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Li C, Wang Y, Wang X, Shao C, Xin M, Xu B, Hao X, Jia M, Yang F, Wang L, Wang H, Hou X, Du Z. Acute kidney injury and cardiogenic shock severity for mortality risk stratification in patients supported with VA ECMO. ESC Heart Fail 2024. [PMID: 39034632 DOI: 10.1002/ehf2.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/18/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024] Open
Abstract
AIMS To assess the stage of acute kidney injury (AKI), as an index of organ perfusion, combined with shock severity, measured by the Society for Cardiovascular Angiography and Interventions (SCAI) shock stage classification, to stratify the risk of mortality in patients diagnosed with cardiogenic shock (CS) and supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). METHODS ANS RESULTS From January 2018 to December 2020, consecutive adult patients diagnosed with CS and received VA ECMO were retrospectively evaluated. The highest AKI stage within 48 h after ECMO initiation was assessed using the Kidney Disease: Improving Global Outcomes criteria. We included 216 patients with a mean age of 58.8 years and 31.0% were females. 88.4% of patients received ECMO for postcardiotomy, while 11.6% for medical CS. The total in-hospital mortality was 53.2%. AKI occurred in 182 (84.3%) patients receiving ECMO for CS. AKI stage 0, 1, 2, and 3 were present in 15.7%, 17.6%, 18.1%, and 48.6% of patients with in-hospital mortality of 26.5%, 26.3%, 61.5%, and 68.6%, respectively (P < 0.001). The AKI stage (P < 0.001), SCAI shock stage before ECMO (P = 0.008), and NYHA ≥ Class III on admission (P = 0.044) were independent predictors of in-hospital mortality. The area under the receiver operating characteristic curve of 0.754 (95% confidence interval: 0.690 to 0.811) for AKI stage combined with SCAI shock stage was better than those for AKI stage (0.676), SCAI shock stage (0.657), serum lactate level (0.682), SOFA score (0.644), SVAE score (0.582), and VIS score (0.530) prior to ECMO. CONCLUSIONS In this single-center CS population who received VA ECMO for circulatory support, predominantly postcardiotomy cases, AKI occurred in 84.3% of the patients. AKI stage, as an index of organ perfusion combined with shock severity measured by the SCAI shock classification, demonstrates a good correlation with in-hospital mortality.
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Affiliation(s)
- Chenglong Li
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yiwen Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaomeng Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chengcheng Shao
- Cardiac Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Meng Xin
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bo Xu
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xing Hao
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ming Jia
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Feng Yang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liangshan Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong Wang
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhongtao Du
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Morooka M, Shirakabe A, Okazaki H, Matsushita M, Shigihara S, Nishigoori S, Sawatani T, Tani K, Kiuchi K, Kawakami S, Michiura Y, Kamitani S, Kobayashi N, Asai K. Late Kidney Injury After Admission to Intensive Care Unit for Acute Heart Failure. Int Heart J 2024; 65:433-443. [PMID: 38825492 DOI: 10.1536/ihj.23-603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Late kidney injury (LKI) in patients with acute heart failure (AHF) requiring intensive care is poorly understood.We analyzed 821 patients with AHF who required intensive care. We defined LKI based on the ratio of the creatinine level 1 year after admission for AHF to the baseline creatinine level. The patients were categorized into 4 groups based on this ratio: no-LKI (< 1.5, n = 509), Class R (risk; ≥ 1.5, n = 214), Class I (injury; ≥ 2.0, n = 78), and Class F (failure; ≥ 3.0, n = 20). Median follow-up after admission for AHF was 385 (346-426) days. Multivariate logistic regression analysis revealed that acute kidney injury (AKI) during hospitalization (Class R, odds ratio [OR]: 1.710, 95% confidence interval [CI]: 1.138-2.571, P = 0.010; Class I, OR: 6.744, 95% CI: 3.739-12.163, P < 0.001; and Class F, OR: 9.259, 95% CI: 4.078-18.400, P < 0.001) was independently associated with LKI. Multivariate Cox regression analysis showed that LKI was an independent predictor of 3-year all-cause death after final follow-up (hazard ratio: 1.545, 95% CI: 1.099-2.172, P = 0.012). The rate of all-cause death was significantly lower in the no-AKI/no-LKI group than in the no-AKI/LKI group (P = 0.048) and in the AKI/no-LKI group than in the AKI/LKI group (P = 0.017).The incidence of LKI was influenced by the presence of AKI during hospitalization, and was associated with poor outcomes within 3 years of final follow-up. In the absence of LKI, AKI during hospitalization for AHF was not associated with a poor outcome.
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Affiliation(s)
- Masaki Morooka
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Masato Matsushita
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Shota Shigihara
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Kenichi Tani
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Shohei Kawakami
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Yu Michiura
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Shogo Kamitani
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School
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Ru S, Lv S, Li Z. Incidence, mortality, and predictors of acute kidney injury in patients with heart failure: a systematic review. ESC Heart Fail 2023; 10:3237-3249. [PMID: 37705352 PMCID: PMC10682870 DOI: 10.1002/ehf2.14520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/22/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
Acute kidney injury (AKI) is common in patients with heart failure (HF), but studies have been inconsistent about the incidence of AKI in patients with HF. We conducted a meta-analysis to examine the incidence of AKI and its impact on mortality in patients with HF. We also looked at inpatient variables that could predict the development of AKI to identify potential risk factors, so that these can be used as a starting point for intervention and prevention in this group. The Embase, Medline, PubMed, Cochrane libraries, and Web of Science databases were used for searching articles from the inception of the database to October 2022. The EndNote software was used for screening. Meta-analysis was performed using Stata 16.0 software to combine effect sizes. A total of 37 studies were included. Of all the 3 533 583 patients with HF, 774 887 had AKI, with a pooled incidence of 33% [95% confidence interval (CI): 32-35%]. The incidence rate of AKI in acute HF and chronic HF was 36% (95% CI: 31-40%) and 30% (95% CI: 24-35%), respectively. Eleven studies found that AKI patients had higher in-hospital mortality than non-AKI patients [risk ratio (RR): 3.65; 95% CI: 3.04-4.39, P < 0.001]. Mortality was assessed in five studies, and it was found that mortality remained high at 1-year follow-up after onset of AKI (RR: 1.85, 95% CI: 1.54-2.22, P < 0.001). Fifteen admission variables were included and analysed in 13 studies. The combined results showed that diabetes, hypertension, history of chronic kidney disease, chronic HF systolic, age, N-terminal pro-B-type natriuretic peptide, creatinine > 1.0 mg/dL, index estimated glomerular filtration rate < 60 mL/min/1.73 m2 , blood urea nitrogen > 24 mg/dL, intravenous dobutamine, and serum albumin were predictor factors for HF patients with AKI (P < 0.05). In this meta-analysis, AKI occurred in approximately 33% of HF patients during hospitalization and the risk of dying in the hospital was tripled. Even during 1-year long-term follow-up, the risk of death remained high, and multiple inpatient variables showed that HF patients tended to have AKI. Early intervention and treatment are important to reduce the incidence of AKI and improve the prognosis.
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Affiliation(s)
- Song‐Chao Ru
- Department of CardiologyThe First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and TechnologyLuoyangChina
| | - Shu‐Bin Lv
- Department of CardiologyThe First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and TechnologyLuoyangChina
| | - Zhi‐Juan Li
- Department of CardiologyThe First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and TechnologyLuoyangChina
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Mewton N, Donal E, Picard F, Derimay F, Grinberg D, Boulch DM, Bochaton T, Piriou N, De Lorgeril A, Samson G, Rouleau F, Riche B, Trochu JN. Prognostic impact of precipitated cardiac decompensation in symptomatic heart failure with reduced ejection fraction and severe secondary mitral regurgitation. Am Heart J 2023; 265:83-91. [PMID: 37271359 DOI: 10.1016/j.ahj.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 05/19/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Our aim was to assess the distribution of primary (with no trigger) and secondary (with a decompensation trigger) heart failure events in a severe heart failure population and their association with 2-year all-cause mortality in the Mitra.Fr study. METHODS We included 304 patients with symptomatic heart failure, and severe mitral regurgitation and guideline directed medical therapy randomized to medical therapy alone or medical therapy with percutaneous mitral valve repair. According to the follow-up, we defined 3 categories of events: follow-up without any heart failure event, at least 1 decompensation starting with a primary heart failure decompensation or starting with a precipitated secondary heart failure event. The primary outcome was 2-years all-cause mortality. RESULTS A total of 179 patients (59 %) had at least 1 heart failure decompensation within 24-months of follow-up. 129 heart failure decompensations (72%) were a first primary heart failure and 50 (28%) were a first secondary decompensation. Finally, 30 patients had both types of decompensations but these were not taken into account for the comparison of primary and secondary decompensations. Primary decompensations were 3-times more frequent than secondary decompensations, but the mean number of heart failure decompensations was similar in the "Primary heart failure group" compared to the "Secondary heart failure group": (1.94 ± 1.39 vs 1.80 ± 1.07 respectively; P = .480). Compared to patients without heart failure decompensation, patients with "Only primary decompensation" or with "Only secondary decompensation" had a significantly increased risk of death (HR = 4.87, 95% CI [2.86, 8.32] and 2.68 95%CI [1.64, 4.37] respectively). All-cause mortality, was not significantly different between these 2 type of decompensations (HR = 1.82, 95% CI [0.93, 3.58]; P = .082), but each additional heart failure recurrence was associated with a significant increase in mortality risk (HR = 1.27, 95% CI [1.08; 1.50]; P = .005). CONCLUSIONS In heart failure with reduced ejection fraction and severe secondary mitral regurgitation patients, primary heart failure decompensations were 3-times more frequent compared to precipitated decompensations with a nonsignificant trend in increased risk of all-cause mortality. Our results fail to support the differentiation between primary and secondary decompensations as they seem to portend the same outcome impact.
