Worsening Renal Function and Mortality in Heart Failure

Testani, Jeffrey M.; Brisco‐Bacik, Meredith A.

doi:10.1161/circheartfailure.117.003835

Cited by 25 publications

(26 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…26 WRF in the setting of aggressive diuresis is often considered acute kidney injury, and thus, further diuresis or renin-angiotensin-aldosterone system blockade is suspended. 27 This belief has been widely incorporated into clinical practice, and WRF is a commonly used outcome for multiple AHF clinical trials, both completed and planned. 2,3,15 However, several lines of recent evidence challenge this paradigm, suggesting that it is the context by which WRF develops, rather than simply its presence, that is the principal determinant of adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Our finding of no significant change in 3 well-established markers of tubular injury with treatment-induced WRF provides substantial reassurance that small to moderate treatment-induced bumps in creatinine that inevitably occur in the setting of aggressive diuresis should not carry negative connotations and trigger withdrawal of potentially beneficial therapy. 27…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury

Ahmad¹,

Jackson²,

Rao³

et al. 2018

Circulation

Self Cite

274

214

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury

Ahmad¹,

Jackson²,

Rao³

et al. 2018

Circulation

Self Cite

274

214

View full text Add to dashboard Cite

show abstract

“…Although these studies show similar results, the precise mechanism by which WRF exerts adverse prognostic effects remains unclear. Testani et al explained that several hypothetical mechanisms, including inflammation, oxidative stress, or induction of apoptosis by uremic toxins, may partially contribute to the adverse effect of WRF . However, this study also claimed that it is still uncertain whether WRF is a mediator or marker for adverse outcomes.…”

Section: Discussionmentioning

confidence: 80%

“…Testani et al explained that several hypothetical mechanisms, including inflammation, oxidative stress, or induction of apoptosis by uremic toxins, may partially contribute to the adverse effect of WRF. 16 However, this study also claimed that it is still uncertain whether WRF is a mediator or marker for adverse outcomes. In this study, magnitude of effect size for WRF decreased from 3.18, to 1.66, to 1.39 for adverse in-hospital outcomes, and 3-and 12-month mortality, respectively.…”

Section: Wrf As a Risk Factor In Hfmentioning

confidence: 91%

Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry

Kang

Park

Cho

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundWorsening renal function (WRF) is associated with adverse outcomes in patients with heart failure. We investigated the predictors and prognostic value of WRF during admission, in patients with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF).Methods and ResultsA total of 5625 patients were enrolled in the KorAHF (Korean Acute Heart Failure) registry. WRF was defined as an absolute increase in creatinine of ≥0.3 mg/dL. Transient WRF was defined as recovery of creatinine at discharge, whereas persistent WRF was indicated by a nonrecovered creatinine level. HFpEF and HFrEF were defined as a left ventricle ejection fraction ≥50% and ≤40%, respectively. Among the total population, WRF occurred in 3101 patients (55.1%). By heart failure subgroup, WRF occurred more frequently in HFrEF (57.0% versus 51.3%; P<0.001 in HFrEF and HFpEF). Prevalence of WRF increased as creatinine clearance decreased in both heart failure subgroups. Among various predictors of WRF, chronic renal failure was the strongest predictor. WRF was an independent predictor of adverse in‐hospital outcomes (HFrEF: odds ratio; 2.75; 95% confidence interval, 1.50–5.02; P=0.001; HFpEF: odds ratio, 9.48; 95% confidence interval, 1.19–75.89; P=0.034) and 1‐year mortality (HFrEF: hazard ratio, 1.41; 95% confidence interval, 1.12–1.78; P=0.004 versus HFpEF: hazard ratio, 1.72; 95% confidence interval, 1.23–2.42; P=0.002). Transient WRF was a risk factor for 1‐year mortality, whereas persistent WRF had no additive risk compared to transient WRF.ConclusionsIn patients with acute heart failure patients, WRF is an independent predictor of adverse in‐hospital and follow‐up outcomes in both HFrEF and HFpEF, though with a different effect size.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01389843.

show abstract

“…Indeed, its association with adverse events is highly dependent on the inciting event: for example, WRF following initiation of renin-angiotensin-aldosterone inhibition appears to be benign. [6][7][8][9] Furthermore, small to moderate increases in creatinine commonly encountered during aggressive diuresis appear unrelated to significant renal injury and have even been associated with improved outcomes. 7,10 Nonetheless, ongoing concerns about the safety of diuresis-induced WRF in the clinical arena remain; physicians are likely to halt attempts at aggressive diuresis when WRF occurs in an effort to limit the perceived severity of kidney injury.…”

Section: Introductionmentioning

confidence: 99%

Renal Effects of Intensive Volume Removal in Heart Failure Patients With Preexisting Worsening Renal Function

Rao

Ahmad

Brisco‐Bacik

et al. 2019

Circ: Heart Failure

Self Cite

View full text Add to dashboard Cite

Background:The relationship between intensive volume removal in ADHF patients with preexisting WRF and renal tubular injury, post-discharge renal function, and clinical outcomes is unknown. Methods and Results:We used data from the multicenter CARRESS-HF trial that randomized patients with ADHF and pre-existing WRF to intensive volume removal with stepped pharmacologic therapy (SPT) or fixed rate ultrafiltration (UF). Patients in the urinary renal tubular injury biomarker sub-study (NAG, KIM-1, and NGAL) were evaluated (N=105). The severity of pre-randomization WRF was unrelated to baseline renal tubular injury biomarkers (r=0.14, P=0.17). During randomized intensive volume removal, creatinine further worsened in 53% of patients. Despite a small to moderate magnitude increase in creatinine in most of these patients, post-randomization WRF was strongly associated with worsening in renal tubular injury

show abstract

Worsening Renal Function and Mortality in Heart Failure

Cited by 25 publications

References 23 publications

Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury

Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury

Predictors and Prognostic Value of Worsening Renal Function During Admission in HFpEF Versus HFrEF: Data From the KorAHF (Korean Acute Heart Failure) Registry

Renal Effects of Intensive Volume Removal in Heart Failure Patients With Preexisting Worsening Renal Function

Contact Info

Product

Resources

About