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RESEARCH PRODUCT
B-type natriuretic peptide trend predicts clinical significance of worsening renal function in acute heart failure
Richard M. NowakGerhard A. MuellerChad M. CannonDirk J. Van VeldhuisenGerasimos FilippatosMichael C. KontosAlan S. MaiselKenneth McdonaldNiall MahonChristian MuellerClaudio PassinoYu HoriuchiYu HoriuchiNicholas WetterstenNicholas WetterstenRobert H. BirkhahnPam R. TaubCarlo BriguoriGary M. VilkeChristopher HoganPatrick T. MurrayJulio NúñezOlga Barnettsubject
InotropeMaleTime Factorsmedicine.medical_treatmentWorsening renal function030204 cardiovascular system & hematologyKidneyKidney Function TestsRISK STRATIFICATIONchemistry.chemical_compound0302 clinical medicineAcute heart failure; B-type natriuretic peptide; Mortality; Worsening renal function; Acute Disease; Acute Kidney Injury; Aged; Biomarkers; Creatinine; Disease Progression; Female; Follow-Up Studies; Glomerular Filtration Rate; Heart Failure; Humans; Kidney; Kidney Function Tests; Male; Natriuretic Peptide Brain; Prognosis; Prospective Studies; Time FactorsNatriuretic Peptide BrainNatriuretic peptideProspective StudiesDISCHARGEAcute kidney injuryBrainAcute Kidney InjuryPrognosis3. Good healthDERIVATIONHOSPITALIZATIONCreatinineAcute DiseaseCardiologyDisease ProgressionFemaleCardiology and Cardiovascular Medicinehormones hormone substitutes and hormone antagonistsGlomerular Filtration RateVENOUS CONGESTIONmedicine.medical_specialtymedicine.drug_classRenal functionPRESSUREVALIDATION03 medical and health sciencesNatriuretic PeptideInternal medicinemedicineHumansRenal replacement therapycardiovascular diseasesAgedMechanical ventilationHeart FailureCreatininebusiness.industryMORTALITYAcute heart failuremedicine.diseasechemistryB-type natriuretic peptideHeart failurebusinessBiomarkersFollow-Up Studiesdescription
Aims In acute heart failure (AHF), relationships between changes in B-type natriuretic peptide (BNP) and worsening renal function (WRF) and its prognostic implications have not been fully determined. We investigated the relationship between WRF and a decrease in BNP with in-hospital and 1-year mortality in AHF. Methods and results The Acute Kidney Injury NGAL Evaluation of Symptomatic heart faIlure Study (AKINESIS) was a prospective, international, multicentre study of AHF patients. Severe WRF (sWRF) was a sustained increase of >= 44.2 mu mol/L (0.5 mg/dL) or >= 50% in creatinine, non-severe WRF (nsWRF) was a non-sustained increase of >= 26.5 mu mol/L (0.3 mg/dL) or >= 50% in creatinine, and WRF with clinical deterioration was nsWRF with renal replacement therapy, inotrope use, or mechanical ventilation. Decreased BNP was defined as a >= 30% reduction in the last measured BNP compared to admission BNP. Among 814 patients, the incidence of WRF was not different between patients with or without decreased BNP (nsWRF: 33% vs. 31%, P = 0.549; sWRF: 11% vs. 9%, P = 0.551; WRF with clinical deterioration: 8% vs. 10%, P = 0.425). Decreased BNP was associated with better in-hospital and 1-year mortality regardless of WRF, while WRF was associated with worse outcomes only in patients without decreased BNP. In multivariate Cox regression analysis, decreased BNP, sWRF, and WRF with clinical deterioration were significantly associated with 1-year mortality. Conclusions Decreased BNP was associated with better in-hospital and long-term outcomes. WRF was only associated with adverse outcomes in patients without decreased BNP.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-12-01 |