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Affiliation(s)
- Nathan Mewton
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France.
| | - Erwan Donal
- Cardiology Department, Hospital University Rennes, LTSI UMR1099, INSERM, Rennes, France
| | - François Picard
- Heart Failure Department, Aquitaine Expert Center for Primary Pulmonary Hypertension, University Hospital Bordeaux, Bordeaux, France
| | - François Derimay
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Daniel Grinberg
- Cardiac Surgery Department, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Delphine Maucort Boulch
- Biostatistics Department, Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Lyon, France
| | - Thomas Bochaton
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Piriou
- Cardiology Department, Clinique cardiologique et des maladies vasculaires Pôle hospitalo-universitaire institut du thorax et du système nerveux CIC INSERM 1413 - Institut du Thorax- UMR INSERM 1087 Université de Nantes, Nantes, France
| | - Amélie De Lorgeril
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Geraldine Samson
- Heart Failure Department, Centre d'Investigation Clinique, Inserm 1407, CarMeN Inserm 1060, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Rouleau
- Cardiology department, University Hospital Angers, Angers, France
| | - Benjamin Riche
- Biostatistics Department, Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100, Lyon, France
| | - Jean Noël Trochu
- Cardiology Department, Clinique cardiologique et des maladies vasculaires Pôle hospitalo-universitaire institut du thorax et du système nerveux CIC INSERM 1413 - Institut du Thorax- UMR INSERM 1087 Université de Nantes, Nantes, France
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Aklilu AM, Kumar S, Yamamoto Y, Moledina DG, Sinha F, Testani JM, Wilson FP. Outcomes Associated with Sodium-Glucose Cotransporter-2 Inhibitor Use in Acute Heart Failure Hospitalizations Complicated by AKI. KIDNEY360 2023; 4:1371-1381. [PMID: 37644648 PMCID: PMC10615381 DOI: 10.34067/kid.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
Key Points In a multicenter retrospective cohort study of adults hospitalized with acute heart failure, exposure to sodium-glucose cotransporter-2 inhibitor during AKI was associated with lower risk of 30-day mortality. Exposure to sodium-glucose cotransporter-2 inhibitor during acute heart failure–associated AKI was associated with no difference in time to renal recovery. The findings were reproducible in inverse probability-weighted analysis. Background Although sodium-glucose cotransporter-2 inhibitor (SGLT2i) use during acute heart failure (AHF) hospitalizations is associated with symptomatic improvement, reduction in rehospitalizations, and mortality, these medications are often withheld during AKI because of concerns about worsening GFR. We aimed to investigate the safety of SGLT2i exposure during AKI among patients hospitalized with AHF. We hypothesized that SGLT2i exposure would not worsen mortality but may prolong return of creatinine to baseline. Methods This was a retrospective study of adults hospitalized across five Yale New Haven Health System hospitals between January 2020 and May 2022 with AHF complicated by Kidney Disease Improving Global Outcomes–defined AKI. Patients with stage 5 CKD and those with potential contraindications to SGLT2i were excluded. We tested the association of SGLT2i use with kidney function recovery at 14 days and death at 30 days using time-varying, multivariable Cox-regression analyses. Results Of 3305 individuals hospitalized with AHF and AKI, 356 received SGLT2i after AKI diagnosis either as initiation or continuation. The rate of renal recovery was not significantly different among those exposed and unexposed to SGLT2i after AKI (adjusted hazard ratio, 0.94; 95% confidence interval, 0.79 to 1.11; P = 0.46). SGLT2i exposure was associated with lower risk of 30-day mortality (adjusted hazard ratio, 0.45; 95% confidence interval, 0.23 to 0.87; P = 0.02). Sensitivity analyses using an inverse probability-weighted time-varying Cox regression analysis and using alternate definitions of AHF with different NT-proBNP cutoffs yielded similar results. Rates of renal recovery were similar between the exposed and unexposed cohorts regardless of the proximity of SGLT2i exposure to AKI diagnosis. Conclusion In adults experiencing AHF-associated AKI, exposure to SGLT2i was associated with decreased mortality and no delay in renal recovery. Prospective studies are needed to elucidate the effect of SGLT2i exposure during AKI, particularly during heart failure hospitalizations.
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Affiliation(s)
- Abinet M. Aklilu
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, Connecticut
| | - Sanchit Kumar
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, Connecticut
| | - Yu Yamamoto
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, Connecticut
| | - Dennis G. Moledina
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, Connecticut
| | - Frederick Sinha
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Jeffrey M. Testani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - F. Perry Wilson
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Clinical and Translational Research Accelerator, Yale School of Medicine, New Haven, Connecticut
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Shirakabe A, Okazaki H, Matsushita M, Shibata Y, Shigihara S, Nishigoori S, Sawatani T, Tani K, Kiuchi K, Kobayashi N, Asai K. Timing and Degree of Acute Kidney Injury in Patients Requiring Non-Surgical Intensive Care. Circ J 2023; 87:1392-1402. [PMID: 37648518 DOI: 10.1253/circj.cj-23-0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND The degree and timing of acute kidney injury (AKI) on admission and during hospitalization in patients requiring non-surgical intensive care remain unclear. METHODS AND RESULTS In this study, 3,758 patients requiring intensive care were analyzed retrospectively. AKI was defined based on the ratio of serum creatinine concentrations recorded at each time point (i.e., on admission and during the first 5 days in the intensive care unit and during hospitalization) to those measured at baseline. Patients were grouped by combining AKI severity (RIFLE class) and timing (i.e., from admission to 5 days [A-5D]; from 5 days to hospital discharge [5D-HD]) as follows: No-AKI; New-AKI (no AKI to Class R [risk; ≥1.5-fold increase in serum creatinine], I [injury; ≥2.0-fold increase in serum creatinine], and F [failure; ≥3.0-fold increase in serum creatinine or receiving dialysis during hospitalization]); Stable-AKI (Class R to R; Class I to I); and Worsening-AKI (Class R to I or F; Class I to F). Multivariate logistic regression analysis indicated that 730-day mortality was independently associated with Class R, I, and F on admission; Class I and F during the 5D-H period; and New-AKI and Worsening-AKI during A-5D and 5D-HD. CONCLUSIONS AKI on admission, even Class R, was associated with a poor prognosis. An increase in RIFLE class during hospitalization was identified as an important factor for poor prognosis in patients requiring intensive care.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Masato Matsushita
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Yusaku Shibata
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Shota Shigihara
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Kenichi Tani
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School
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Shirakabe A, Matsushita M, Shibata Y, Shighihara S, Nishigoori S, Sawatani T, Kiuchi K, Asai K. Organ dysfunction, injury, and failure in cardiogenic shock. J Intensive Care 2023; 11:26. [PMID: 37386552 DOI: 10.1186/s40560-023-00676-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/18/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Cardiogenic shock (CS) is caused by primary cardiac dysfunction and induced by various and heterogeneous diseases (e.g., acute impairment of cardiac performance, or acute or chronic impairment of cardiac performance). MAIN BODY Although a low cardiac index is a common finding in patients with CS, the ventricular preload, pulmonary capillary wedge pressure, central venous pressure, and systemic vascular resistance might vary between patients. Organ dysfunction has traditionally been attributed to the hypoperfusion of the organ due to either progressive impairment of the cardiac output or intravascular volume depletion secondary to CS. However, research attention has recently shifted from this cardiac output ("forward failure") to venous congestion ("backward failure") as the most important hemodynamic determinant. Both hypoperfusion and/or venous congestion by CS could lead to injury, impairment, and failure of target organs (i.e., heart, lungs, kidney, liver, intestines, brain); these effects are associated with an increased mortality rate. Treatment strategies for the prevention, reduction, and reversal of organ injury are warranted to improve morbidity in these patients. The present review summarizes recent data regarding organ dysfunction, injury, and failure. CONCLUSIONS Early identification and treatment of organ dysfunction, along with hemodynamic stabilization, are key components of the management of patients with CS.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shota Shighihara
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Dutta A, Saha S, Bahl A, Mittal A, Basak T. A comprehensive review of acute cardio-renal syndrome: need for novel biomarkers. Front Pharmacol 2023; 14:1152055. [PMID: 37288107 PMCID: PMC10242013 DOI: 10.3389/fphar.2023.1152055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Cardiorenal syndrome represents a wide-spectrum disorder involving the heart and kidneys as the primary affected organs. India has an increasingly high burden of acute CRS, coinciding with the rise in global statistics. Up to 2022, approximately 46.1% of all cardiorenal patients have been diagnosed with acute CRS in India. Acute CRS involves a sudden deterioration of kidney functionalities, referred to as acute kidney injury (AKI) in acute heart failure patients. The pathophysiology of CRS involves hyperactivation of the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS) following acute myocardial stress. The pathological phenotype of acute CRS is associated with perturbed inflammatory, cellular, and neurohormonal markers in circulation. These complications increase the risk of mortality in clinically diagnosed acute CRS patients, making it a worldwide healthcare burden. Hence, effective diagnosis and early prevention are crucial to prevent the progression of CRS in AHF patients. Present biomarkers, such as serum creatinine (sCr), cystatin C (CysC), glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum and/or urine neutrophil gelatinase-associated lipocalin (NGAL), B-type natriuretic peptide (BNP), and NT-proBNP, are clinically used to diagnose AKI stages in CRS patients but are limitedly sensitive to the early detection of the pathology. Therefore, the need for protein biomarkers is emerging for early intervention in CRS progression. Here, we summarized the cardio-renal nexus in acute CRS, with an emphasis on the present clinicopathological biomarkers and their limitations. The objective of this review is to highlight the need for novel proteomic biomarkers that will curb the burgeoning concern and direct future research trials.
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Affiliation(s)
- Abhi Dutta
- School of Biosciences and Bioengineering, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
- BioX Center, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
| | - Shubham Saha
- School of Biosciences and Bioengineering, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
- BioX Center, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Mittal
- Department of Translational and Regenerative Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Trayambak Basak
- School of Biosciences and Bioengineering, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
- BioX Center, Indian Institute of Technology (IIT)-Mandi, Mandi, Himachal Pradesh, India
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9
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Davis MG, Bobba A, Chourasia P, Gangu K, Shuja H, Dandachi D, Farooq A, Avula SR, Shekhar R, Sheikh AB. COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample. Viruses 2022; 14:2791. [PMID: 36560794 PMCID: PMC9785561 DOI: 10.3390/v14122791] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Coronavirus-19 (COVID-19), preliminarily a respiratory virus, can affect multiple organs, including the heart. Myocarditis is a well-known complication among COVID-19 infections, with limited large-scale studies evaluating outcomes associated with COVID-19-related Myocarditis. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without Myocarditis. A total of 1,659,040 patients were included in the study: COVID-19 with Myocarditis (n = 6,455, 0.4%) and COVID-19 without Myocarditis (n = 1,652,585, 99.6%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, sudden cardiac arrest, cardiogenic shock, acute kidney injury requiring hemodialysis, length of stay, health care utilization costs, and disposition. We conducted a secondary analysis with propensity matching to confirm results obtained by traditional multivariate analysis. COVID-19 patients with Myocarditis had significantly higher in-hospital mortality compared to COVID-19 patients without Myocarditis (30.5% vs. 13.1%, adjusted OR: 3 [95% CI 2.1-4.2], p < 0.001). This cohort also had significantly increased cardiogenic shock, acute kidney injury requiring hemodialysis, sudden cardiac death, required more mechanical ventilation and vasopressor support and higher hospitalization cost. Vaccination and more research for treatment strategies will be critical for reducing worse outcomes in patients with COVID-19-related Myocarditis.
