Competing Risk of Cardiac Status and Renal Function During Hospitalization for Acute Decompensated Heart Failure
Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
OBJECTIVES: The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF).
BACKGROUND: Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters.
METHODS: This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge.
RESULTS: A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables.
CONCLUSIONS: When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe 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.
| Errataetall: |
CommentIn: JACC Heart Fail. 2015 Oct;3(10):762-4. - PMID 26449996 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2015 |
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| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:3 |
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| Enthalten in: |
JACC. Heart failure - 3(2015), 10 vom: 23. Okt., Seite 751-61 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Salah, Khibar [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 26.07.2016 Date Revised 08.04.2022 published: Print CommentIn: JACC Heart Fail. 2015 Oct;3(10):762-4. - PMID 26449996 Citation Status MEDLINE |
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| doi: |
10.1016/j.jchf.2015.05.009 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM253518571 |
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| 100 | 1 | |a Salah, Khibar |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Competing Risk of Cardiac Status and Renal Function During Hospitalization for Acute Decompensated Heart Failure |
| 264 | 1 | |c 2015 | |
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| 500 | |a Date Completed 26.07.2016 | ||
| 500 | |a Date Revised 08.04.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: JACC Heart Fail. 2015 Oct;3(10):762-4. - PMID 26449996 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF) | ||
| 520 | |a BACKGROUND: Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters | ||
| 520 | |a METHODS: This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge | ||
| 520 | |a RESULTS: A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables | ||
| 520 | |a CONCLUSIONS: When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe 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 | ||
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| 650 | 7 | |a Natriuretic Peptide, Brain |2 NLM | |
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| 700 | 1 | |a Kok, Wouter E |e verfasserin |4 aut | |
| 700 | 1 | |a Eurlings, Luc W |e verfasserin |4 aut | |
| 700 | 1 | |a Bettencourt, Paulo |e verfasserin |4 aut | |
| 700 | 1 | |a Pimenta, Joana M |e verfasserin |4 aut | |
| 700 | 1 | |a Metra, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Verdiani, Valerio |e verfasserin |4 aut | |
| 700 | 1 | |a Tijssen, Jan G |e verfasserin |4 aut | |
| 700 | 1 | |a Pinto, Yigal M |e verfasserin |4 aut | |
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