Cardiorenal syndrome in decompensated heart failure

Tang, W.H. Wilson; Mullens, Wilfried

doi:10.1136/hrt.2009.166256

Cited by 119 publications

(86 citation statements)

References 63 publications

(38 reference statements)

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“…Increasingly, a spectrum of cardiorenal syndromes, [22][23][24] Gene descriptions include the USA National Centre for Biotechnology Information Reference Sequence accession number. LogFC is the logarithmically transformed fold change in gene expression.…”

Section: Discussionmentioning

confidence: 99%

White Blood Cell Transcriptome Correlates With Renal Function in Acute Heart Failure

et al. 2012

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SummaryIt is notoriously difficult to classify patients with acute heart failure (AHF) because of variations in clinical presentation, different etiologies, the impact of comorbidities, and variable prognoses. In this study, we used DNA whole-genome microarrays to classify 24 patients with AHF based on the transcriptome of their peripheral blood nuclear cells. The main purpose was to verify whether any transcriptomic sub-clusters had clinical correlations. We identified two distinct groups of transcriptomic profiles that correlated with normal (1.125 mg/dL) and increased (1.783 mg/dL) mean blood creatinine concentrations. These two subgroups of patients (n = 12) differed in the expression of more than 6000 genes and 108 signaling pathways. The most significant regulated signaling pathway was the aldosterone-regulated sodium reabsorption pathway and the most significant regulated genes included the angiotensin-converting enzyme gene. This suggests that kidney impairment in patients with AHF is related to dysregulation of the renin-angiotensin-aldosterone system. The interesting findings of our study were the significant differences in expression of genes belonging to the aldosterone-regulated signaling pathway: Na + /K + transporting ATPase and NEDD4L (neuronal precursor cell expressed developmentally down-regulated 4-like) between patients with and without renal dysfunction. Future studies of bloodcell transcriptomic profiles in patients with AHF will provide further insights into the molecular pathogenesis of this cardiorenal disorder. (Int Heart J 2012; 53: 117-124)

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Section: Discussionmentioning

confidence: 99%

White Blood Cell Transcriptome Correlates With Renal Function in Acute Heart Failure

et al. 2012

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“…30 Furthermore, those with worsening renal function often require a longer hospital stay. 17 Worsening renal function is defined in most reports as a change in serum creatinine ≥0.3 mg/ml during hospitalization, and it has been reported to be associated with an increased risk for long-term all-cause/cardiovascular mortality and morbidity in ADHF patients.…”

Section: Aki and Prognosis For Adhf Patientsmentioning

confidence: 99%

Prognostic Impact of Acute Kidney Injury in Patients With Acute Decompensated Heart Failure

Shirakabe

Hata

Kobayashi

et al. 2013

Circ J

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“…Recent studies have demonstrated that risk of mortality exponentially increased with increasing stages of AKI in the setting of ADHF (10). Early detection of patients at higher risk for AKI progression would help physicians to plan and initiate the appropriate managements to improve renal safety of therapies, augment surveillance of cardiac and renal dysfunction, and develop renal-preserving treatments (11,12).…”

Section: Introductionmentioning

confidence: 99%

Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome

Chen¹,

Yang

Lei

et al. 2016

CJASN

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Background and objectives A major challenge in early treatment of acute cardiorenal syndrome (CRS) is the lack of predictors for progression of AKI. We aim to investigate the utility of urinary angiotensinogen and other renal injury biomarkers in predicting AKI progression in CRS.Design, settings, participants, & measurements In this prospective, multicenter study, we screened 732 adults who admitted for acute decompensated heart failure from September 2011 to December 2014, and evaluated whether renal injury biomarkers measured at time of AKI diagnosis can predict worsening of AKI. In 213 patients who developed Kidney Disease Improving Global Outcomes stage 1 or 2 AKI, six renal injury biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), plasma neutrophil gelatinase-associated lipocalin, urinary IL-18 (uIL-18), urinary kidney injury molecule-1, and urinary albumin-to-creatinine ratio, were measured at time of AKI diagnosis. The primary outcome was AKI progression defined by worsening of AKI stage (50 patients). The secondary outcome was AKI progression with subsequent death (18 patients).Results After multivariable adjustment, the highest tertile of three urinary biomarkers remained associated with AKI progression compared with the lowest tertile: uAGT (odds ratio [OR], 10.8; 95% confidence interval [95% CI], 3.4 to 34.7), uNGAL (OR, 4.7; 95% CI, 1.7 to 13.4), and uIL-18 (OR, 3.6; 95% CI, 1.4 to 9.5). uAGT was the best predictor for both primary and secondary outcomes with area under the receiver operating curve of 0.78 and 0.85. These three biomarkers improved risk reclassification compared with the clinical model alone, with uAGT performing the best (category-free net reclassification improvement for primary and secondary outcomes of 0.76 [95% CI, 0.46 to 1.06] and 0.93 [95% CI, 0.50 to 1.36]; P,0.001). Excellent performance of uAGT was further confirmed with bootstrap internal validation.Conclusions uAGT, uNGAL, and uIL-18 measured at time of AKI diagnosis improved risk stratification and identified CRS patients at highest risk of adverse outcomes.

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Cardiorenal syndrome in decompensated heart failure

Cited by 119 publications

References 63 publications

White Blood Cell Transcriptome Correlates With Renal Function in Acute Heart Failure

White Blood Cell Transcriptome Correlates With Renal Function in Acute Heart Failure

Prognostic Impact of Acute Kidney Injury in Patients With Acute Decompensated Heart Failure

Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome

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