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Affiliation(s)
- Monique G. Davis
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Aniesh Bobba
- Department of Medicine, John H Stronger Hospital, Cook County, Chicago, IL 60612, USA
| | - Prabal Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA 22401, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Hina Shuja
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Dima Dandachi
- Division of Infectious Diseases, University of Missouri-Columbia, Columbia, MO 65211, USA
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, TX 79409, USA
| | - Sindhu Reddy Avula
- Department of Interventional Cardiology, Division of Cardiology, University of Kansas, St Francis Campus, Kansas City, KS 66606, USA
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
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10
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Zhao HL, Hu HJ, Zhao XJ, Chi WW, Liu DM, Wang Q, Cui W. Urine N-terminal pro-B-type natriuretic peptide and plasma proenkephalin are promising biomarkers for early diagnosis of cardiorenal syndrome type 1 in acute decompensated heart failure: a prospective, double-center, observational study in real-world. Ren Fail 2022; 44:1486-1497. [PMID: 36000917 PMCID: PMC9423828 DOI: 10.1080/0886022x.2022.2114367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Patients with acute decompensated heart failure (ADHF) show cardiorenal syndrome type 1 (CRS-1) are more likely to have a poor outcome. However, the current criteria often lead to delayed CRS-1 diagnosis. Therefore, we evaluated the predictive value of plasma proenkephalin (pPENK) and urine NT-proBNP (uNT-proBNP) for early diagnosis of CRS-1 and vulnerable-phase prognosis in ADHF patients. Methods The plasma NT-proBNP (pNT-proBNP), pPENK, and uNT-proBNP were measured in 121 ADHF patients on admission. The plasma neutrophil gelatinase-associated lipocalin (pNGAL) was chosen as the reference. Logistic regression was used to determine the predictors of CRS-1. The area under the receiver operating curves (ROCs) was calculated to assess the early diagnostic value of pNGAL, pPENK, and uNT-proBNP/uCr for CRS-1. To evaluate the prognostic risk of factors for the 90-d outcomes of all ADHF patients, the Cox regression was performed and the cumulative risk curve was plotted. Results We found that pPENK [OR 1.093 (95% CI 1.022–1.169), p = 0.010; AUROC = 0.899 (95% CI 0.831–0.946)] and uNT-proBNP/uCr ratio [OR 1.015 (95% CI 1.003–1.028), p = 0.012; AUROC = 0.934 (95% CI 0.874–0.971)] could independently predict the occurrence of CRS-1 in hospitalized patients with ADHF. The pPENK [HR 1.014 (95% CI 1.000–1.042), p = 0.044] and uNT-proBNP/uCr ration [HR 0.998 (95% CI 0.997–1.000), p = 0.045] were also independent predictors of the risk of HF readmission or all-cause death 90 d after discharge in ADHF patients. Conclusions The newly found pPENK and noninvasive test of uNT-proBNP/uCr ratio (pg/nmol) on admission may be two promising novel predictive biomarkers for early diagnosis of CRS-1 occurrence and vulnerable-phase outcomes in ADHF patients.
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Affiliation(s)
- Hong-Liang Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Hai-Juan Hu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xiu-Jie Zhao
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wei-Wei Chi
- Biobank, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - De-Min Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
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11
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Maulion C, Chen S, Rao VS, Ivey-Miranda JB, Cox ZL, Mahoney D, Coca SG, Negoianu D, Asher JL, Turner JM, Inker LA, Wilson FP, Testani JM. Hemoconcentration of Creatinine Minimally Contributes to Changes in Creatinine during the Treatment of Decompensated Heart Failure. KIDNEY360 2022; 3:1003-1010. [PMID: 35845336 PMCID: PMC9255871 DOI: 10.34067/kid.0007582021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/21/2022] [Indexed: 01/10/2023]
Abstract
Background Worsening serum creatinine is common during treatment of acute decompensated heart failure (ADHF). A possible contributor to creatinine increase is diuresis-induced changes in volume of distribution (VD) of creatinine as total body water (TBW) contracts around a fixed mass of creatinine. Our objective was to better understand the filtration and nonfiltration factors driving change in creatinine during ADHF. Methods Participants in the ROSE-AHF trial with baseline to 72-hour serum creatinine; net fluid output; and urinary KIM-1, NGAL, and NAG were included (n=270). Changes in VD were calculated by accounting for measured input and outputs from weight-based calculated TBW. Changes in observed creatinine (Crobserved) were compared with predicted changes in creatinine after accounting for alterations in VD and non-steady state conditions using a kinetic GFR equation (Cr72HR Kinetic). Results When considering only change in VD, the median diuresis to elicit a ≥0.3 mg/dl rise in creatinine was -7526 ml (IQR, -5932 to -9149). After accounting for stable creatinine filtration during diuresis, a change in VD alone was insufficient to elicit a ≥0.3 mg/dl rise in creatinine. Larger estimated decreases in VD were paradoxically associated with improvement in Crobserved (r=-0.18, P=0.003). Overall, -3% of the change in eCr72HR Kinetic was attributable to the change in VD. A ≥0.3 mg/dl rise in eCr72HR Kinetic was not associated with worsening of KIM-1, NGAL, NAG, or postdischarge survival (P>0.05 for all). Conclusions During ADHF therapy, increases in serum creatinine are driven predominantly by changes in filtration, with minimal contribution from change in VD.
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Affiliation(s)
- Christopher Maulion
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sheldon Chen
- Division of Nephrology, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Veena S. Rao
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Juan B. Ivey-Miranda
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Department of Heart Failure, Cardiology Hospital, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
| | - Zachary L. Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee
| | - Devin Mahoney
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Steven G. Coca
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dan Negoianu
- Division of Renal Electrolyte and Hypertension, Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer L. Asher
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M. Turner
- Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lesley A. Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - F. Perry Wilson
- Clinical and Translational Research Accelerator, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M. Testani
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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12
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Dotare T, Ishiwata S, Matsue Y, Nakamura Y, Sunayama T, Maeda D, Yatsu S, Suda S, Kato T, Hiki M, Kasai T, Minamino T. Prevalence and Prognostic Relevance of Isolated Tubular Dysfunction in Patients With Acute Heart Failure. Circ J 2021; 86:709-714. [PMID: 34955476 DOI: 10.1253/circj.cj-21-0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Renal dysfunction includes glomerular dysfunction (GD) and tubular dysfunction (TD); however, there is limited information regarding the prevalence, coexistence, and prognostic relevance of TD and GD among patients with acute heart failure (AHF).Methods and Results:This study reviewed 489 patients with AHF who had undergone testing at the time of their admission to identify GD (estimated glomerular filtration rate <60 mL/min/1.73 m2) and TD (urinary β-2-microglobulin ≥300 µg/gCr). Patients were grouped according to the presence/absence of GD and TD as having neither condition (n=116), isolated TD (n=101), isolated GD (n=83), or coexisting GD plus TD (n=189). During a median follow up of 466 days (interquartile range: 170-871 days), 107 deaths were observed. Kaplan-Meier curve analysis revealed that, relative to the absence of a GD and TD group, higher mortality rates were observed in the groups with isolated TD, isolated GD, and coexisting GD plus TD (log-rank P<0.001). Similarly, the adjusted Cox regression analyses revealed that significantly higher risks of mortality were associated with isolated TD, isolated GD, and coexisting GD plus TD. Moreover, isolated GD and isolated TD were both independently associated with increased risks of all-cause mortality. CONCLUSIONS As a significant proportion of patients with AHF had isolated TD and an increased risk of mortality, patients with AHF should be screened for TD even if they do not have GD.
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Affiliation(s)
- Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Department of Cardiology, Osaka Medical and Pharmaceutical University
| | - Shoichiro Yatsu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development
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13
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Ishiwata S, Matsue Y, Nakamura Y, Dotare T, Sunayama T, Suda S, Yatsu S, Kato T, Hiki M, Kasai T, Minamino T. Clinical and prognostic values of urinary alpha1-microglobulin as a tubular marker in acute heart failure. Int J Cardiol 2021; 338:115-120. [PMID: 34181994 DOI: 10.1016/j.ijcard.2021.06.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although urinary alpha-1-microglobulin has been used as a marker of tubular dysfunction, its clinical and prognostic values in patients with acute heart failure have not been validated. METHODS We analyzed 623 patients (74 ± 13 years old, 60.0% male) with acute heart failure in whom urinary alpha-1-microglobulin (A1MG) levels were measured as tubular markers at the time of admission. The primary endpoint was all-cause mortality. RESULTS The median levels of urinary alpha-1-microglobulin with and without correction for urinary creatinine concentration were 8.80 (interquartile range: 4.20-17.7) mg/dL and 12.9 (5.92-30.7) mg/gCr, respectively. Urinary A1MG levels were significantly correlated with all of beta-2-microglobulin (r = 0.77), N-acetyl-β-D-glucosaminidase (r = 0.51), and estimated glomerular filtration rate (r = -0.42); however, alpha-1-microglobulin was most often predicted using beta-2-microglobulin or N-acetyl-β-D-glucosaminidase. During the 488-day (interquartile range: 185-938 days) follow-up, 141 deaths occurred. Higher A1MG levels were associated with higher mortality even after adjustment for other covariates. Only A1MG, but not beta-2-microglobulin or N-acetyl-β-D-glucosaminidase, yielded incremental prognostic information in addition to the preexisting prognostic factors (net-reclassification improvement: 0.254, P = 0.023; integrated discrimination improvement: 0.015, P = 0.028). CONCLUSIONS In patients hospitalized due to acute heart failure, urinary alpha-1-microglobulin was a marker of tubular dysfunction. High alpha-1-microglobulin was associated with all-cause mortality independent of glomerular function and was a better predictor of mortality than urinary beta-2-microglobulin.
