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Decongestion, kidney injury and prognosis in patients with acute heart failure.
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift) |
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ID |
4665013 |
Author(s) |
Horiuchi, Yu; Wettersten, Nicholas; van Veldhuisen, Dirk J; Mueller, Christian; Filippatos, Gerasimos; Nowak, Richard; Hogan, Christopher; Kontos, Michael C; Cannon, Chad M; Müeller, Gerhard A; Birkhahn, Robert; Taub, Pam; Vilke, Gary M; Barnett, Olga; McDonald, Kenneth; Mahon, Niall; Nuñez, Julio; Briguori, Carlo; Passino, Claudio; Duff, Stephen; Maisel, Alan; Murray, Patrick T |
Author(s) at UniBasel |
Müller, Christian
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Year |
2022 |
Title |
Decongestion, kidney injury and prognosis in patients with acute heart failure. |
Journal |
International journal of cardiology |
Volume |
354 |
Pages / Article-Number |
29-37 |
Keywords |
Acute heart failure; Acute renal tubular damage; Congestion; Prognosis |
Mesh terms |
Acute Disease; Acute Kidney Injury; Biomarkers; Diuretics, therapeutic use; Heart Failure, complications, diagnosis, drug therapy; Humans; Kidney, physiology; Lipocalin-2; Natriuretic Peptide, Brain; Prognosis; Retrospective Studies |
Abstract |
In patients with acute heart failure (AHF), the development of worsening renal function with appropriate decongestion is thought to be a benign functional change and not associated with poor prognosis. We investigated whether the benefit of decongestion outweighs the risk of concurrent kidney tubular damage and leads to better outcomes.; We retrospectively analyzed data from the AKINESIS study, which enrolled AHF patients requiring intravenous diuretic therapy. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and B-type natriuretic peptide (BNP) were serially measured during the hospitalization. Decongestion was defined as ≥30% BNP decrease at discharge compared to admission. Univariable and multivariable Cox models were assessed for one-year mortality.; Among 736 patients, 53% had ≥30% BNP decrease at discharge. Levels of uNGAL and BNP at each collection time point had positive but weak correlations (r ≤ 0.133). Patients without decongestion and with higher discharge uNGAL values had worse one-year mortality, while those with decongestion had better outcomes regardless of uNGAL values (p for interaction 0.018). This interaction was also significant when the change in BNP was analyzed as a continuous variable (p < 0.001). Although higher peak and discharge uNGAL were associated with mortality in univariable analysis, only ≥30% BNP decrease was a significant predictor after multivariable adjustment.; Among AHF patients treated with diuretic therapy, decongestion was generally not associated with kidney tubular damage assessed by uNGAL. Kidney tubular damage with adequate decongestion does not impact outcomes; however, kidney injury without adequate decongestion is associated with a worse prognosis. |
ISSN/ISBN |
1874-1754 |
Full Text on edoc |
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Digital Object Identifier DOI |
10.1016/j.ijcard.2022.02.026 |
PubMed ID |
http://www.ncbi.nlm.nih.gov/pubmed/35202737 |
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