Prognostic Value of Fractional Excretion of Urea Nitrogen at Discharge in Acute Decompensated Heart Failure

Nogi, Kazutaka; Kawakami, Rika; Ueda, Tomoya; Nogi, Maki; Ishihara, Shoichiro; Nakada, Yasuki; Hashimoto, Yukihiro; Nakagawa, Hitoshi; Nishida, Taku; Seno, Ayako; Onoue, Kenji; Soeda, Tsunenari; Watanabe, Makoto; Saito, Yoshihiko

doi:10.1161/jaha.120.020480

Cited by 6 publications

(25 citation statements)

References 25 publications

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“…These results were similar to the previous study showing that FEUN was more useful in patients with eGFR <60 mL/min per 1.73 m 2 . 11 However, given the small number of patients with eGFR ≥60 mL/min per 1.73 m 2 in the present study, it is not yet clear whether the differences of the renal function affect the combined assessment of the FEUN and ePVS values. Therefore, generalizing our results to all patients with ADHF might be limited.…”

Section: Discussionmentioning

confidence: 64%

“…In the present study, we focused on the ePVS that is associated with congestion 12 and the FEUN that is associated with renal perfusion in patients with ADHF. 8 , 11 These indices are minimally invasive and do not vary in interpretation among clinicians because they are objective results that are measured using blood or urine tests. However, no studies have evaluated the association between the combined assessment of the FEUN and ePVS values at discharge and the long‐term prognosis in patients with ADHF.…”

Section: Discussionmentioning

confidence: 99%

“… 12 In the multivariate analysis, the following variables were selected as pre‐existing and known prognostic factors for HF: age, sex, the New York Heart Association functional classification, diabetes, BNP, left ventricular ejection fraction at discharge, BUN, creatinine, serum sodium, systolic blood pressure at discharge, angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, beta‐blockers, and aldosterone antagonists. 11 In addition to the Cox proportional hazard analysis, a competing‐risk analysis using the Fine and Gray model was used to analyze the risk of HF readmission. Finally, subgroup analyses in Kaplan–Meier analyses with log‐rank tests for postdischarge all‐cause death were conducted by eGFR (<60 mL/min per 1.73 m 2 , ≥60 mL/min per 1.73 m 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, we identified a lower FEUN as a predictor of the prognosis in patients with ADHF, especially in those with estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m 2 . 11 However, we were unable to determine whether the low FEUN was because of the low cardiac function or the decrease in the circulating plasma volume.…”

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confidence: 93%

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New Classification for the Combined Assessment of the Fractional Excretion of Urea Nitrogen and Estimated Plasma Volume Status in Acute Heart Failure

Nogi

Ueda

Nakamura

et al. 2023

JAHA

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Background The fractional excretion of urea nitrogen (FEUN) has been used as a renal blood flow index related to cardiac output, and the estimated plasma volume status (ePVS) as a body fluid volume index. However, the usefulness of their combination in acute decompensated heart failure (HF) management is unclear. We investigated the effect of 4 hemodynamic categories according to the high and low FEUN and ePVS values at discharge on the long‐term prognosis of patients with acute decompensated HF. Methods and Results Between April 2011 and December 2018, we retrospectively identified 466 patients with acute decompensated HF with FEUN and ePVS values at discharge. Primary end point was postdischarge all‐cause death. Secondary end points were (1) the composite of all‐cause death and HF readmission, and (2) HF readmission in a time‐to‐event analysis. The patients were divided into 4 groups according to the high/low FEUN (≥35%, <35%) and ePVS (>5.5%, ≤5.5%) values at discharge: high‐FEUN/low‐ePVS, high‐FEUN/high‐ePVS, low‐FEUN/low‐ePVS, and low‐FEUN/high‐ePVS groups. During a median follow‐up period of 28.1 months, there were 173 all‐cause deaths (37.1%), 83 cardiovascular deaths (17.8%), and 121 HF readmissions (26.0%). The Kaplan–Meier curve analysis showed that the high‐FEUN/low‐ePVS group had a better prognosis than the other groups (log‐rank test, P <0.001). In the multivariable Cox regression analysis, the low‐FEUN/high‐ePVS group had a higher mortality than the high‐FEUN/low‐ePVS group (hazard ratio, 2.92 [95% CIs, 1.73–4.92; P <0.001]). Conclusions The new classification of the 4 hemodynamic profiles using the FEUN and ePVS values may play an important role in improving outcomes in patients with stable acute decompensated HF.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 93%

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New Classification for the Combined Assessment of the Fractional Excretion of Urea Nitrogen and Estimated Plasma Volume Status in Acute Heart Failure

