Decongestion, kidney injury and prognosis in patients with acute heart failure.

BACKGROUND: 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 k...

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Autores: Horiuchi, Yu, Wettersten, Nicholas, van Veldhuisen, Dirk J, Mueller, Christian, Filippatos, Gerasimos, Nowak, Richard, Hogan, Christopher, Kontos, Michael C, Cannon, Chad M, Mueller, Gerhard A, Birkhahn, Robert, Taub, Pam, Vilke, Gary M, Barnett, Olga, McDonald, Kenneth, Mahon, Niall, Nunez, Julio, Briguori, Carlo, Passino, Claudio, Duff, Stephen, Maisel, Alan, Murray, Patrick T
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p16465
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/16465
Access Level:acceso abierto
Palabra clave:Acute heart failure
Acute renal tubular damage
Congestion
Prognosis
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spelling Decongestion, kidney injury and prognosis in patients with acute heart failure.Horiuchi, YuWettersten, Nicholasvan Veldhuisen, Dirk JMueller, ChristianFilippatos, GerasimosNowak, RichardHogan, ChristopherKontos, Michael CCannon, Chad MMueller, Gerhard ABirkhahn, RobertTaub, PamVilke, Gary MBarnett, OlgaMcDonald, KennethMahon, NiallNunez, JulioBriguori, CarloPassino, ClaudioDuff, StephenMaisel, AlanMurray, Patrick TAcute heart failureAcute renal tubular damageCongestionPrognosisBACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.ELSEVIER IRELAND LTD2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/16465International Journal of CardiologyISSN: 01675273ISSNe: 18741754reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p164652026-06-07T16:35:31Z
dc.title.none.fl_str_mv Decongestion, kidney injury and prognosis in patients with acute heart failure.
title Decongestion, kidney injury and prognosis in patients with acute heart failure.
spellingShingle Decongestion, kidney injury and prognosis in patients with acute heart failure.
Horiuchi, Yu
Acute heart failure
Acute renal tubular damage
Congestion
Prognosis
title_short Decongestion, kidney injury and prognosis in patients with acute heart failure.
title_full Decongestion, kidney injury and prognosis in patients with acute heart failure.
title_fullStr Decongestion, kidney injury and prognosis in patients with acute heart failure.
title_full_unstemmed Decongestion, kidney injury and prognosis in patients with acute heart failure.
title_sort Decongestion, kidney injury and prognosis in patients with acute heart failure.
dc.creator.none.fl_str_mv Horiuchi, Yu
Wettersten, Nicholas
van Veldhuisen, Dirk J
Mueller, Christian
Filippatos, Gerasimos
Nowak, Richard
Hogan, Christopher
Kontos, Michael C
Cannon, Chad M
Mueller, Gerhard A
Birkhahn, Robert
Taub, Pam
Vilke, Gary M
Barnett, Olga
McDonald, Kenneth
Mahon, Niall
Nunez, Julio
Briguori, Carlo
Passino, Claudio
Duff, Stephen
Maisel, Alan
Murray, Patrick T
author Horiuchi, Yu
author_facet Horiuchi, Yu
Wettersten, Nicholas
van Veldhuisen, Dirk J
Mueller, Christian
Filippatos, Gerasimos
Nowak, Richard
Hogan, Christopher
Kontos, Michael C
Cannon, Chad M
Mueller, Gerhard A
Birkhahn, Robert
Taub, Pam
Vilke, Gary M
Barnett, Olga
McDonald, Kenneth
Mahon, Niall
Nunez, Julio
Briguori, Carlo
Passino, Claudio
Duff, Stephen
Maisel, Alan
Murray, Patrick T
author_role author
author2 Wettersten, Nicholas
van Veldhuisen, Dirk J
Mueller, Christian
Filippatos, Gerasimos
Nowak, Richard
Hogan, Christopher
Kontos, Michael C
Cannon, Chad M
Mueller, Gerhard A
Birkhahn, Robert
Taub, Pam
Vilke, Gary M
Barnett, Olga
McDonald, Kenneth
Mahon, Niall
Nunez, Julio
Briguori, Carlo
Passino, Claudio
Duff, Stephen
Maisel, Alan
Murray, Patrick T
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Acute heart failure
Acute renal tubular damage
Congestion
Prognosis
topic Acute heart failure
Acute renal tubular damage
Congestion
Prognosis
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/16465
url https://incliva.portalinvestigacion.com/publicaciones/16465
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER IRELAND LTD
publisher.none.fl_str_mv ELSEVIER IRELAND LTD
dc.source.none.fl_str_mv International Journal of Cardiology
ISSN: 01675273
ISSNe: 18741754
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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