Prognostic Impact of BNP Variations in Patients Admitted for Acute Decompensated Heart Failure with In-Hospital Worsening Renal Function

Stolfo, Davide; Stenner, Elisabetta; Merlo, Marco; Porto, Andrea Giuseppe; Moras, Cristina; Barbati, Giulia; Aleksova, Aneta; Buiatti, Alessandra; Sinagra, Gianfranco

doi:10.1016/j.hlc.2016.06.1205

Cited by 19 publications

(20 citation statements)

References 30 publications

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“…Four prospective studies were identified in the meta-analysis, while the other 9 studies were retrospective or post hoc studies. Most studies regarded WRF as an increase in creatinine of >0.3 mg/dl from baseline, except studies by Stolfo et al 24 and Testani et al, 21 in which WRF was defined as a decrease in estimated glomerular filtration rate of $20%. The definition of decongestion varied by study.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Systematic Review of the Association Between Worsening Renal Function and Mortality in Patients With Acute Decompensated Heart Failure

Yamada

Ueyama

Chopra

et al. 2020

Kidney International Reports

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Introduction: Outcomes in acute decompensated heart failure (ADHF) have remained poor. Worsening renal function (WRF) is common among patients with ADHF. However, the impact of WRF on the prognosis is controversial. We hypothesized that in patients with ADHF, the achievement of concomitant decongestion would diminish the signal for harm associated with WRF. Methods: We performed a systematic search of PubMed, EMBASE, and the Cochrane Library up to December 2019 for studies that assessed signs of decongestion in patients with WRF during ADHF admission. The primary outcome was all-cause mortality and heart transplantation. Results: Thirteen studies were selected with a pooled population of 8138 patients. During the follow-up period of 60-450 days, 19.2% of patients died. Unstratified, patients with WRF versus no WRF had a higher risk for mortality (odds ratio [OR], 1.71 [95% confidence interval {CI}, 1.45-2.01]; P < 0.0001). However, patients who achieved decongestion had a similar prognosis (OR, 1.15 [95% CI, 0.89-1.49]; P ¼ 0.30). Moreover, patients with WRF who achieved decongestion had a better prognosis compared with those without WRF or decongestion (OR, 0.63 [95% CI, 0.46-0.86]; P ¼ 0.004). This tendency persisted for the sensitivity analyses. Conclusions: Decongestion is a powerful effect modifier that attenuates harmful associations of WRF with mortality. Future studies should not assess WRF as an endpoint without concomitant assessment of achieved volume status.

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Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Systematic Review of the Association Between Worsening Renal Function and Mortality in Patients With Acute Decompensated Heart Failure

Yamada

Ueyama

Chopra

et al. 2020

Kidney International Reports

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“…The prognosis of patients with AHF was initially thought to be worse in those with WRF than in those without WRF based on several observational studies [5]. However, subsequent studies have clearly shown that the clinical and prognostic implications of WRF were not always straightforward [6][7][8]. Moreover, it has been suggested that the timing of WRF assessment can alter its prognosis; in trials that defined WRF in the acute phase, WRF was not a simple prognostic marker.…”

Section: Plos Onementioning

confidence: 99%

“…However, the use of loop diuretics causes worsening renal function (WRF), which has been reported to be associated with a poor prognosis in patients with AHF [5]. This association, however, does not always hold, as several recent studies have shown that the prognostic impact of WRF varies according to the clinical context in which it occurs [6][7][8]. More specifically, WRF occurring during successful decongestive treatment is not associated with a poor prognosis, whereas WRF occurring during an unfavorable clinical course is associated with a poor prognosis [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure

et al. 2020

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The prognostic impact of worsening renal function (WRF) in patients with acute heart failure (AHF) remains under debate. Successful decongestion might offset the negative impact of WRF, but little is known about indicators of successful decongestion in the very acute phase of AHF. We hypothesized that decongestion as evaluated by the percent reduction in brain natriuretic peptide (BNP) could identify relevant prognostic implications of WRF in the very acute phase of AHF. Methods and results Data on 907 consecutive hospitalized patients with AHF in the REALITY-AHF study (age: 78±12 years; 55.1% male) were analyzed. Creatinine and BNP were measured at baseline and 48 hours from admission. WRF was defined as an increase in creatinine >0.3 mg at 48 hours from admission. The primary endpoint was 1-year all-cause mortality. Patients were divided into four groups according to the presence/absence of WRF and a BNP reduction higher/lower than the median: no-WRF/higher-BNP-reduction (n = 390), no-WRF/lower-BNP-reduction (n = 397), WRF/higher-BNP-reduction (n = 63), and WRF/lower-BNP-reduction groups (n = 57). Kaplan-Meier curve analysis showed that the WRF/lower-BNP-reduction

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“…Consistently, creatinine, BUN and estimated GFR are independent predictors of prognosis [40]. However, WRF occurs frequently during uptitration of diuretic treatment in case of clinical congestion and is not necessarily related to poor outcomes [35]. In idiopathic DCM, renal failure occurs in 20% of patients during the first 8 years after diagnosis, up to 50% at 20-year follow-up [59].…”

Section: Biomarkers and Dilated Cardiomyopathymentioning

confidence: 99%

“…Accordingly, the evaluation of their plasmatic concentration on hospital admission is predictive of outcome in patients with acute HF, and their increase despite optimized therapy in chronic HF predicts morbidity and mortality [34]. Moreover, in the setting of acute decompensated HF, the occurrence of WRF with a significant decrease of BNP is a marker of adequate decongestion and favourable outcome [35]. Few studies investigated the role of natriuretic peptides in the peculiar setting of idiopathic DCM.…”

Section: Biomarkers and Dilated Cardiomyopathymentioning

confidence: 99%

Regenerative Medicine and Biomarkers for Dilated Cardiomyopathy

Lesizza

Aleksova

Ortis

et al. 2019

Dilated Cardiomyopathy

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Prognostic Impact of BNP Variations in Patients Admitted for Acute Decompensated Heart Failure with In-Hospital Worsening Renal Function

Cited by 19 publications

References 30 publications

Systematic Review of the Association Between Worsening Renal Function and Mortality in Patients With Acute Decompensated Heart Failure

Systematic Review of the Association Between Worsening Renal Function and Mortality in Patients With Acute Decompensated Heart Failure

Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure

Regenerative Medicine and Biomarkers for Dilated Cardiomyopathy

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