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Affiliation(s)
- Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan; Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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14
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do Nascimento GVR, de Brito HCD, de Lima CEB. Type 1 Cardiorenal Syndrome in Decompensated Heart Failure Patients in a Low-Income Region in Brazil: Incidence of Acute Kidney Injury (AKIN and KDIGO Criteria), Need for Dialysis and Mortality. Arq Bras Cardiol 2021; 117:385-391. [PMID: 34495237 PMCID: PMC8395783 DOI: 10.36660/abc.20200097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/31/2020] [Accepted: 08/16/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Type 1 cardiorenal syndrome is associated with higher mortality in heart failure patients. However, few studies have compared the diagnostic criteria of acute kidney injury (AKI) in this population. OBJECTIVE To assess clinical and functional features and factors associated AKI in patients with heart failure. METHOD Retrospective, cohort study on patients with decompensated heart failure or recent acute myocardial infarction, conducted in a tertiary hospital in a low-income region of Brazil. Clinical, laboratory and echocardiographic features were compared between patients with and without AKI according to the Acute Kidney Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The level of statistical significance was set at p < 0.05. RESULTS Of 81 patients, 61.73% had AKI. Mean creatinine and urea levels were 1.79±1.0 mg/dL and 81.5±46.0 mg/dL, respectively, and higher in the group with AKI (p < 0.05). No evidence of a relationship between cardiac changes and reduced renal function. Chronic renal disease was associated with higher prevalence of AKI. Higher mortality was observed in patients with AKI than in patients without AKI (32.0% vs. 9.8%, p = 0.04, OR 8.187 ad 95% confidence interval 1.402-17.190, p = 0.020). CONCLUSION In this population of patients with heart failure, AKI was highly prevalent and considered an independent risk factor for mortality. Cardiac changes were not associated with AKI, and the KDIGO and AKIN criteria showed similar performance.
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Affiliation(s)
- Ginivaldo Victor Ribeiro do Nascimento
- Universidade Estadual do PiauíTeresinaPIBrasilUniversidade Estadual do Piauí, Teresina, PI - Brasil
- Faculdade Integral Diferencial Curso de MedicinaTeresinaPIBrasilFaculdade Integral Diferencial Curso de Medicina, Teresina, PI - Brasil
| | - Heitor Carlos Domingues de Brito
- Faculdade Integral Diferencial Curso de MedicinaTeresinaPIBrasilFaculdade Integral Diferencial Curso de Medicina, Teresina, PI - Brasil
| | - Carlos Eduardo Batista de Lima
- Universidade Federal do PiauíTeresinaPIBrasilUniversidade Federal do Piauí, Centro de Ciências da Saúde, Teresina, PI - Brasil
- Centro de Pesquisa CARDIOLIMATeresinaPIBrasilCentro de Pesquisa CARDIOLIMA, Teresina, PI - Brasil
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15
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Ilges DT, Dermody ML, Blankenship C, Mansfield V, Van Tuyl JS. Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Renal Function in Type 1 Cardiorenal Syndrome. J Cardiovasc Pharmacol Ther 2021; 26:611-618. [PMID: 34138673 DOI: 10.1177/10742484211022625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) discontinuation during acute heart failure (AHF) is associated with increased mortality following hospitalization. Although the etiology of acute kidney injury (AKI) in type 1 cardiorenal syndrome (CRS) has been linked to renal venous congestion, ACE-I/ARB withdrawal (AW) theoretically promotes renal function recovery. ACE-I/ARBs are dose-reduced or withheld in approximately half of patients with CRS, but the subsequent impact on renal function remains largely uninvestigated. This study compared AW to ACE-I/ARB continuation (AC) during CRS. METHODS This was a retrospective, single-center chart review. Patients aged 18-89 years admitted from April 2018 to August 2019 with AHF and AKI were identified using discharge ICD-10 codes. All patients were treated with an ACE-I/ARB before admission. Key exclusion criteria included shock, pregnancy, and end-stage renal disease. The primary endpoint was change in serum creatinine (SCr) from admission through 72 hours. Data were analyzed utilizing chi-square and Mann-Whitney U tests with SPSS software. RESULTS A total of 111 admissions were included. AW occurred in 68 patients upon admission. AW patients presented with a higher blood urea nitrogen (P = 0.034), higher SCr (P = 0.021), and lower ejection fraction (P = 0.04). Median SCr change from admission to 72 hours did not differ between groups (AW -0.1 mg/dL vs AC 0.0 mg/dL, P = 0.05). There was no difference in SCr reduction ≥0.3 mg/dL at 72 hours, 30-day readmissions, or ACE-I/ARB prescription at discharge. CONCLUSIONS In patients with type 1 CRS, AW was not associated with improved renal function at 72 hours. A larger sample size is necessary to confirm these results.
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Affiliation(s)
- Daniel T Ilges
- Department of Pharmacy Services, 25213SSM Health Saint Louis University Hospital, St. Louis, MO, USA
| | - Morgan L Dermody
- Department of Pharmacy Practice, St. Louis College of Pharmacy at UHSP, St. Louis, MO, USA
| | - Caitlyn Blankenship
- Department of Pharmacy Practice, St. Louis College of Pharmacy at UHSP, St. Louis, MO, USA
| | - Valerie Mansfield
- Department of Pharmacy Services, 25213SSM Health Saint Louis University Hospital, St. Louis, MO, USA
| | - Joseph S Van Tuyl
- Department of Pharmacy Services, 25213SSM Health Saint Louis University Hospital, St. Louis, MO, USA.,Department of Pharmacy Practice, St. Louis College of Pharmacy at UHSP, St. Louis, MO, USA
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16
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Shetty S, Malik AH, Ali A, Yang YC, Aronow WS, Briasoulis A. Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure - A propensity-score matched analysis. Eur J Intern Med 2020; 79:76-80. [PMID: 32513504 DOI: 10.1016/j.ejim.2020.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/30/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
AIM We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). Data from National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. METHODS Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. RESULTS Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications such as sepsis, transfusions and cardiac arrest were also higher in the AKI group (p<0.01). Similarly, in-hospital procedures including pacemaker, coronary artery bypass graft, mechanical ventilation and intra-aortic balloon pump were performed more in the AKI group compared to the non-AKI group. The rate of AKI in patients with AHF has gradually increased from 29 % in the year 2012 to 35% in 2014. AHF patients with AKI had longer in-hospital stay of ~1.7 days. CONCLUSION In this propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group.
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Affiliation(s)
- Suchith Shetty
- Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa, USA.
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Abbas Ali
- Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa, USA
| | - Ying Chi Yang
- Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Alexandros Briasoulis
- Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa, USA
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17
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Peesapati VSR, Sadik M, Verma S, Attallah MA, Khan S. Panoramic Dominance of the Immune System in Cardiorenal Syndrome Type I. Cureus 2020; 12:e9869. [PMID: 32963910 PMCID: PMC7500732 DOI: 10.7759/cureus.9869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
Physiological organ cross-talk is necessary to maintain equilibrium and homeostasis. Heart and kidney are the essences of this equilibrium. Organ failure in either of these organs can perturb the bidirectional communication between them, impinging this unpleasant vascular and cellular milieu on other distant organs. Cardiorenal syndrome (CRS) type I occurs due to acute deterioration of cardiac function, ultimately causing acute kidney injury (AKI). This syndrome is an intricate condition with neurohormonal and inflammatory aspects. Inflammation creates a vicious circle filled with the innate and adaptive immune systems, pro-inflammatory cytokines, chemokines to actuate hemodynamic compromise in CRS type I patients. Pro-inflammatory cytokines not only aggravate fluid retention and venous congestion but also initiate apoptosis and oxidative stress. The immune response's primary motive is to elicit the heart and kidney to produce cytokines, intensifying the inflammatory process. Despite the possible standard of care, patient mortality, treatment cost, readmissions are extreme in CRS type I, and inflammation certainly has critical inferences warranting future research in humans.
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Affiliation(s)
| | - Mohammad Sadik
- Research, California Institute of Behavorial Neurosciences and Psychology, Fairfield, USA
| | - Sadhika Verma
- Research, California Institute of Behavorial Neurosciences and Psychology, Fairfield, USA
- Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Marline A Attallah
- Research, California Institute of Behavorial Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavorial Neurosciences and Psychology, Fairfield, USA
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Dass B, Dimza M, Singhania G, Schwartz C, George J, Bhatt A, Radhakrishnan N, Bansari A, Bozorgmehri S, Mohandas R. Renin-Angiotensin-Aldosterone System Optimization for Acute Decompensated Heart Failure Patients (ROAD-HF): Rationale and Design. Am J Cardiovasc Drugs 2020; 20:373-380. [PMID: 31797310 DOI: 10.1007/s40256-019-00389-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The long-term benefits of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on outcomes in patients with chronic congestive heart failure are well-known, making them one of the most widely prescribed medications. However, the administration of ACEIs/ARBs in acute decompensated heart failure (ADHF) can increase the risk of morbidity and mortality secondary to worsening renal function (WRF). A decrease in estimated glomerular filtration rate (eGFR) during the treatment of ADHF has been associated with an increase in mortality proportional to the degree of WRF. AIM The aim of our study is to determine whether withholding ACEIs/ARBs during the initial 72 h of admission in patients with ADHF will prevent WRF and allow more effective diuresis. METHODS Four hundred and thirty patients will be randomized to the intervention (withholding ACEIs/ARBs) or control (continue/start ACEIs/ARBs) arms for 72 h. Primary outcomes include rates of acute kidney injury (AKI), patient global assessment, and change in kinetic eGFR over 72 h, while secondary outcomes include change in weight, fluid balance, change in signs and symptoms of congestion, change in renal function, change in urinary biomarkers (tissue inhibitor of metalloproteinases 2 [TIMP-2] × insulin-like growth factor-binding protein 7 [IGFBP7]), patients experiencing treatment failure, hospital length of stay (LOS), cost analysis, mortality within 30 days, and hospital readmissions over 30 days and 1 year. CONCLUSION This prospective clinical trial will prove if withholding ACEIs/ARBs will prevent AKI in ADHF. It will help us understand the complex interactions between the heart and kidney, and delineate the best treatment strategy for ADHF. Holding ACEIs/ARBs might help preserve renal function, and decrease hospital LOS, readmission rates, and cost of care in ADHF. REGISTRATION ClinicalTrials.gov identifier: NCT03695120.
