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Eguchi S, Morita Y, Mitani H, Kanegasaki A, Iwasaki K, Yoshikawa T, Kitagawa H, Oyama N. Burden of Repeated Hospitalizations on Patients with Heart Failure: An Analysis of Administrative and Claims Data in Japan. Drugs Real World Outcomes 2022; 9:377-389. [PMID: 35753032 PMCID: PMC9392661 DOI: 10.1007/s40801-022-00315-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/28/2022] Open
Abstract
Background Repeated hospitalization is a predictor of outcomes in heart failure, indicating the presence of symptoms, a deteriorated condition at pre-admission, and worsened prognosis. Objectives The current database study aimed to understand the clinical and economic burden of repeated hospitalizations among patients with heart failure in Japan. The effect of repeated hospitalizations on the subsequent in-hospital mortality was the primary objective; economic burden of heart failure after discharge was investigated as a secondary outcome. Methods Between 2013 and 2018, administrative claims and discharge summary data of patients aged ≥ 20 years and diagnosed with heart failure were obtained from a Diagnosis Procedure Combination database maintained by Medical Data Vision. Hospitalization, mortality, and economic burden data were analyzed. Results This study included 49,094 patients. The mean length of the first hospital stay was 22.9 days. The in-hospital mortality rate was approximately 10%, with one to five repeated hospitalizations. The time interval between repeated hospitalizations for heart failure decreased with an increasing number of hospitalizations. In-hospital mortality did not increase even with an increasing number of hospitalizations. The mean heart failure-related healthcare cost per patient was ¥564,281 ± 990,447 (US$5178 ± 9,088), 67.3% of which was hospitalization costs. Among hospitalization costs, other costs were high, mainly for basic hospitalization fees (71.7%; ¥233,146/person-year). Conclusions Repeated hospitalization did not increase in-hospital mortality; however, it may shorten the intervals between heart failure-related hospitalizations, potentially caused by deterioration of the patient’s condition, and increase the clinical and economic burden on patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-022-00315-5.
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Affiliation(s)
- Shunsuke Eguchi
- Cardio-Renal-Metabolism Medical Franchise Department, Medical Division, Novartis Pharma K.K., Toranomon Hills Mori Tower, 1-23-1 Toranomon, Minato-ku, Tokyo, 105-6333, Japan.
| | - Yohei Morita
- Cardio-Renal-Metabolism Medical Franchise Department, Medical Division, Novartis Pharma K.K., Toranomon Hills Mori Tower, 1-23-1 Toranomon, Minato-ku, Tokyo, 105-6333, Japan
| | - Hironobu Mitani
- Cardio-Renal-Metabolism Medical Franchise Department, Medical Division, Novartis Pharma K.K., Toranomon Hills Mori Tower, 1-23-1 Toranomon, Minato-ku, Tokyo, 105-6333, Japan
| | | | | | | | - Hiroshi Kitagawa
- Cardio-Renal-Metabolism Medical Franchise Department, Medical Division, Novartis Pharma K.K., Toranomon Hills Mori Tower, 1-23-1 Toranomon, Minato-ku, Tokyo, 105-6333, Japan
| | - Naotsugu Oyama
- Cardio-Renal-Metabolism Medical Franchise Department, Medical Division, Novartis Pharma K.K., Toranomon Hills Mori Tower, 1-23-1 Toranomon, Minato-ku, Tokyo, 105-6333, Japan
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Peng H, Fan Y, Li J, Zheng X, Zhong C, Zhu Z, He Y, Zhang M, Zhang Y. DNA Methylation of the Natriuretic Peptide System Genes and Ischemic Stroke: Gene-Based and Gene Set Analyses. Neurol Genet 2022; 8:e679. [PMID: 35620136 PMCID: PMC9128040 DOI: 10.1212/nxg.0000000000000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/18/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives The natriuretic peptide (NP) system has been considered an important regulator for ischemic stroke (IS) with a limited clinical implication. A better understanding of the underlying molecular mechanisms is urgent. Here, we aimed to examine the role of DNA methylation of NP system genes in IS. Methods DNA methylation at promoter regions of 4 core NP system genes, e.g., CORIN, FURIN, NPPA, and NPPB, was measured by targeted bisulfite sequencing in 853 patients with IS and 918 controls. We first examined the association between DNA methylation at each single CpG and IS, followed by gene-based and gene set analyses to examine the joint associations of DNA methylation at multiple CpGs in a gene or all 4 genes as a pathway with IS. Results After control of covariates and multiple testing, DNA methylation at 19 of the 36 assayed CpGs was individually associated with IS at q < 0.05. Higher average methylation levels at the targeted regions of CORIN (odds ratio [OR] = 0.64, 95% confidence interval [CI]: 0.56–0.73), FURIN (OR = 0.78, 95% CI: 0.69–0.88), and NPPA (OR = 0.78, 95% CI: 0.69–0.88) were associated with a lower odds of IS (all q < 0.05). The truncated product method revealed the same gene-based associations (all q < 0.05) and found that DNA methylation at all 4 NP system genes together was jointly associated with IS (p = 0.0001). Discussion DNA methylation at NP system genes was downregulated in patients with IS. Our results may unravel a molecular mechanism underlying the regulating effect of the NP system on IS and highlight the relevance of testing the joint effect of multiple CpGs in the epigenetic analysis.
