TY - JOUR
TI - Decongestion, kidney injury and prognosis in patients with acute heart failure
AU - Horiuchi, Y.
AU - Wettersten, N.
AU - van Veldhuisen, D.J.
AU - Mueller, C.
AU - Filippatos, G.
AU - Nowak, R.
AU - Hogan, C.
AU - Kontos, M.C.
AU - Cannon, C.M.
AU - Müeller, G.A.
AU - Birkhahn, R.
AU - Taub, P.
AU - Vilke, G.M.
AU - Barnett, O.
AU - McDonald, K.
AU - Mahon, N.
AU - Nuñez, J.
AU - Briguori, C.
AU - Passino, C.
AU - Duff, S.
AU - Maisel, A.
AU - Murray, P.T.
JO - International Journal of Cardiology
PY - 2022
VL - null
TODO - null
SP - null
PB - Elsevier Ireland Ltd
SN - 0167-5273
TODO - 10.1016/j.ijcard.2022.02.026
TODO - null
TODO - 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. © 2022 Elsevier B.V.
ER -