Wendy McCallum1, Hocine Tighiouart2, Michael S Kiernan3, Gordon S Huggins3, Mark J Sarnak4. 1. Division of Nephrology, Tufts Medical Center, Boston, Mass. 2. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Mass. 3. Division of Cardiology, Tufts Medical Center, Boston, Mass. 4. Division of Nephrology, Tufts Medical Center, Boston, Mass. Electronic address: msarnak@tuftsmedicalcenter.org.
Abstract
BACKGROUND: Acute declines in kidney function occur in approximately 20%-30% of patients with acute decompensated heart failure, but its significance is unclear, and the importance of its context is not known. This study aimed to determine the prognostic value of a decline in kidney function in the context of decongestion among patients admitted with acute decompensated heart failure. METHODS: Using data from patients enrolled in the Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome Study (CARRESS) and Diuretic Optimization Strategies Evaluation (DOSE) trials, we used multivariable Cox regression models to evaluate the association between decline in estimated glomerular filtration rate (eGFR) and change in N-terminal pro-b-type natriuretic peptide (NT-proBNP) with a composite outcome of death and rehospitalization, as well as testing for an interaction between the two. RESULTS: Among 435 patients, in-hospital decline in eGFR was not significantly associated with death and rehospitalization (hazard ratio [HR] = 0.89 per 30% decline, 95% confidence interval [CI] 0.74, 1.07), whereas decline in NT-proBNP was associated with lower risk (HR = 0.69 per halving, 95% CI 0.58, 0.83). There was a significant interaction (P = 0.002 unadjusted; P = 0.03 adjusted) between decline in eGFR and change in NT-proBNP where a decline in eGFR was associated with better outcomes when NT-proBNP declined (HR = 0.78 per 30% decline in eGFR, 95% CI 0.61, 0.99), but not when NT-proBNP increased (HR = 0.99, 95% CI 0.76, 1.30). CONCLUSIONS: Decline in kidney function during therapy for acute decompensated heart failure is associated with improved outcomes as long as NT-proBNP levels are decreasing as well, suggesting that incorporation of congestion biomarkers may aid clinical interpretation of eGFR declines.
BACKGROUND: Acute declines in kidney function occur in approximately 20%-30% of patients with acute decompensated heart failure, but its significance is unclear, and the importance of its context is not known. This study aimed to determine the prognostic value of a decline in kidney function in the context of decongestion among patients admitted with acute decompensated heart failure. METHODS: Using data from patients enrolled in the Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome Study (CARRESS) and Diuretic Optimization Strategies Evaluation (DOSE) trials, we used multivariable Cox regression models to evaluate the association between decline in estimated glomerular filtration rate (eGFR) and change in N-terminal pro-b-type natriuretic peptide (NT-proBNP) with a composite outcome of death and rehospitalization, as well as testing for an interaction between the two. RESULTS: Among 435 patients, in-hospital decline in eGFR was not significantly associated with death and rehospitalization (hazard ratio [HR] = 0.89 per 30% decline, 95% confidence interval [CI] 0.74, 1.07), whereas decline in NT-proBNP was associated with lower risk (HR = 0.69 per halving, 95% CI 0.58, 0.83). There was a significant interaction (P = 0.002 unadjusted; P = 0.03 adjusted) between decline in eGFR and change in NT-proBNP where a decline in eGFR was associated with better outcomes when NT-proBNP declined (HR = 0.78 per 30% decline in eGFR, 95% CI 0.61, 0.99), but not when NT-proBNP increased (HR = 0.99, 95% CI 0.76, 1.30). CONCLUSIONS: Decline in kidney function during therapy for acute decompensated heart failure is associated with improved outcomes as long as NT-proBNP levels are decreasing as well, suggesting that incorporation of congestion biomarkers may aid clinical interpretation of eGFR declines.
Authors: Wendy McCallum; Hocine Tighiouart; Jeffrey M Testani; Matthew Griffin; Marvin A Konstam; James E Udelson; Mark J Sarnak Journal: Am J Kidney Dis Date: 2021-11-27 Impact factor: 11.072
Authors: Wendy McCallum; Hocine Tighiouart; Jeffrey M Testani; Matthew Griffin; Marvin A Konstam; James E Udelson; Mark J Sarnak Journal: Kidney Int Rep Date: 2020-07-23
Authors: Wouter C Meijers; Antoni Bayes-Genis; Alexandre Mebazaa; Johann Bauersachs; John G F Cleland; Andrew J S Coats; James L Januzzi; Alan S Maisel; Kenneth McDonald; Thomas Mueller; A Mark Richards; Petar Seferovic; Christian Mueller; Rudolf A de Boer Journal: Eur J Heart Fail Date: 2021-10-10 Impact factor: 17.349
Authors: Johanna E Emmens; Jozine M Ter Maaten; Yuya Matsue; Sylwia M Figarska; Iziah E Sama; Gad Cotter; John G F Cleland; Beth A Davison; G Michael Felker; Michael M Givertz; Barry Greenberg; Peter S Pang; Thomas Severin; Claudio Gimpelewicz; Marco Metra; Adriaan A Voors; John R Teerlink Journal: Eur J Heart Fail Date: 2021-12-02 Impact factor: 17.349
Authors: Wendy McCallum; Hocine Tighiouart; Jeffrey M Testani; Matthew Griffin; Marvin A Konstam; James E Udelson; Mark J Sarnak Journal: JACC Heart Fail Date: 2020-06-10 Impact factor: 12.544