TY - JOUR
T1 - Worsening renal function is not associated with response to treatment in acute heart failure
AU - Ather, Sameer
AU - Bavishi, Chirag
AU - McCauley, Mark D.
AU - Dhaliwal, Amandeep
AU - Deswal, Anita
AU - Johnson, Sarah
AU - Chan, Wenyaw
AU - Aguilar, David
AU - Pritchett, Allison M.
AU - Ramasubbu, Kumudha
AU - Wehrens, Xander H.T.
AU - Bozkurt, Biykem
N1 - Funding Information:
S.A. is supported by American Heart Association SCA predoctoral fellowship (2010–2012) and Alkek foundation fellowship (2009–2012).
PY - 2013/9/1
Y1 - 2013/9/1
N2 - Background: About a fourth of acute decompensated heart failure (ADHF) patients develop renal dysfunction during their admission. To date, the association of ADHF treatment with the development of worsening renal function (WRF) remains contentious. Thus, we examined the association of WRF with changes in BNP levels and with mortality. Methods: We performed retrospective chart review of patients admitted with ADHF who had BNP, eGFR, creatinine and blood urea nitrogen (BUN) values measured both on admission and discharge. Survival analysis was conducted using Cox proportional hazards model and correlation was measured using Spearman's rank correlation test. Results: 358 patients admitted for ADHF were evaluated. WRF was defined as > 20% reduction in eGFR from admission to discharge and response to treatment was assessed by ΔBNP. There was a statistically significant reduction in BNP and increase in BUN during the admission. ΔBNP did not correlate with either ΔGFR or ΔBUN. Patients who developed WRF and those who did not, had a similar reduction in BNP. On univariate survival analysis, ΔBUN, but not ΔeGFR, was associated with 1-year mortality. In multivariate Cox proportional hazards model, BUN at discharge was associated with 1-year mortality (HR: 1.02, p < 0.001), but ΔeGFR and ΔBUN were not associated with the primary endpoint. Conclusion: During ADHF treatment, ΔBNP was not associated with changes in renal function. Development of WRF during ADHF treatment was not associated with mortality. Our study suggests that development of WRF should not preclude diuresis in ADHF patients in the absence of volume depletion.
AB - Background: About a fourth of acute decompensated heart failure (ADHF) patients develop renal dysfunction during their admission. To date, the association of ADHF treatment with the development of worsening renal function (WRF) remains contentious. Thus, we examined the association of WRF with changes in BNP levels and with mortality. Methods: We performed retrospective chart review of patients admitted with ADHF who had BNP, eGFR, creatinine and blood urea nitrogen (BUN) values measured both on admission and discharge. Survival analysis was conducted using Cox proportional hazards model and correlation was measured using Spearman's rank correlation test. Results: 358 patients admitted for ADHF were evaluated. WRF was defined as > 20% reduction in eGFR from admission to discharge and response to treatment was assessed by ΔBNP. There was a statistically significant reduction in BNP and increase in BUN during the admission. ΔBNP did not correlate with either ΔGFR or ΔBUN. Patients who developed WRF and those who did not, had a similar reduction in BNP. On univariate survival analysis, ΔBUN, but not ΔeGFR, was associated with 1-year mortality. In multivariate Cox proportional hazards model, BUN at discharge was associated with 1-year mortality (HR: 1.02, p < 0.001), but ΔeGFR and ΔBUN were not associated with the primary endpoint. Conclusion: During ADHF treatment, ΔBNP was not associated with changes in renal function. Development of WRF during ADHF treatment was not associated with mortality. Our study suggests that development of WRF should not preclude diuresis in ADHF patients in the absence of volume depletion.
KW - BNP
KW - Heart failure
KW - Renal function
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U2 - 10.1016/j.ijcard.2012.05.004
DO - 10.1016/j.ijcard.2012.05.004
M3 - Article
C2 - 22633437
AN - SCOPUS:84883307321
SN - 0167-5273
VL - 167
SP - 1912
EP - 1917
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 5
ER -