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19
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Sanchez-Serna J, Hernandez-Vicente A, Garrido-Bravo IP, Pastor-Perez F, Noguera-Velasco JA, Casas-Pina T, Rodriguez-Serrano AI, Núñez J, Pascual-Figal D. Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure. Eur J Intern Med 2020; 77:66-72. [PMID: 32127300 DOI: 10.1016/j.ejim.2020.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/06/2020] [Accepted: 02/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious complication in patients hospitalized for decompensated heart failure (HF). Currently, AKI definitions consider creatinine levels at admission as reference of baseline renal function (RF). However, renal impairment may already be present at admission. We aimed to study the impact on AKI detection of considering outpatient RF as reference. METHODS In a cohort of 458 patients hospitalized for decompensated HF, we studied the occurrence of AKI using the standardized KDIGO criteria and grading (stages: 1, 2, 3), and considering two different definitions according to the RF used as reference or baseline: the latest outpatient measurement prior to admission vs. the first measurement at admission. We compared the prevalence, timing and prognostic value for both AKI definitions. RESULTS The definition based on outpatient RF was associated with an increase in overall AKI detection from 20.1% to 33.8% (p < 0.001), and from 3.1% to 5.0% for advanced stages (2-3) (p < 0.001); additionally, 12.5% of patients already had criteria of AKI at admission (36.8% of AKI cases). Both definitions were associated with longer hospital stay. However, only AKI already present at admission, as based on pre-hospital creatinine, was independently associated with all-cause death, in-hospital and after discharge, and death or HF readmission in the follow-up: 1 stage (HR 2.72, 95%CI 1.83-4.06, p < 0.001) and 2-3 stage (HR 7.29, 95%CI, 3.02-17.64, p < 0.001). CONCLUSIONS Evaluation of AKI in patients admitted with HF should consider pre-hospital RF, since it improves early identification of AKI and has implications for risk assessment.
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Affiliation(s)
- Juan Sanchez-Serna
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Alvaro Hernandez-Vicente
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Iris P Garrido-Bravo
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Francisco Pastor-Perez
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | | | - Teresa Casas-Pina
- Servicio de Bioquimica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana I Rodriguez-Serrano
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Julio Núñez
- Servicio de Cardiologia, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades (CIBER) Cardiovasculares, Madrid, Spain
| | - Domingo Pascual-Figal
- Servicio de Cardiologia, Hospital Universitario Virgen de La Arrixaca, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades (CIBER) Cardiovasculares, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Bonavia A, Vece G, Karamchandani K. Prerenal acute kidney injury—still a relevant term in modern clinical practice? Nephrol Dial Transplant 2020; 36:1570-1577. [DOI: 10.1093/ndt/gfaa061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
Abstract
The traditional taxonomy of acute kidney injury (AKI) has remained pervasive in clinical nephrology. While the terms ‘prerenal’, ‘intrarenal’ and ‘postrenal’ highlight the diverse pathophysiology underlying AKI, they also imply discrete disease pathways and de-emphasize the nature of AKI as an evolving clinical syndrome with multiple, often simultaneous and overlapping, causes. In a similar vein, prerenal AKI comprises a diverse spectrum of kidney disorders, albeit one that is often managed by using a standardized clinical algorithm. We contend that the term ‘prerenal’ is too vague to adequately convey our current understanding of hypoperfusion-related AKI and that it should thus be avoided in the clinical setting. Practice patterns among nephrologists indicate that AKI-related terminology plays a significant role in the approaches that clinicians take to patients that have this complex disease. Thus, it appears that precise terminology does impact the treatment that patients receive. We will outline differences in the diagnosis and management of clinical conditions lying on the so-called prerenal disease spectrum to advocate caution when administering intravenous fluids to these clinically decompensated patients. An understanding of the underlying pathophysiology may, thus, avert clinical missteps such as fluid and vasopressor mismanagement in tenuous or critically ill patients.
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Affiliation(s)
- Anthony Bonavia
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Gregory Vece
- The Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Kunal Karamchandani
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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21
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Lopez C, Holgado JL, Fernandez A, Sauri I, Uso R, Trillo JL, Vela S, Bea C, Nuñez J, Ferrer A, Gamez J, Ruiz A, Redon J. Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study. J Clin Med 2020; 9:jcm9061869. [PMID: 32549339 PMCID: PMC7355985 DOI: 10.3390/jcm9061869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 02/05/2023] Open
Abstract
Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, representing 3.6/100 HF patients/year. The risk of hospitalization increased with one episode (Hazard Ratio = 1.30, 95% confidence interval (CI) 1.19-1.43), two or more episodes (HR = 1.59, 95% CI 1.14-2.23, and concurrent AKI (HR = 1.61, 95% CI 1.27-2.03). A total of 10,490 patients have died, representing 8.1/100 HF patients/year. The risk of mortality was HR = 2.20 (95% CI 2.06-2.35) for one episode, HR = 3.14 (95% CI 2.48-3.97) for two or more episodes, and HR = 3.20 (95% CI 2.73-3.75) with AKI. In the two or more episodes and AKI groups, Hb levels at the baseline were significantly lower (10.2-11.4 g/dL) than in the no episodes group (12.8 g/dL), and a higher and significant mortality in these subgroups was observed. Conclusions: Hb falls in heart failure patients identified those with a worse prognosis requiring a more careful evaluation and follow-up.
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Affiliation(s)
- Cristina Lopez
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
| | - Jose Luis Holgado
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
| | - Antonio Fernandez
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
| | - Inmaculada Sauri
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
| | - Ruth Uso
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
| | - Jose Luis Trillo
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
| | - Sara Vela
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain; (S.V.); (C.B.); (A.R.)
| | - Carlos Bea
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain; (S.V.); (C.B.); (A.R.)
| | - Julio Nuñez
- Cardiology Hospital Clínico de Valencia, 46010 Valencia, Spain;
| | - Ana Ferrer
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
| | - Javier Gamez
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
| | - Adrian Ruiz
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain; (S.V.); (C.B.); (A.R.)
| | - Josep Redon
- Cardiovascular and Renal Research Group INCLIVA Research Institute University of Valencia, 46010 Valencia, Spain; (C.L.); (J.L.H.); (A.F.); (I.S.); (R.U.); (J.L.T.); (A.F.); (J.G.)
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain; (S.V.); (C.B.); (A.R.)
- CIBERObn Carlos III Institute Madrid, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-658-909-676
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Doshi R, Dhawan T, Rendon C, Rodriguez MA, Al-Khafaji JF, Taha M, Win TT, Gullapalli N. Incidence and implications of acute kidney injury in patients hospitalized with acute decompensated heart failure. Intern Emerg Med 2020; 15:421-428. [PMID: 31686359 DOI: 10.1007/s11739-019-02188-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/29/2019] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) is a common complication in patients hospitalized with heart failure (HF). There is a paucity of research on the incidence and consequences of AKI among patients hospitalized with HF who do not have evidence of chronic kidney disease (CKD). The National Inpatient Sample database was used to identify index hospitalizations for acute HF from January 2012 through September 2015. The incidence of new-onset AKI was determined, and the study population was divided into two groups: HF with AKI (HFwAKI) and HF without AKI (HFwoAKI). These groups were further divided into the subgroups HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). A total of 2,010,095 index hospitalizations for HF were identified. The incidence of new-onset AKI was found to be ~ 20% for this population. In a fully adjusted model, in-hospital mortality was higher in the HFwAKI group (adjusted OR 3.63, P ≤ 0.001) and higher among patients with HFrEF (adjusted OR 3.85), as opposed to patients with HFpEF (adjusted OR 3.21). Similarly, length of stay and cost of care for the HFwAKI group were significantly higher as well. New-onset AKI among hospitalizations for HF poses a significant health problem, especially considering the increasing prevalence of HF. Further research into the causes of AKI among HF hospitalizations is, therefore, important as it will enable the development of treatment strategies to prevent AKI in HF hospitalizations and, consequently, benefit both the patients and health care system of the United States.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA.
| | - Tania Dhawan
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Casey Rendon
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Marines Acevedo Rodriguez
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Jaafar F Al-Khafaji
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Mohamed Taha
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Thi Thi Win
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
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23
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Holgado JL, Lopez C, Fernandez A, Sauri I, Uso R, Trillo JL, Vela S, Nuñez J, Redon J, Ruiz A. Acute kidney injury in heart failure: a population study. ESC Heart Fail 2020; 7:415-422. [PMID: 32059081 PMCID: PMC7160477 DOI: 10.1002/ehf2.12595] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 11/16/2022] Open
Abstract
Aims The objective of the present study is to assess the prognostic value of acute kidney injury (AKI) in the evolution of patients with heart failure (HF) using real‐world data. Methods and results Patients with a diagnosis of HF and with serial measurements of renal function collected throughout the study period were included. Estimated glomerular filtration rate (GFR) was calculated with the CKD‐EPI (Chronic Kidney Disease Epidemiology Collaboration). AKI was defined when a sudden drop in creatinine with posterior recovery was recorded. According to the Risk, Injury, Failure, Loss, and End‐Stage Renal Disease (RIFLE) scale, AKI severity was graded in three categories: risk [1.5‐fold increase in serum creatinine (sCr)], injury (2.0‐fold increase in sCr), and failure (3.0‐fold increase in sCr or sCr > 4.0 mg/dL). AKI incidence and risk of hospitalization and mortality after the first episode were calculated by adjusting for potential confounders. A total of 30 529 patients with HF were included. During an average follow‐up of 3.2 years, 5294 AKI episodes in 3970 patients (13.0%) and incidence of 3.3/100 HF patients/year were recorded. One episode was observed in 3161 (10.4%), two in 537 (1.8%), and three or more in 272 (0.9%). They were more frequent in women with diabetes and hypertension. The incidence increases across the GFR levels (Stages 1 to 4: risk 7.6%, 6.8%, 11.3%, and 12.5%; injury 2.1%, 2.0%, 3.3%, and 5.5%; and failure 0.9%, 0.6%. 1.4%, and 8.0%). A total of 3817 patients with acute HF admission were recorded during the follow‐up, with incidence of 38.4/100 HF patients/year, 3101 (81.2%) patients without AKI, 545 (14.3%) patients with one episode, and 171 (4.5%) patients with two or more. The number of AKI episodes [one hazard ratio (HR) 1.05 (0.98–1.13); two or more HR 2.01 (1.79–2.25)] and severity [risk HR 1.05 (0.97–1.04); injury HR 1.41 (1.24–1.60); and failure HR 1.90 (1.64–2.20)] increases the risk of hospitalization. A total of 10 560 deaths were recorded, with incidence of 9.3/100 HF patients/year, 8951 (33.7%) of subjects without AKI episodes, 1180 (11.17%) of subjects with one episode, and 429 (4.06%) with two or more episodes. The number of episodes [one HR 1.05 (0.98–1.13); two or more HR 2.01 (1.79–2.25)] and severity [risk 1.05 confidence interval (CI) (0.97–1.14), injury 1.41 (CI 1.24–1.60), and failure 1.90 (CI 1.64–2.20)] increases mortality risk. Conclusions The study demonstrated the worse prognostic value of sudden renal function decline in HF patients and pointed to those with more future risk who require review of treatment and closer follow‐up.
