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Title: Prognostic Value of Glomerular Filtration Changes Versus Natriuretic Response in Decompensated Heart Failure With Reduced Ejection
Authors: VERBRUGGE, Frederik 
NIJST, Petra 
DUPONT, Matthias 
Reynders, Carmen
Tang, W. H. Wilson
MULLENS, Wilfried 
Issue Date: 2014
Source: JOURNAL OF CARDIAC FAILURE, 20 (11), p. 817-824
Abstract: Background: Glomerular filtration rate (GFR) and natriuretic response to diuretics represent important treatment targets in acute decompensated heart failure (ADHF). Methods and Results: Consecutive ADHF patients (n = 50) with ejection fraction <= 45% and clinical signs of volume overload received protocol-driven decongestive therapy. Serum creatinine (Cr), cystatin C (CysC), and beta-trace protein (beta TP) were measured on admission and three subsequent days of treatment. Worsening renal function (WRF) was defined as a >= 0.3 increase in absolute biomarker levels or >= 20% decrease in estimated GFR. Consecutive 24-hour urinary collections were simultaneously performed to measure Cr clearance and natriuresis. Serum Cr, CysC, and beta TP were strongly correlated at admission (p = 0.788-0.909) and during decongestive treatment (p = 0.884-888). Moreover, derived GFR estimates correlated well with Cr clearance (p = 0.820-0.908.). Nevertheless, WRF incidence differed markedly according to Cr- (26%-30%), CysC- (46%-54%), or beta TP-based definitions (31%-48%). WRF by any definition was not associated with all-cause mortality or ADHF readmission, in contrast to stronger natriuresis per loop diuretic dose [hazard ratio 0.20 (95% confidence interval 0.06-0.64); P = .007]. Conclusions: Serial measurements of CysC/beta TP, compared with serum Cr, more frequently indicate WRF during decongestive treatment in ADHF. However, adverse clinical outcome in such patients might be better predicted by the natriuretic response to diuretic therapy.
Notes: [Verbrugge, Frederik Hendrik; Nijst, Petra; Dupont, Matthias; Mullens, Wilfred] Ziekenhuis Oost Limburg, Dept Cardiol, B-3600 Genk, Belgium. [Verbrugge, Frederik Hendrik; Nijst, Petra] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Reynders, Carmen; Penders, Joris] Ziekenhuis Oost Limburg, Dept Lab Med, B-3600 Genk, Belgium. [Penders, Joris; Mullens, Wilfred] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. [Tang, W. H. Wilson] Cleveland Clin, Inst Heart & Vasc, Dept Cardiovasc Med, Cleveland, OH 44106 USA.
Keywords: glomerular filtration rate; congestive heart failure; natriuresis.;Glomerular filtration rate; congestive heart failure; natriuresis
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ISSN: 1071-9164
e-ISSN: 1532-8414
DOI: 10.1016/j.cardfail.2014.08.002
ISI #: 000344837300004
Rights: © 2014 Elsevier Inc. All rights reserved.
Category: A1
Type: Journal Contribution
Validations: ecoom 2015
Appears in Collections:Research publications

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