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Affiliation(s)
- Hao Peng
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
| | - Yiming Fan
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
| | - Jing Li
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
| | - Xiaowei Zheng
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
| | - Chongke Zhong
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
| | - Zhengbao Zhu
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
| | - Yan He
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
| | - Mingzhi Zhang
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
| | - Yonghong Zhang
- Department of Epidemiology (H.P., J.L., X.Z., C.Z., Z.Z., Y.H., M.Z., Y.Z.), School of Public Health, Medical College of Soochow University; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases (H.P.); and Medical College of Soochow University (Y.F.), Suzhou, China
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Serum Atrial Natriuretic Peptide, NPPA Promoter Methylation, and Cardiovascular Disease: A 10-year Follow-Up Study in Chinese Adults. Glob Heart 2022; 17:27. [PMID: 35586748 PMCID: PMC8992767 DOI: 10.5334/gh.1116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
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Li J, Zhu J, Ren L, Ma S, Shen B, Yu J, Zhang R, Zhang M, He Y, Peng H. Association between NPPA promoter methylation and hypertension: results from Gusu cohort and replication in an independent sample. Clin Epigenetics 2020; 12:133. [PMID: 32883357 PMCID: PMC7469321 DOI: 10.1186/s13148-020-00927-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
Background Atrial natriuretic peptide (ANP), one of the main members of the natriuretic peptides system, has been associated with hypertension and related complications, but the underlying molecular mechanisms are not very clear. Here, we aimed to examine whether DNA methylation, a molecular modification to the genome, of the natriuretic peptide A gene (NPPA), the coding gene of ANP, was associated with hypertension. Methods Peripheral blood DNA methylation of NPPA promoter was quantified by target bisulfite sequencing in 2498 community members (mean aged 53 years, 38% men) as a discovery sample and 1771 independent participants (mean aged 62 years, 54% men) as a replication sample. In both samples, we conducted a single CpG association analysis, followed by a gene-based association analysis, to examine the association between NPPA promoter methylation and hypertension, adjusting for age, sex, education level, cigarette smoking, alcohol consumption, obesity, fasting glucose, and lipids. Multiple testing was controlled by the false discovery rate approach. Results Of the 9 CpG loci assayed, hypermethylation at 5 CpGs (CpG1, CpG3, CpG6, CpG8, and CpG9) was significantly associated with a lower odds of prevalent hypertension in the discovery sample, and one CpG methylation (CpG1 located at Chr1:11908353) was successfully replicated in the replication sample (OR = 0.82, 95%CI 0.74–0.91, q = 0.002) after adjusting for covariates and multiple testing. The gene-based analysis found that DNA methylation of the 9 CpGs at NPPA promoter as a whole was significantly associated with blood pressure and prevalent hypertension in both samples (all P < 0.05). Conclusions DNA methylation levels at NPPA promoter were decreased in Chinese adults with hypertension. Aberrant DNA methylation of the NPPA gene may participate in the mechanisms of hypertension.
