Wendy McCallum1, Hocine Tighiouart2, Jeffrey M Testani3, Matthew Griffin3, Marvin A Konstam4, James E Udelson4, Mark J Sarnak5. 1. Division of Nephrology, Tufts Medical Center, Boston, Massachusetts. 2. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts. 3. Division of Cardiovascular Medicine, School of Medicine, Yale University, New Haven, Connecticut. 4. Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts. 5. Division of Nephrology, Tufts Medical Center, Boston, Massachusetts. Electronic address: msarnak@tuftsmedicalcenter.org.
Abstract
RATIONALE & OBJECTIVE: Achievement of decongestion in acute heart failure (AHF) is associated with improved survival and cardiovascular outcomes but can be associated with acute declines in estimated glomerular filtration rate (eGFR). We examined whether the rate of in-hospital decongestion is associated with longer term kidney function decline. STUDY DESIGN: Post hoc analysis of trial data. SETTINGS & PARTICIPANTS: Patients with ≥2 measures of kidney function (n = 3,500) from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial. EXPOSURE: In-hospital rate of change in assessments of volume overload, including B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and clinical congestion score (0-12); and rate of change in hemoconcentration including measures of hematocrit, albumin, and total protein. OUTCOME: Incident chronic kidney disease GFR category 4 or worse (chronic kidney disease [CKD] categories G4-G5; defined by a new eGFR of <30 mL/min/1.73 m2) and eGFR decline of >40%. ANALYTICAL APPROACH: Multivariable cause-specific hazards models. RESULTS: Over median 10-month follow-up period, faster decreases in volume overload and more rapid increases in hemoconcentration were associated with a decreased risk of incident CKD G4-G5 and eGFR decline of >40%. In adjusted analyses, for every 6% faster decline in BNP per week, there was a 32% lower risk of both incident CKD G4-G5 (HR, 0.68 [95% CI, 0.58-0.79]) and eGFR decline of >40% (HR, 0.68 [95% CI, 0.57-0.80]). For every 1% faster increase per week in absolute hematocrit, there was a lower risk for both incident CKD G4-G5 (HR, 0.73 [95% CI, 0.64-0.84]) and eGFR decline of >40% (HR, 0.82 [95% CI, 0.71-0.95]), with results consistent for other biomarkers. LIMITATIONS: Possibility of residual confounding. CONCLUSIONS: These results provide reassurance that more rapid decongestion in patients with AHF does not increase the risk of adverse kidney outcomes in patients with heart failure.
RATIONALE & OBJECTIVE: Achievement of decongestion in acute heart failure (AHF) is associated with improved survival and cardiovascular outcomes but can be associated with acute declines in estimated glomerular filtration rate (eGFR). We examined whether the rate of in-hospital decongestion is associated with longer term kidney function decline. STUDY DESIGN: Post hoc analysis of trial data. SETTINGS & PARTICIPANTS: Patients with ≥2 measures of kidney function (n = 3,500) from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial. EXPOSURE: In-hospital rate of change in assessments of volume overload, including B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and clinical congestion score (0-12); and rate of change in hemoconcentration including measures of hematocrit, albumin, and total protein. OUTCOME: Incident chronic kidney disease GFR category 4 or worse (chronic kidney disease [CKD] categories G4-G5; defined by a new eGFR of <30 mL/min/1.73 m2) and eGFR decline of >40%. ANALYTICAL APPROACH: Multivariable cause-specific hazards models. RESULTS: Over median 10-month follow-up period, faster decreases in volume overload and more rapid increases in hemoconcentration were associated with a decreased risk of incident CKD G4-G5 and eGFR decline of >40%. In adjusted analyses, for every 6% faster decline in BNP per week, there was a 32% lower risk of both incident CKD G4-G5 (HR, 0.68 [95% CI, 0.58-0.79]) and eGFR decline of >40% (HR, 0.68 [95% CI, 0.57-0.80]). For every 1% faster increase per week in absolute hematocrit, there was a lower risk for both incident CKD G4-G5 (HR, 0.73 [95% CI, 0.64-0.84]) and eGFR decline of >40% (HR, 0.82 [95% CI, 0.71-0.95]), with results consistent for other biomarkers. LIMITATIONS: Possibility of residual confounding. CONCLUSIONS: These results provide reassurance that more rapid decongestion in patients with AHF does not increase the risk of adverse kidney outcomes in patients with heart failure.
Authors: Mihai Gheorghiade; Ferenc Follath; Piotr Ponikowski; Jeffrey H Barsuk; John E A Blair; John G Cleland; Kenneth Dickstein; Mark H Drazner; Gregg C Fonarow; Tiny Jaarsma; Guillaume Jondeau; Jose Lopez Sendon; Alexander Mebazaa; Marco Metra; Markku Nieminen; Peter S Pang; Petar Seferovic; Lynne W Stevenson; Dirk J van Veldhuisen; Faiez Zannad; Stefan D Anker; Andrew Rhodes; John J V McMurray; Gerasimos Filippatos Journal: Eur J Heart Fail Date: 2010-03-30 Impact factor: 15.534
Authors: Jorge Rubio-Gracia; Biniyam G Demissei; Jozine M Ter Maaten; John G Cleland; Christopher M O'Connor; Marco Metra; Piotr Ponikowski; John R Teerlink; Gad Cotter; Beth A Davison; Michael M Givertz; Daniel M Bloomfield; Howard Dittrich; Kevin Damman; Juan I Pérez-Calvo; Adriaan A Voors Journal: Int J Cardiol Date: 2018-05-01 Impact factor: 4.164
Authors: Lesley A Inker; Hiddo J Lambers Heerspink; Hasi Mondal; Christopher H Schmid; Hocine Tighiouart; Farzad Noubary; Josef Coresh; Tom Greene; Andrew S Levey Journal: Am J Kidney Dis Date: 2014-10-16 Impact factor: 8.860
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: Wilfried Mullens; Zuheir Abrahams; Gary S Francis; George Sokos; David O Taylor; Randall C Starling; James B Young; W H Wilson Tang Journal: J Am Coll Cardiol Date: 2009-02-17 Impact factor: 24.094
Authors: Eugenia Raichlin; Nicholas A Haglund; Ioana Dumitru; Elizabeth R Lyden; Michael D Johnston; Joan M Mack; John R Windle; Brian D Lowes Journal: J Card Fail Date: 2014-05 Impact factor: 5.712
Authors: Marco Metra; Gad Cotter; Stefanie Senger; Christopher Edwards; John G Cleland; Piotr Ponikowski; Guillermo C Cursack; Olga Milo; John R Teerlink; Michael M Givertz; Christopher M O'Connor; Howard C Dittrich; Daniel M Bloomfield; Adriaan A Voors; Beth A Davison Journal: Circ Heart Fail Date: 2018-05 Impact factor: 8.790
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