Relation of Kidney Function Decline and NT-proBNP With Risk of Mortality and Readmission in Acute Decompensated Heart Failure

Abstract

Background-Acute declines in kidney function occur in approximately 20-30% of patients with acute decompensated heart failure, but its significance is unclear and importance of its context is not known. This study aimed to determine the prognostic value of a decline in kidney function in the context of decongestion among patients admitted with acute decompensated heart failure. Methods-Using data from patients enrolled in the Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome Study (CARRESS) and Diuretic Optimization Strategies Evaluation (DOSE) trials, we used multivariable Cox regression models to evaluate the association between decline in estimated glomerular filtration rate (eGFR) and change in N-terminal pro-btype natriuretic peptide (NT-proBNP) with the composite outcome, as well as testing for an interaction between the two. Results-Among 435 patients, in-hospital decline in eGFR was not significantly associated with death and re-hospitalization (HR=0.89 per 30% decline, 95% CI 0.74, 1.07) while decline in NT-proBNP was associated with lower risk (HR=0.69 per halving, 95% CI 0.58, 0.83). There was a significant interaction (p = 0.003 unadjusted; p = 0.03 adjusted) between decline in eGFR and change in NT-proBNP where a decline in eGFR was associated with better outcomes when NT-proBNP declined (HR=0.78 per 30% decline in eGFR, 95% CI 0.61, 0.99), but not when NT-proBNP increased (HR=0.99, 95% CI 0.76, 1.30). Conclusions-Decline in kidney function during therapy for acute decompensated heart failure is associated with improved outcomes as long as NT-proBNP levels are decreasing as well,

Association of Volume Overload With Kidney Function Outcomes Among Patients With Heart Failure With Reduced Ejection Fraction

“…Measurements of kidney function obtained outside of these prespecified protocol visits were excluded, as indication for testing was unclear. Given the known variability in kidney function during in-hospital treatment for acute HF and the fact that the relation of short-term declines in kidney function with outcomes is controversial, 5 , 6 , 34 only kidney endpoints occurring after discharge from the initial hospitalization were included in the primary analysis. In order to avoid short-term perturbation in hemodynamics that resulted in reaching the kidney outcomes, reaching the kidney endpoint required 2 consecutive measures of eGFR.…”

“…Reduced levels of kidney function are highly prevalent among patients with HFrEF and are associated with adverse clinical outcomes. 1 , 2 , 3 , 4 Acute declines in kidney function, such as during hospitalizations or after starting certain medications, may or may not be associated with worse clinical outcomes 5 , 6 ; however, longer-term declines in kidney function are consistently associated with increased risk for mortality and cardiovascular outcomes in HFrEF. 7 , 8 Few studies have examined risk factors for longitudinal declines in eGFR among patients with HFrEF.…”

Accelerated decline in renal function after hospitalization for acute heart failure: an opportunity to intervene, or a sign of the inevitable?

“…However, the complex relationship between change in renal function and outcomes among patients with AHF complicates matters. A temporary in‐hospital decline in eGFR appears to portend better outcomes as long as it is accompanied by effective decongestion 5,6 . For the patients in this study 3 several questions remain unanswered: What events occurred in the hospital?…”

“…A temporary in-hospital decline in eGFR appears to portend better outcomes as long as it is accompanied by effective decongestion. 5,6 For the patients in this study 3 several questions remain unanswered: What events occurred in the hospital? What medications or other treatments were administered?…”

The Congestion-Creatinine Interplay in Acute Heart Failure: Time to Move Up to the Next Level

“…1−3 The article by McCallum et al is the latest of this long series. 4 The authors have combined data from patients enrolled in the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) and Diuretic Optimization Strategies Evaluation (DOSE) trials to explore the prognostic impact of rise in serum creatinine in the setting of acute heart failure therapy. They, too, found that increase in serum creatinine was not associated with adverse outcomes, whereas decongestion (measured through decrease in N-terminal pro-b-type natriuretic peptide [NT-proBNP]) showed a 31% reduction in the rate of death and hospital readmission.…”