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Affiliation(s)
- Jing Li
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, China
| | - Jinhua Zhu
- Department of Chronic Disease Management, Center for Disease Prevention and Control of Wujiang District, Suzhou, China
| | - Liyun Ren
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, China
| | - Shengqi Ma
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, China
| | - Bin Shen
- Department of Chronic Disease Management, Center for Disease Prevention and Control of Wujiang District, Suzhou, China
| | - Jia Yu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, China
| | - Rongyan Zhang
- Department of Chronic Disease Management, Center for Disease Prevention and Control of Wujiang District, Suzhou, China
| | - Mingzhi Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, China
| | - Yan He
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, 215123, China. .,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, China.
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Kamiya M, Sato N, Matsuda J, Nozaki A, Akiya M, Sato T, Okazaki H, Takahashi Y, Shimizu W. Predictors of responders for low-dose carperitide monotherapy in patients with acute heart failure. Heart Vessels 2019; 35:59-68. [PMID: 31227874 DOI: 10.1007/s00380-019-01450-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 06/14/2019] [Indexed: 12/29/2022]
Abstract
Human atrial natriuretic peptide, known as carperitide, is approved for early relief of dyspnea in patients with acute heart failure (AHF). However, the diuretic effect of carperitide is sometimes insufficient for controlling volume overload. We investigated predictors for the carperitide response in patients with AHF. Forty-seven patients (age: 74 ± 10 years; left ventricular ejection fraction: 42.0% ± 15.9%) with AHF were enrolled and treated with carperitide monotherapy at a dose of 0.0125 μg/kg/min. Patients without sufficient diuresis (< 60 ml/h) or improvement of symptoms by 4 h after carperitide administration, despite increasing to twice the dose of carperitide and adding another agent, were defined as non-responders. Twenty-four (51%) patients were defined as responders and treated with low-dose carperitide monotherapy on the first day. Multiple logistic regression analysis showed that the response to carperitide monotherapy was independently predicted by serum creatinine levels and systolic blood pressure (SBP) on admission. The area under the receiver-operating characteristic curve for predicting the response to carperitide by SBP was 0.808 (95% confidence interval [0.686-0.930], sensitivity: 83.3%, specificity: 65.2%, cutoff value: 135 mmHg). Four (8.5%) patients developed asymptomatic transient hypotension. Worsening renal function occurred within 3 days of admission in three (6.4%) patients who received low-dose carperitide therapy. SBP and serum creatinine levels on admission might be useful for predicting the diuretic response to low-dose carperitide monotherapy in patients with AHF. Initial use of low-dose carperitide therapy does not have adverse effects on renal function.
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Affiliation(s)
- Masataka Kamiya
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Naoki Sato
- Department of Internal Medicine and Cardiology, Nippon Medical School, Musashi-Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki-shi, 211-8533, Kanagawa, Japan
| | - Junya Matsuda
- Department of Internal Medicine, Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Ayaka Nozaki
- Department of Internal Medicine, Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Mai Akiya
- Department of Internal Medicine, Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Taisuke Sato
- Department of Internal Medicine, Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Hirotake Okazaki
- Department of Internal Medicine, Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Yasuhiro Takahashi
- Department of Internal Medicine, Fraternity Memorial Hospital, 2-1-11 Yokoami, Sumida-ku, Tokyo, 130-8587, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Bartels ED, Guo S, Kousholt BS, Larsen JR, Hasenkam JM, Burnett J, Nielsen LB, Ashina M, Goetze JP. High doses of ANP and BNP exacerbate lipolysis in humans and the lipolytic effect of BNP is associated with cardiac triglyceride content in pigs. Peptides 2019; 112:43-47. [PMID: 30508635 DOI: 10.1016/j.peptides.2018.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022]
Abstract
Drugs facilitating the cardioprotective effects of natriuretic peptides are introduced in heart failure treatment. ANP and BNP also stimulate lipolysis and increase circulating concentrations of free fatty acids (FFAs); an aspect, however, thought to be confined to primates. We examined the lipolytic effect of natriuretic peptide infusion in healthy young men and evaluated the effect in a porcine model of myocardial ischemia and reperfusion. Six young healthy normotensive men underwent infusion with ANP, BNP, or CNP for 20 min. Blood samples were collected before, during, and after infusion for measurement of FFAs. In a porcine model of myocardial ischemia and reperfusion, animals were infused for 3 h with either BNP (n = 7) or saline (n = 5). Blood samples were collected throughout the infusion period, and cardiac tissue was obtained after infusion for lipid analysis. In humans, ANP infusion dose-dependently increased the FFA concentration in plasma 2.5-10-fold (baseline vs. 0.05 μg/kg/min P < 0.002) and with BNP 1.6-3.5-fold (P = 0.001, baseline vs. 0.02 μg/kg/min) 30 min after initiation of infusion. Infusion of CNP did not affect plasma FFA. In pigs, BNP infusion induced a 3.5-fold increase in plasma FFA (P < 0.0001), which remained elevated throughout the infusion period. Triglyceride content in porcine right cardiac ventricle tissue increased ∼5.5 fold in animals infused with BNP (P = 0.02). Natriuretic peptide infusion has similar lipolytic activity in human and pig. Our data suggest that short-term infusion increases the cardiac lipid content, and that the pig is a suitable model for studies of long-term effects mediated by natriuretic peptides.
