Acute Kidney Function Declines in the Context of Decongestion in Acute Decompensated Heart Failure.

JACC. Heart Failure
Wendy McCallumMark J Sarnak

Abstract

This study aimed to examine whether incorporation of a comprehensive set of measures of decongestion modifies the association of acute declines in kidney function with outcomes. In-hospital acute declines in kidney function occur in approximately 20% to 30% of patients admitted with acute decompensated heart failure (ADHF) and may be associated with adverse outcomes. Using data from EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan), we used multivariable Cox regression models to evaluate the association between in-hospital changes in estimated glomerular filtration rate (eGFR) with death and a composite outcome of cardiovascular death and hospitalization for heart failure. We evaluated eGFR declines within the context of changes in markers of volume overload including b-type natriuretic peptide (BNP), N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and weight, as well as changes in measures of hemoconcentration including hematocrit, albumin, and total protein. Among 3,715 patients over a median follow-up of 9.9 months, every 30% decline in eGFR was associated with higher risk of both death (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.07 to 1.31) and the comp...Continue Reading

References

Jan 13, 2004·Journal of the American College of Cardiology·Daniel E FormanHarlan M Krumholz
Mar 27, 2007·JAMA : the Journal of the American Medical Association·Marvin A KonstamUNKNOWN Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators
Oct 10, 2007·Journal of Cardiac Failure·Kevin DammanHans L Hillege
Feb 14, 2009·Journal of the American College of Cardiology·Wilfried MullensW H Wilson Tang
Nov 26, 2010·European Journal of Heart Failure·Heiko UthoffChristian Mueller
Jul 6, 2012·The New England Journal of Medicine·Lesley A InkerUNKNOWN CKD-EPI Investigators
Mar 12, 2013·European Journal of Heart Failure·Doron AronsonAndrew J Burger
Aug 6, 2013·Journal of Cardiac Failure·Sergio Manzano-FernándezJames L Januzzi
Jun 4, 2014·JAMA : the Journal of the American Medical Association·Josef CoreshAndrew S Levey
Feb 23, 2018·Circulation Journal : Official Journal of the Japanese Circulation Society·Takumi KondoMasatake Fukunami

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Citations

Sep 11, 2020·Current Cardiology Reports·W H Wilson Tang, Alan Kiang
Mar 13, 2021·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Saif AliDmitry Abramov
Apr 1, 2021·European Journal of Heart Failure·Nicholas WetterstenPatrick T Murray
May 14, 2021·Circulation Research·Joyce N Njoroge, John R Teerlink
Nov 18, 2021·European Journal of Heart Failure·Johanna E EmmensJohn R Teerlink

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