Acidic urine as a novel risk factor for diuretic resistance and worse in-hospital prognosis in acute heart failure

Imiela, Tomasz; Imiela, Anna M; Karczmarewicz, Grzegorz; Budaj, Andrzej

doi:10.20452/pamw.16054

Cited by 3 publications

(3 citation statements)

References 34 publications

(49 reference statements)

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“…The most clinically relevant finding in our study is the demonstration that urinary KIM-1 uniquely identifies patients at risk of dying during the most vulnerable period (1-4 months following discharge), regardless of renal function or cardiovascular status (NT-proBNP). The elevation in urinary KIM-1 might represent residual tubular cell stress, which has been recently associated with worse acute outcomes in ADHF [48]. Furthermore, the risk associated with elevated discharge uKIM1 was additive to that associated with elevated discharge sNGAL, AKI incidence or low renal function at admission.…”

Section: Discussionmentioning

confidence: 94%

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

Josa-Laorden¹,

Rubio-Gracia²,

Sánchez‐Marteles³

et al. 2022

Polish Archives of Internal Medicine

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In a 12-month follow-up study of patients suffering from an acute decompensated heart failure (ADHF) episode, more than half of the fatalities happened in the first four months following discharge. We found that elevated relative urine Kidney Injury Molecule 1 (KIM-1) level (µg/g creatinine) on discharge is a significant and independent predictor of increased mortality risk during the most susceptible time (4-month follow-up). The association was independent of previous renal function or N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) levels and was additive to risk conferred by acute kidney injury (AKI) incidence.Urinary KIM-1 measurements in ADHF patients may be beneficial in identifying individuals at higher risk of adverse outcomes and so requiring closer follow-up. Our finding differs from other studies showing a dissociation between renal function and tubular markers in that KIM-1 was measured in urine collected at the time of discharge when clinical stability had been achieved.

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Section: Discussionmentioning

confidence: 94%

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

Josa-Laorden¹,

Rubio-Gracia²,

Sánchez‐Marteles³

et al. 2022

Polish Archives of Internal Medicine

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“…Further, acetazolamide might improve acid-base disorders (such as metabolic alkalosis) that prevalently occur during heart failure [38,39]. Moreover, heart failure patients developing blood alkalosis and urine acidosis have been associated with increased diuretic resistance [40]. These conditions could be mitigated Original Article by acetazolamide since it acts in promoting tubular bicarbonate excretion and absorption of chloride ions into blood stream [41].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of acetazolamide and loop diuretics combinatorial therapy in congestive heart failure: A meta-analysis

Duta,

Zulfa,

Alina

et al. 2024

Narra X

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Acetazolamide, one of the carbonic anhydrase inhibitors, has been known to improve the efficacy of diuretic therapy in patients with in congestion heart failure. The aim this study was to investigate the effectiveness of acetazolamide when combined with loop diuretics in ameliorating diuresis and natriuresis in congestive heart failure using systematic review and meta-analysis. Randomized controlled trials (RCTs) and cohort studies were searched on PubMed, Scopus, and Embase on March 7, 2023, by using combinations of ‘acetazolamide’, ‘heart failure’ and along with their respective synonyms. The protocol had been registered on PROSPERO (CRD42023409864). The studies must investigate the effect of oral acetazolamide as the add-on to loop diuretic therapy to be included. Successful decongestion, natriuresis, and diuresis were set as the primary outcomes. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for RCTs and Newcastle Ottawa Scale for observational studies. We identified 1176 titles in the initial search, and further reduced to five studies (three RCTs and two cohort studies) after in-depth screening. A total of 625 patients were recruited in the included studies published from 2015 to 2022. Results from meta-analysis revealed that acetazolamide and loop diuretics combination therapy ameliorated natriuresis (n=4; standardized means difference (SMD)=0.65; 95%CI: 0.07–1.24; p=0.03) and diuresis (n=2; SMD=0.29; 95%CI: 0.12–0.46; p=0.0009) when compared to loop diuretics alone. Acetazolamide and loop diuretics combinatorial therapy is efficacious in alleviating congestion in heart failure patients.

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“…Several lines of evidence indicate that different biomarkers or ratios might be useful in cardiovascular prognosis after myocardial infarction (MI) [6][7][8]. Atherogenic lipoproteins, mainly low-density lipoprotein (LDL) cholesterol, initiate atherosclerosis by depositing in the arterial intima [9] and promote arterial wall inflammation [10].…”

Section: Introductionmentioning

confidence: 99%

Thin-cap fibroatheroma and increased coronary intima-media thickness are associated with an altered arginine metabolites balance

Mołek¹,

Żmudzki²,

Machnik³

et al. 2022

Polish Archives of Internal Medicine

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What's new?Nitric oxide synthase (NOS) produces a potent signaling molecule nitric oxide but arginase competes with NOS for the same substrate arginine reducing nitric oxide production. This study demonstrates that during the acute phase of myocardial infarction arginine metabolism is shifted towards arginase over NOS. An enhanced arginase activity in the acute setting is associated with the presence of the features of unstable coronary plaque responsible for acute coronary syndromes expressed as thin-cap fibroatheroma. In turn, a similar residual metabolic shift towards arginase in the chronic phase is correlated with a higher thickness of intima-media in the stable segments of infarct-related artery. The current study provides arguments that arginine metabolites and their derivatives might be considered as the new, non-invasive indicators useful for identification of patients who are more likely to have vulnerable plaque as well as for monitoring of the extent of chronic atherosclerotic lesions.

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Acidic urine as a novel risk factor for diuretic resistance and worse in-hospital prognosis in acute heart failure

Cited by 3 publications

References 34 publications

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

Elevated urinary Kidney Injury Molecule 1 (KIM-1) at discharge strongly predicts early mortality following an episode of acute decompensated heart failure

Efficacy of acetazolamide and loop diuretics combinatorial therapy in congestive heart failure: A meta-analysis

Thin-cap fibroatheroma and increased coronary intima-media thickness are associated with an altered arginine metabolites balance

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