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Affiliation(s)
- Jose Luis Holgado
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Cristina Lopez
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Antonio Fernandez
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Inmaculada Sauri
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Ruth Uso
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Jose Luis Trillo
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Sara Vela
- Internal Medicine Hospital, Clínico de Valencia, Valencia, Spain
| | - Julio Nuñez
- Cardiology Hospital, Clínico de Valencia, Valencia, Spain
| | - Josep Redon
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,Internal Medicine Hospital, Clínico de Valencia, Valencia, Spain.,CIBERObn, Carlos III Health Institute, Madrid, Spain
| | - Adrian Ruiz
- Internal Medicine Hospital, Clínico de Valencia, Valencia, Spain
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Zhang H, Qiu S, Chen F, Zhu Z. Three-dimensional speckle-tracking echocardiography for evaluating myocardial motion in patients with cardiorenal syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:412-418. [PMID: 31172541 DOI: 10.1002/jcu.22749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/19/2019] [Accepted: 05/27/2019] [Indexed: 06/09/2023]
Abstract
Because of better awareness and understanding of its pathophysiology, the cardiorenal syndrome (CRS) is more often diagnosed and better managed. The echocardiographic evaluation of CRS now benefits from three-dimensional speckle tracking echocardiography (3D-STE), which allows multidimensional and real-time evaluation of regional myocardial and overall cardiac function, and helps assessing the degree of myocardial damage. This article describes the application of 3D-STE in evaluating the myocardial motion in patients with CRS.
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Affiliation(s)
- Hua Zhang
- Department of Medical Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shaodong Qiu
- Department of Medical Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fei Chen
- Department of Medical Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhimin Zhu
- Department of Medical Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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25
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Sanchez-Serna J, Martinez-Villanueva M, Hernández-Vicente Á, Asensio-Lopez M, Noguera J, Pascual-Figal D. Galectina-3 como biomarcador de riesgo de daño renal agudo en pacientes con insuficiencia cardiaca descompensada. Rev Clin Esp 2019; 219:315-319. [DOI: 10.1016/j.rce.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/23/2018] [Accepted: 10/28/2018] [Indexed: 12/28/2022]
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26
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Sanchez-Serna J, Martinez-Villanueva M, Hernández-Vicente Á, Asensio-Lopez M, Noguera J, Pascual-Figal D. Galectina-3 as a biomarker of acute kidney injury risk in patients with decompensated heart failure. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Patients with acute or chronic decompensated heart failure (ADHF) present with various degrees of heart and kidney dysfunction characterizing cardiorenal syndrome (CRS). CRS can be generally defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of 1 organ may induce acute or chronic dysfunction of the other. ADHF is a challenge in the management of heart failure. This review provides an overview the pathophysiology of type 1 CRS together with new approaches to treatment in patients with heart failure with worsening renal function or acute kidney disease.
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Affiliation(s)
- Claudio Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
| | - Antonio Bellasi
- Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Piazza Aldo Moro, 1, Colleferro, Roma 00034, Italy.
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Shirakabe A, Okazaki H, Matsushita M, Shibata Y, Goda H, Uchiyama S, Tani K, Kiuchi K, Kobayashi N, Hata N, Asai K, Shimizu W. Hyperuricemia complicated with acute kidney injury is associated with adverse outcomes in patients with severely decompensated acute heart failure. IJC HEART & VASCULATURE 2019; 23:100345. [PMID: 31321285 PMCID: PMC6612750 DOI: 10.1016/j.ijcha.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/23/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
Abstract
Background The relationship between the serum level of uric acid (UA) and the acute kidney injury on admission in patients with acute heart failure (AHF) remain unclear. Methods and results A total of 1326 AHF patients were screened, and data for 1047 patients who were admitted to the intensive-care unit were analyzed. The patients were assigned to a low-UA group (UA ≤ 7.0 mg/dl, n = 569) or a high-UA group (UA > 7.0 mg/dl, n = 478) according to their UA level at admission. Acute kidney injury (AKI) at admission was defined based on the ratio of the serum creatinine value recorded on admission to the baseline creatinine value: no-AKI (n = 736) or AKI (n = 311). The patients were therefore assigned to four groups: low-UA/no-AKI (n = 428), high-UA/no-AKI (n = 308), low-UA/AKI (n = 141) and high-UA/AKI (n = 170). The high-UA patients were significantly more frequent in the AKI group than in the non-AKI group among all patients and the non-chronic kidney injury (CKD) cohort. A Kaplan-Meier curve showed a significantly lower 365-day survival rate in the high-UA/AKI group than in the other groups. The multivariate Cox regression model identified only high-UA/AKI as an independent predictor of 365-day mortality (hazard ratio [HR]: 2.511, 95% confidence interval [CI] 1.671–3.772 in all AHF patients, HR: 1.884, 95% CI 1.022–3.473 in non-CKD patients and HR: 3.546, 95% CI 2.136–5.884 in CKD patients). Conclusion An elevated serum UA level complicated with AKI was an independent predictor of mortality in patients with severely decompensated AHF.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- Corresponding author at: ICU, Chiba Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba 270-1694, Japan.
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Hiroki Goda
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Saori Uchiyama
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kenichi Tani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
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Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Uchiyama S, Sawatani T, Asai K, Shimizu W. Worsening renal failure in patients with acute heart failure: the importance of cardiac biomarkers. ESC Heart Fail 2019; 6:416-427. [PMID: 30801997 PMCID: PMC6437438 DOI: 10.1002/ehf2.12414] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/08/2019] [Indexed: 12/19/2022] Open
Abstract
Aims The importance of true worsening renal failure (WRF), which is associated with a poor prognosis, had been suggested in patients with acute heart failure (AHF). The aim of the present study was to establish the biomarker strategy for the prediction of true WRF in AHF. Methods and results Two hundred eighty‐one patients with AHF were analysed. Their biomarkers were measured within 30 min of admission. Patients were assigned to the non‐WRF (n = 168), pseudo‐WRF (n = 56), or true‐WRF (n = 57) groups using the criteria of both acute kidney injury on admission and increasing serum creatinine value during the first 7 days. A Kaplan–Meier curve showed that the survival and heart failure event rate of the true‐WRF group within 1000 days was significantly lower than that of the non‐WRF and pseudo‐WRF groups (P ≤ 0.001). The multivariate Cox regression model also indicated that true WRF was an independent predictor of 1000 day mortality and heart failure events [hazard ratio: 4.315, 95% confidence interval (CI): 2.466–7.550, P ≤ 0.001, and hazard ratio: 2.834, 95% CI: 1.893–4.243, P ≤ 0.001, respectively]. The serum heart‐type fatty acid‐binding protein (s‐HFABP) levels were significantly higher in the true‐WRF group than in the non‐WRF and pseudo‐WRF groups (P ≤ 0.001). The multivariate logistic regression model indicated that the predictive biomarker for the true‐WRF group was the s‐HFABP level (odds ratio: 5.472, 95% CI: 2.729–10.972, P ≤ 0.001). The sensitivity and specificity for indicating the presence of true WRF were 73.7% and 76.8% (area under the curve = 0.831) for s‐HFABP in whole patients, respectively, and 94.7% and 72.7% (area under the curve = 0.904) in non‐chronic kidney disease (CKD) patients, respectively. Conclusions Cardiac biomarkers, especially the s‐HFABP, might predict the development of true WRF in AHF patients. Furthermore, the predictive value was higher in AHF patients without CKD than in those with CKD.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Saori Uchiyama
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Tomofumi Sawatani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Virzì GM, Breglia A, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C. Levels of Proinflammatory Cytokines, Oxidative Stress, and Tissue Damage Markers in Patients with Acute Heart Failure with and without Cardiorenal Syndrome Type 1. Cardiorenal Med 2018; 8:321-331. [PMID: 30205401 DOI: 10.1159/000492602] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiorenal syndrome type 1 (CRS type 1) is characterized by a rapid worsening of cardiac function leading to acute kidney injury (AKI). Inflammation and oxidative stress seem to play a pivotal role in its pathophysiology. In this in vivo study, we examined the putative role of inflammation and humoral markers in the pathogenesis of the CRS type 1. METHODS We enrolled 53 patients with acute heart failure (AHF); 17 of them developed AKI (CRS type 1). The cause of AKI was presumed to be related to cardiac dysfunction after having excluded other causes. We assessed the plasma levels of proinflammatory cytokines (TNF-α, IL-6, IL-18, sICAM, RANTES, GMCSF), oxidative stress marker (myeloperoxidase, MPO), brain natriuretic peptide (BNP), and neutrophil gelatinase-associated lipocalin (NGAL) in AHF and CRS type 1 patients. RESULTS We observed a significant increase in IL-6, IL-18, and MPO levels in CRS type 1 group compared to AHF (p < 0.001). We found higher NGAL at admission in the CRS type 1 group compared to the AHF group (p = 0.008) and a positive correlation between NGAL and IL-6 (Spearman's rho = 0.45, p = 0.003) and between IL-6 and BNP (Spearman's rho = 0.43, p = 0.004). We observed lower hemoglobin levels in CRS type 1 patients compared to AHF patients (p < 0.05) and inverse correlation between hemoglobin and cytokines (IL-6: Spearman's rho = -0.38, p = 0.005; IL-18: Spearman's rho = -0.32, p = 0.02). CONCLUSION Patients affected by CRS type 1 present increased levels of proinflammatory cytokines and oxidative stress markers, increased levels of tissue damage markers, and lower hemoglobin levels. All these factors may be implicated in the pathophysiology of CRS type 1 syndrome.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Andrea Breglia
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy.,Department of Internal Medicine, University of Trieste, Trieste, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy.,Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Chiara Bolin
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza, Italy.,Internal Medicine Unit Sant'Antonio Hospital, Padua, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute, Vicenza, Italy
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Uduman J. Epidemiology of Cardiorenal Syndrome. Adv Chronic Kidney Dis 2018; 25:391-399. [PMID: 30309456 DOI: 10.1053/j.ackd.2018.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/20/2022]
Abstract
Cardiorenal syndrome is a spectrum of disorders that emphasizes the bidirectional nature of cardiac and kidney injury. Observational and retrospective studies have helped us to understand the prevalence and burden of each of the 5 types of cardiorenal syndromes. Cardiorenal syndrome type 1 is the most common. The nature of epidemiologic data limits clear delineation between cardiorenal syndrome types 2 and 4. Overall, the presence of cardiac or renal dysfunction strongly predicts a poor outcome of the contrary organ.
