Julio Núñez1, Pau Llàcer2, Sergio García-Blas3, Clara Bonanad4, Silvia Ventura5, José María Núñez6, Ruth Sánchez7, Lorenzo Fácila8, Rafael de la Espriella4, Juana María Vaquer9, Alberto Cordero10, Mercè Roqué11, Carlos Chamorro7, Vicent Bodi3, Ernesto Valero3, Enrique Santas4, María Del Carmen Moreno2, Gema Miñana3, Arturo Carratalá9, Enrique Rodríguez9, Anna Mollar4, Patricia Palau12, María José Bosch5, Vicente Bertomeu-González10, Josep Lupón13, Jorge Navarro14, Francisco J Chorro3, Jose L Górriz15, Juan Sanchis3, Adriaan A Voors16, Antoni Bayés-Genís13. 1. Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain. Electronic address: yulnunez@gmail.com. 2. Internal Medicine Department, Hospital de Manises, Manises, Valencia, Spain. 3. Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain. 4. Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain. 5. Internal Medicine Department, Hospital de La Plana, Villa-Real, Castellón, Spain. 6. Critical Care Unit, Hospital Universitario del Vinalopó, Elche, Alicante, Spain. 7. Internal Medicine Department, Hospital Virgen de Los Lirios, Alcoy, Spain. 8. Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain. 9. Biochemistry Department, Hospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVA, Valencia, Spain. 10. Cardiology Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain. 11. Cardiology Department, Hospital Clínic de Barcelona, Barcelona, Spain. 12. Cardiology Department, Hospital General Universitario de Castellón. Universitat Jaume I, Castellón, Spain. 13. CIBER Cardiovascular, Madrid, Spain; Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain. 14. Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain. 15. Nephrology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain. 16. Cardiology Department, University Medical Center Groningen, Netherlands.
Abstract
BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. RESULTS:The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). CONCLUSION: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.
RCT Entities:
BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. RESULTS: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). CONCLUSION: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.
Authors: Diana Rodríguez-Espinosa; Joan Guzman-Bofarull; Juan Carlos De La Fuente-Mancera; Francisco Maduell; José Jesús Broseta; Marta Farrero Journal: Front Physiol Date: 2022-07-08 Impact factor: 4.755
Authors: Valentina Bracun; Navin Suthahar; Canxia Shi; Sanne de Wit; Wouter C Meijers; IJsbrand T Klip; Rudolf A de Boer; Joseph Pierre Aboumsallem Journal: Front Cardiovasc Med Date: 2021-12-08
Authors: Marko Kumric; Tina Ticinovic Kurir; Josko Bozic; Duska Glavas; Tina Saric; Bjørnar Marcelius; Domenico D'Amario; Josip A Borovac Journal: Card Fail Rev Date: 2021-06-12