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Affiliation(s)
- Emil D Bartels
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Song Guo
- Department of Neurology and Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte S Kousholt
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jens R Larsen
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Michael Hasenkam
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - John Burnett
- Department of Cardiorenal physiology (Mayo Clinic, Rochester, MN, USA
| | - Lars B Nielsen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Copenhagen University, Denmark; Aarhus University, Denmark
| | - Messoud Ashina
- Department of Neurology and Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen University, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiorenal physiology (Mayo Clinic, Rochester, MN, USA; Copenhagen University, Denmark
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Tamargo J, Caballero R, Delpón E. New drugs in preclinical and early stage clinical development in the treatment of heart failure. Expert Opin Investig Drugs 2018; 28:51-71. [DOI: 10.1080/13543784.2019.1551357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, Madrid,
Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, Madrid,
Spain
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, Madrid,
Spain
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Okuhara Y, Asakura M, Azuma K, Orihara Y, Nishimura K, Ando T, Kondo H, Naito Y, Kashiwase K, Hirotani S, Ishihara M, Masuyama T. Effects of early diuretic response to carperitide in acute decompensated heart failure treatment: A single-center retrospective study. PLoS One 2018; 13:e0199263. [PMID: 29912952 PMCID: PMC6005462 DOI: 10.1371/journal.pone.0199263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/04/2018] [Indexed: 02/05/2023] Open
Abstract
Background Diuretic response is a strong predictor of outcome for admitted patients of acute decompensated heart failure (ADHF). However, little is known about the effects of early diuretic response to carperitide. Methods We retrospectively analyzed records of 85 patients hospitalized for ADHF who received carperitide as initial treatment and <40 mg furosemide during the early period. The eligible patients were divided into good diuretic responder (GR) group and poor diuretic responder (PR) group on the basis of median urinary volume. Results The PR group demonstrated older age, lower body mass index (BMI), lower estimated glomerular filtration rate, and higher blood urea nitrogen (BUN) level, left ventricular ejection fraction, and β-blockers prescribed at baseline than the GR group. The incidence of worsening renal function (WRF) was significantly higher in the PR group than in the GR group. There was no correlation between early intravenous furosemide dose and urinary volume (Spearman correlation, ρ = 0.111, p = 0.312). Multivariate analysis showed that the statistically significant independent factors associated with poor diuretic response to carperitide were BMI (Odds ratio (OR) = 0.82, 95% confidence interval (CI) 0.68–0.94, p = 0.004) and BUN (OR = 1.07, 95%CI 1.01–1.15, p = 0.018). Kaplan–Meier analysis indicated a lower event-free rate in the PR group than in the GR group (log-rank, p = 0.007). Conclusions BMI and BUN levels on admission were significant determinants of early poor diuretic response to carperitide. Early poor diuretic response to carperitide was associated with future poor outcomes.
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Affiliation(s)
- Yoshitaka Okuhara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
- * E-mail:
| | - Masanori Asakura
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kohei Azuma
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshiyuki Orihara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Koichi Nishimura
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Tomotaka Ando
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Hideyuki Kondo
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Yoshiro Naito
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Kazunori Kashiwase
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shinichi Hirotani
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Masaharu Ishihara
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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