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Palazzuoli A, Ruocco G. Heart-Kidney Interactions in Cardiorenal Syndrome Type 1. Adv Chronic Kidney Dis 2018; 25:408-417. [PMID: 30309458 DOI: 10.1053/j.ackd.2018.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 01/15/2023]
Abstract
The exact significance of kidney function deterioration during acute decompensated heart failure (ADHF) episodes is still under debate. Several studies reported a wide percentage of worsening renal function (WRF) in ADHF patients ranging from 20% to 40%. This is probably because of different populations enrolled with different baseline kidney and cardiac function, varying definition of acute kidney injury (AKI), etiology of kidney dysfunction (KD), and occurrence of transient or permanent KD over the observational period. Current cardiorenal syndrome classification does not distinguish among the mechanisms leading to cardiac and renal deterioration. Cardiorenal syndrome type 1 (CRS-1) is the result of a combination of neurohormonal activation, fluid imbalance, arterial underfilling, increased renal and abdominal pressure, and aggressive decongestive treatment. A more complete mechanistic approach to CRS-1 should include evaluation of baseline kidney function, timing, course and magnitude of KD, and introduction of specific biomarkers able to identify early kidney damage. Therefore, clinical and laboratory parameters may yield a different combination among predisposing, precipitating, and amplifying factors that may influence cardiorenal syndrome development. Thus, CRS-1 is a heterogeneous syndrome that needs to be better defined and categorized taking into account clinical status, renal condition, and treatment. The application of universal definitions for WRF/AKI definition would be the first step to achieve a clear classification.
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Cardiorenal Syndrome Type 1: Definition, Etiopathogenesis, Diagnostics and Treatment. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.1515/sjecr-2016-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Cardiorenal Syndrome Type 1 (CRS-1) is defined as an acute worsening of heart function leading to acute kidney injury and/or dysfunction. It is an important cause of hospitalization which affects the diagnosis as well as the prognosis and treatment of patients. The purpose of this paper is to analyze causes that lead to the development of cardiorenal syndrome type 1 and its clinical consequences, as well as to emphasize the clinical importance of its early detection. The clinical studies and professional papers dealing with etiopathogenesis, diagnosis and treatment of cardiorenal syndrome type 1, have been analyzed. The most important role in the occurrence of cardio renal syndrome type 1 is played by hemodynamic mechanisms, activation of neurohumoral systems, inflammation and imbalance between the production of reactive oxygen species (ROS) and nitric oxide (NO). Diagnosis of cardiorenal syndrome type 1 involves biomarkers of acute renal injury among which the most important are: neutrophil gelatinaseassociated lipocalin (NGAL), cystatin C, kidney injury molecule 1 (KIM-1), liver-type fatty acid binding protein (L-FABP), IL-18 and the values of nitrogen compounds in serum. In addition to a pharmacological therapy, various modalities of extracorporeal ultrafiltration are applied in treatment of CRS-1, particularly if there is resistance to the use of diuretic therapy. As opposed to the experimental models, in clinical practice acute renal injury is often diagnosed late so that the measures taken do not give the expected results and the protective role shown in experimental conditions do not give the same results. For all these reasons, it is necessary to analyze the pathophysiology of renal impairment in cardiorenal syndrome as well as detect early indicators of kidney injury that could have clinical benefit and positive impact on reducing the cost of treatment.
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Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Asai K, Shimizu W. Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure. ESC Heart Fail 2018; 5:322-331. [PMID: 29388735 PMCID: PMC5933958 DOI: 10.1002/ehf2.12264] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/22/2017] [Indexed: 12/28/2022] Open
Abstract
Aims Whether or not the definition of a worsening renal function (WRF) is adequate for the evaluation of acute renal failure in patients with acute heart failure is unclear. Methods and results One thousand and eighty‐three patients with acute heart failure were analysed. A WRF, indicated by a change in serum creatinine ≥0.3 mg/mL during the first 5 days, occurred in 360 patients while no‐WRF, indicated by a change <0.3 mg/dL, in 723 patients. Acute kidney injury (AKI) upon admission was defined based on the ratio of the serum creatinine value recorded on admission to the baseline creatinine value and placed into groups based on the degree of AKI: no‐AKI (n = 751), Class R (risk; n = 193), Class I (injury; n = 41), or Class F (failure; n = 98). The patients were assigned to another set of four groups: no‐WRF/no‐AKI (n = 512), no‐WRF/AKI (n = 211), WRF/no‐AKI (n = 239), and WRF/AKI (n = 121). A multivariate logistic regression model found that no‐WRF/AKI and WRF/AKI were independently associated with 365 day mortality (hazard ratio: 1.916; 95% confidence interval: 1.234–2.974 and hazard ratio: 3.622; 95% confidence interval: 2.332–5.624). Kaplan–Meier survival curves showed that the rate of any‐cause death during 1 year was significantly poorer in the no‐WRF/AKI and WRF/AKI groups than in the WRF/no‐AKI and no‐WRF/no‐AKI groups and in Class I and Class F than in Class R and the no‐AKI group. Conclusions The presence of AKI on admission, especially Class I and Class F status, is associated with a poor prognosis despite the lack of a WRF within the first 5 days. The prognostic ability of AKI on admission may be superior to WRF within the first 5 days.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Saori Uchiyama
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Asai K, Shimizu W. Prognostic benefit of maintaining the hemoglobin level during the acute phase in patients with severely decompensated acute heart failure. Heart Vessels 2017; 33:264-278. [PMID: 28956134 DOI: 10.1007/s00380-017-1057-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/22/2017] [Indexed: 12/19/2022]
Abstract
The optimum method of managing anemia during the acute phase of acute heart failure (AHF) remains to be elucidated. The data from 1109 AHF patients were enrolled in present study. The hemoglobin (Hb) levels were evaluated in all patients at admission (day 1) and 3 days after admission (day 3), and in survival discharge patients (n = 998) before discharge (pre-discharge). The serum hemoglobin levels were significantly lower on day 3 (11.2 (9.6-12.9) g/dl) than on day 1 (12.4 (10.4-14.2) g/dl) and at pre-discharge (11.6 (10.1-13.2) g/dl). A multivariate Cox regression model showed that mild anemia (11.0 ≤ Hb ≤ 12.9 g/dl, n = 316) and severe anemia (Hb ≤ 10.9 g/dl, n = 517) on day 3 were independent predictors of HF event (hazard ratio (HR) 1.542, 95% confidence interval (CI)1.070-2.221, HR 2.026, 95% CI 1.439-2.853), and severe anemia on day 3 were independent predictors of 365-day mortality (HR 2.247, 95% CI 1.376-3.670). The prognosis, including all-cause death and HF events, in patients with non-anemia on day 1 was significantly poorer in severe new-anemia patients on day 3 (n = 44) than in mild new-anemia patients on day 3 (n = 153) and non-anemia patients on day 3 (n = 252). In patients with anemia on day 1, the prognosis was significantly poorer in patients with severe anemia on day 3 (n = 190) than in those with non-anemia or mild anemia on day 3 (n = 482). The hemoglobin level after the initial treatment might be easily influenced by clinical decongestion. Successfully treated decongestion can help maintain the hemoglobin levels. It, therefore, leads to a prognostic benefit in patients with AHF. These findings might underscore the importance of hemoglobin management of the acute phase of AHF.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Saori Uchiyama
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Breidthardt T, Sabti Z, Ziller R, Rassouli F, Twerenbold R, Kozhuharov N, Gayat E, Shrestha S, Barata S, Badertscher P, Boeddinghaus J, Nestelberger T, Mueller C. Diagnostic and prognostic value of cystatin C in acute heart failure. Clin Biochem 2017; 50:1007-1013. [PMID: 28756070 DOI: 10.1016/j.clinbiochem.2017.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The accurate early diagnosis of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Cystatin C might improve the early detection of AKI. METHODS 207 patients presenting to the emergency department with AHF were enrolled. Cystatin C was measured in plasma in a blinded fashion at presentation and serially thereafter. The potential of Cystatin C levels to predict AKI was assessed as the primary endpoint. Long-term mortality was assessed as a secondary endpoint. RESULTS At presentation, creatinine (140μmol/L [91-203] vs. 97μmol/L [76-132], p<0.01) and Cystatin C (2.00mg/L [1.30-3.08] vs. 1.45mg/L [1.00-1.90], p<0.01) levels were significantly higher in AKI compared to Non-AKI patients. The diagnostic accuracy for AKI quantified by the area under the receiver operating characteristic curve was mediocre and comparable for both markers (creatinine 0.68; 95%CI 0.58-78 vs. Cystatin C 0.67; 95%CI 0.58-0.76). Serial measurements of Cystatin C did not further increase the prognostic accuracy for AKI. Cystatin C levels were significantly higher in decedents than in survivors (1.90mg/L [1.30-2.70] vs. 1.30mg/L [1.0-1.6], p<0.001). The combination of Cystatin C and BNP levels significantly improved the prediction of mortality provided by either parameter alone. In multivariable regression analysis Cystatin C remained independently associated with mortality (HR 1.41; 95%CI 1.02-1.95). CONCLUSION Plasma Cystatin C levels do not adequately predict AKI in patients with AHF. However, in multivariable regression analysis Cystatin C predicted mortality after the adjustment for baseline renal function, AKI, BNP levels and heart failure risk factors.
