gregorio Romero-González; Jorge J Font-Yañez; Andrés De la Torre-Quiroga; Andrés Aranda-G de Quevedo; Alexia Romero-Muñóz; Pablo Maggiani-Aguilera; Gael Chávez-Alonso; Juan Gómez-Fregoso; Guillermo García-García Journal: BMC Nephrol Date: 2022-01-03 Impact factor: 2.388