The Importance of Blood Urea Nitrogen to Creatinine Ratio in Patients With Hfpef and Hfref

The blood urea nitrogen to creatinine ratio in chronic heart failure: ‘When the past is prologue’

“…Moreover, it enhances our understanding of the BUN/Cr ratio's prognostic significance by expanding its recognized use in acute conditions to include chronic HF scenarios. Notably, the relationship between the BUN/Cr ratio and patient outcomes reveals an inflection point around 20, above which the risk increases linearly 5 . This specific cut‐off point aligns with the general population's upper normal limit for the BUN/Cr ratio, aiding in straightforward result interpretation.…”

“…Another interesting finding is that the association between higher BUN/Cr ratio and worse outcomes was of greater magnitude in the upper extreme of LVEF, a point not extensively discussed in the study 5 . Notably, the interaction between the BUN/Cr ratio and LVEF with patient outcomes remained significant regardless of the modelling approach.…”

“…In this issue of the Journal, Tolomeo et al 5 . conduct a post‐hoc analysis using combined individual patient data from five large multinational, randomized, double‐blind chronic HF trials, covering both reduced (HFrEF) and preserved (HFpEF) ejection fraction (HFrEF: PARADIGM‐HF, DAPA‐HF, and ATMOSPHERE, HFpEF: PARAGON‐HF, and I‐PRESERVE).…”

“…Overall, 28 820 patients were analysed. Tolomeo et al 5 . postulate that the BUN/Cr ratio adds independent prognostic information in chronic HF across the entire left ventricular ejection fraction (LVEF) spectrum.…”