Cardiorenal Function in Heart Failure

Study Questions:

What are the changes in kidney function in combination with dynamic changes in N-terminal pro–B-type natriuretic peptide (NT-proBNP) when hospitalized for acute decompensated heart failure (ADHF)?

Methods:

The study authors conducted an individual patient data analysis from six prospective cohorts consisting of 1,232 patients hospitalized for ADHF who satisfied the following inclusion criteria: 1) admitted because of clinically validated ADHF, 2) discharged alive, 3) serum creatinine level, and 4) NT-proBNP measurements were available at admission and at discharge. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge. They defined severe worsening of renal function (sWRF) as an increase in creatinine of >0.5 mg/dl in combination with >25% increase in serum creatinine level between admission and discharge.

Results:

The study authors found that the occurrence of sWRF did not differ between patients with a low and those with a high percentage drop in NT-proBNP, suggesting that severe WRF is not related to the amount of decrease of NT-proBNP. A decrease of more than 30% in NT-proBNP was associated with a 15% absolute lower mortality (all-cause mortality hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.32-2.50) and a reduction in the composite endpoint (HR, 1.36; 95% CI, 1.13-1.64), regardless of changes in renal function and other clinical variables.

Conclusions:

The authors concluded that WRF is a measure of prognosis, but is of lesser value than, and independent of, the prognostic changes induced by adequate NT-proBNP reduction. This suggests that in ADHF patients, it may be warranted to strive for an optimal decrease in NT-proBNP, even if this induces WRF.

Источник: www.acc.org