Nogi

Ueda

Nakamura

et al. 2023

JAHA

Self Cite

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“…A creatinine level higher than 1.2 for women and higher than 1.4 for men may be an early marker that the kidneys are not operating precisely. (34)(35)(36)(37) Unfortunately, our findings can only be validated in the obesity group and cannot necessarily be proven to have the same results in the DM and hypertension subjects, which are also subjects with risk factors for impaired kidney function. This study also cannot confirm that the measured serum NO is synthesized by eNOS, nNOS, or iNOS in pathological conditions, but the relevance of obesity as a risk factor for metabolic syndrome with an accumulation of inflammatory cytokines will certainly induce iNOS activation to produce NO which has opposite effect to eNOS as vascular protection.…”

Section: Discussionmentioning

confidence: 86%

β-1,3/1,6-D-glucan of Mycelia Extract Posses Renal Protection Potential and Reduces Nitric Oxide in Obese Subjects

et al. 2022

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BACKGROUND: Obesity has been widely reported to be associated with loss of kidney function. The efficacy of β-1,3/1,6-D-glucan as a traditional medicine for the improvement of inflammation and vascular status in obesity has known. However, there have been no further studies that prove the effect of β-1,3/1,6-D-glucan in inhibiting kidney injury as an impact of chronic inflammation exposure on obesity. This study aimed to investigate the impact of β-1,3/1,6-D-glucan from mycelia extract supplementation on renal function improvement based on serum nitric oxide (NO), ureum, and creatinine levels.METHODS: This was a randomized control trial study involving 69 obese subjects treated with or without β-1,3/1,6-D-glucan supplementation. The serum NO, ureum, and creatinine levels of the subjects were measured at baseline and post-treatment using enzyme-linked immunosorbent assay (ELISA) and then statistically analyzed with paired T-test.RESULTS: Although slightly decrease, no significant difference was found between the ureum and creatinine level at the baseline and and post-treatment (p=0.806, p=0.306, respectively) after β-1,3/1,6-D-glucan supplementation. Serum NO levels significantly decrease after treatment of β-1,3/1,6-D-glucan (p<0.001).CONCLUSION: Current study concludes that β-1,3/1,6-D-glucan from mycelia extract does not significantly lower urea and creatinine level, however, significantly able to reduce the serum NO concentration in obese subjects. Therefore, β-1,3/1,6-D-glucan from mycelia extract might have the renal protection potential in obesity.KEYWORDS: β-1,3/1,6-D-glucan, Ganoderma lucidum, renal function improvement, obesity

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Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease

et al. 2023

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Aims Maintenance of euvolaemia with diuretics is critical in heart failure (HF) patients with chronic kidney disease (CKD); however, it is challenging because no reliable marker of volume status exists. Fractional excretion of urea nitrogen (FEUN) is a useful index of volume status in patients with renal failure. We aimed to examine whether FEUN is a surrogate marker of volume status for risk stratification in HF patients with CKD. Methods and resultsWe examined 516 HF patients with CKD (defined as discharge estimated glomerular filtration rate < 60 mL/min/1.73 m 2 ) whose FEUN was measured at discharge (median age, 80 years; 58% male). The patients were divided into four groups according to quartile FEUN value at discharge: low-FEUN, FEUN ≤ 32.1; medium-FEUN, 32.1 < FEUN ≤ 38.0; high-FEUN, 38.0 < FEUN ≤ 43.7; and extremely-high-FEUN, FEUN > 43.7. FEUN was calculated by the following formula: (urinary urea × serum creatinine) × 100/(serum urea × urinary creatinine). During the 3 year follow-up, 131 HF readmissions occurred. Kaplan-Meier analysis showed that the HF readmission rate was significantly lower in the medium-FEUN group than in the other three groups (log-rank test, P = 0.029). Multivariate Cox regression analysis identified the low-FEUN, high-FEUN, and extremely-high-FEUN values as independent factors associated with post-discharge HF readmission. In the analysis of 130 patients who underwent right heart catheterization during hospitalization, a significant correlation between FEUN value and right atrial pressure was observed (R = 0.243, P = 0.005). Multivariate linear regression analysis revealed that FEUN value at discharge decreased in a dose-dependent manner with loop diuretics. Conclusions In HF patients with CKD, FEUN is a potential marker of volume status for risk stratification of post-discharge HF readmission. Low FEUN value (FEUN ≤ 32.1) may represent intravascular dehydration, whereas high FEUN value (FEUN > 38.0) may represent residual congestion; both of them were independent risk factors for HF readmission. FEUN may be useful to determine euvolaemia and guide fluid management in HF patients with CKD.

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Prognostic Value of Fractional Excretion of Urea Nitrogen at Discharge in Acute Decompensated Heart Failure

Cited by 6 publications

References 25 publications

New Classification for the Combined Assessment of the Fractional Excretion of Urea Nitrogen and Estimated Plasma Volume Status in Acute Heart Failure

New Classification for the Combined Assessment of the Fractional Excretion of Urea Nitrogen and Estimated Plasma Volume Status in Acute Heart Failure

β-1,3/1,6-D-glucan of Mycelia Extract Posses Renal Protection Potential and Reduces Nitric Oxide in Obese Subjects

Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease

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