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Affiliation(s)
- Tobias Breidthardt
- Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland.
| | - Zaid Sabti
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Ronny Ziller
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Geriatric Medicine, Spital Interlaken, Switzerland
| | - Frank Rassouli
- Medical University Clinic, Kantonsspital, Aarau, Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland; Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | - Nikola Kozhuharov
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Etienne Gayat
- Hôpital Lariboisière APHP, University of Paris, France
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Sara Barata
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Jasper Boeddinghaus
- Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Thomas Nestelberger
- Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland
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Takahama H, Kitakaze M. Pathophysiology of cardiorenal syndrome in patients with heart failure: potential therapeutic targets. Am J Physiol Heart Circ Physiol 2017; 313:H715-H721. [PMID: 28733448 DOI: 10.1152/ajpheart.00215.2017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/27/2017] [Accepted: 07/13/2017] [Indexed: 12/16/2022]
Abstract
Despite the development of pharmacological inventions and new nonpharmacological techniques to prevent and treat heart failure (HF), the mortality rate in patients with symptomatic HF remains high. To conquer these difficulties, the pathophysiology of HF should be considered within a wide range of views. Given the diverse mechanisms of HF pathophysiology, renal and cardiac functions have close and complementary interconnections. Recent studies have suggested that communication between the kidney and heart through bidirectional pathways causes significant pathological changes. This review summarizes the pathophysiology of cardiorenal syndrome (CRS) from three different viewpoints, namely, underlying chronic kidney disease, worsening renal function during hospitalization due to HF, and resistance to diuretics. We also summarize the presently available data on the pathophysiology of CRS, identify the challenges associated with some clinical approaches, and explore the potential therapeutic target for CRS.
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Affiliation(s)
- Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; and
| | - Masafumi Kitakaze
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; and.,Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Asai K, Shimizu W. Clinical Usefulness of Urinary Liver Fatty Acid-Binding Protein Excretion for Predicting Acute Kidney Injury during the First 7 Days and the Short-Term Prognosis in Acute Heart Failure Patients with Non-Chronic Kidney Disease. Cardiorenal Med 2017; 7:301-315. [PMID: 29118769 DOI: 10.1159/000477825] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/15/2017] [Indexed: 12/20/2022] Open
Abstract
Background The clinical significance of urinary liver fatty acid-binding protein (u-LFABP) in acute heart failure (AHF) patients remains unclear. Methods and Results The u-LFABP levels on admission of 293 AHF patients were analyzed. The patients were divided into 2 groups according to the u-LFABP quartiles (Q1, Q2, and Q3 = low u-LFABP [L] group vs. Q4 = high u-LFABP [H] group). We evaluated the diagnostic and prognostic value of u-LFABP and compared the findings between the chronic kidney disease (CKD; n = 165) and non-CKD patients (n = 128). Acute kidney injury (AKI) during the first 7 days was evaluated based on the RIFLE criteria. In the non-CKD group, the number of AKI patients during the first 7 days was significantly greater in the H group (70.0%) than in the L group (45.6%). A multivariate logistic regression model indicated that the H group (odds ratio: 3.850, 95% confidence interval [CI] 1.128-13.140) was independently associated with AKI during the first 7 days. The sensitivity and specificity of u-LFABP for predicting AKI were 63.6 and 59.7% (area under the ROC curve 0.631) at 41.9 ng/mg × cre. A Cox regression model identified the H group (hazard ratio: 13.494, 95% CI 1.512-120.415) as an independent predictor of the 60-day mortality. A Kaplan-Meier curve, including all-cause death within 60 days, showed a significantly poorer survival rate in the H group than in the L group (p = 0.036). Conclusions The u-LFABP level is an effective biomarker for predicting AKI during the first 7 days of hospitalization and an adverse outcome in AHF patients with non-CKD.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Saori Uchiyama
- Division of Intensive Care Unit, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Hou FF, Yang X. Advances in the Management of Acute Cardiorenal Syndrome in China: Biomarkers for Predicting Development and Outcomes. KIDNEY DISEASES 2017; 2:145-150. [PMID: 28232931 DOI: 10.1159/000449026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/10/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Acute cardiorenal syndrome (CRS) is a common clinical condition associated with adverse outcomes. Early identification of acute kidney injury in this setting remains challenging given that serum creatinine level is a marker of renal function and not kidney injury. SUMMARY Several renal injury-related molecules are now available, which may help elucidate the complexities of the organ crosstalk, enabling more accurate risk stratification and effective interventions. KEY MESSAGES This review highlights the major studies that have characterized the diagnostic and prognostic predictive power of these biomarkers with reference to acute CRS. Although more research is needed, the current results are very promising.
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Affiliation(s)
- Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Xiaobing Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
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Aoun M, Tabbah R. Case report: severe bradycardia, a reversible cause of "Cardio-Renal-Cerebral Syndrome". BMC Nephrol 2016; 17:162. [PMID: 27784284 PMCID: PMC5081674 DOI: 10.1186/s12882-016-0375-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background Cardio-Renal Syndromes were first classified in 2008 and divided into five subtypes. The type 1 Cardio-Renal Syndrome (CRS) is characterized by acute decompensation of heart failure leading to acute kidney injury (AKI). Bradyarrhythmia was not mentioned in the classification as a cause for low cardiac output (CO) in type 1 CRS. Besides, CRS was not previously associated with central nervous system (CNS) injury despite the fact that cardiac, renal and neurological diseases can coexist. Case presentation We report the case of a 93-year old diabetic man who presented for obnubilation. He had a slow atrial fibrillation, was not hypotensive and was not taking any beta-blocker. He developed, simultaneously, during his hospitalization, severe bradycardia (<35 beats per minute), oligoanuria and further neurological deterioration without profound hypotension. An ECG revealed a complete atrioventricular (AV) block and all his symptoms were completely reversed after pacemaker insertion. His creatinine decreased progressively afterwards and at discharge, he was conscious, alert and well oriented. Conclusion Our case highlights the importance of an early recognition of low cardiac output secondary to severe bradyarrhythmia and its concurrent repercussion on the kidney and the brain. This association of the CRS with CNS injury-that we called “Cardio-Renal-Cerebral Syndrome”–was successfully treated with permanent pacemaker implantation.
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Affiliation(s)
- Mabel Aoun
- Nephrology Department of Saint-Georges Hospital Ajaltoun and Saint-Joseph University, Beirut, Lebanon.
| | - Randa Tabbah
- Holy Spirit University of Kaslik, Jounieh, Lebanon
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Chen C, Yang X, Lei Y, Zha Y, Liu H, Ma C, Tian J, Chen P, Yang T, Hou FF. Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome. Clin J Am Soc Nephrol 2016; 11:1536-1544. [PMID: 27538426 PMCID: PMC5012473 DOI: 10.2215/cjn.00910116] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/19/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES A major challenge in early treatment of acute cardiorenal syndrome (CRS) is the lack of predictors for progression of AKI. We aim to investigate the utility of urinary angiotensinogen and other renal injury biomarkers in predicting AKI progression in CRS. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS In this prospective, multicenter study, we screened 732 adults who admitted for acute decompensated heart failure from September 2011 to December 2014, and evaluated whether renal injury biomarkers measured at time of AKI diagnosis can predict worsening of AKI. In 213 patients who developed Kidney Disease Improving Global Outcomes stage 1 or 2 AKI, six renal injury biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), plasma neutrophil gelatinase-associated lipocalin, urinary IL-18 (uIL-18), urinary kidney injury molecule-1, and urinary albumin-to-creatinine ratio, were measured at time of AKI diagnosis. The primary outcome was AKI progression defined by worsening of AKI stage (50 patients). The secondary outcome was AKI progression with subsequent death (18 patients). RESULTS After multivariable adjustment, the highest tertile of three urinary biomarkers remained associated with AKI progression compared with the lowest tertile: uAGT (odds ratio [OR], 10.8; 95% confidence interval [95% CI], 3.4 to 34.7), uNGAL (OR, 4.7; 95% CI, 1.7 to 13.4), and uIL-18 (OR, 3.6; 95% CI, 1.4 to 9.5). uAGT was the best predictor for both primary and secondary outcomes with area under the receiver operating curve of 0.78 and 0.85. These three biomarkers improved risk reclassification compared with the clinical model alone, with uAGT performing the best (category-free net reclassification improvement for primary and secondary outcomes of 0.76 [95% CI, 0.46 to 1.06] and 0.93 [95% CI, 0.50 to 1.36]; P<0.001). Excellent performance of uAGT was further confirmed with bootstrap internal validation. CONCLUSIONS uAGT, uNGAL, and uIL-18 measured at time of AKI diagnosis improved risk stratification and identified CRS patients at highest risk of adverse outcomes.
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Affiliation(s)
- Chunbo Chen
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Xiaobing Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Ying Lei
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang Medical University, Guiyang, China
| | - Huafeng Liu
- Division of Nephrology, Institute of Nephrology, Guangdong Medical College, Zhanjiang, China
| | - Changsheng Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China; and
| | - Jianwei Tian
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Pingyan Chen
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
| | - Tiecheng Yang
- Division of Nephrology, The Futian Hospital, Guangdong Medical College, Shenzhen, China
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China
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Shirakabe A, Kobayashi N, Hata N, Shinada T, Tomita K, Tsurumi M, Okazaki H, Matsushita M, Yamamoto Y, Yokoyama S, Asai K, Shimizu W. The serum heart-type fatty acid-binding protein (HFABP) levels can be used to detect the presence of acute kidney injury on admission in patients admitted to the non-surgical intensive care unit. BMC Cardiovasc Disord 2016; 16:174. [PMID: 27596162 PMCID: PMC5011936 DOI: 10.1186/s12872-016-0340-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/23/2016] [Indexed: 01/12/2023] Open
Abstract
Background No cardiac biomarkers for detecting acute kidney injury (AKI) on admission in non-surgical intensive care patients have been reported. The aim of the present study is to elucidate the role of cardiac biomarkers for quickly identifying the presence of AKI on admission. Methods Data for 1183 patients who underwent the measurement of cardiac biomarkers, including the serum heart-type fatty acid-binding protein (s-HFABP) level, in the emergency department were screened, and 494 non-surgical intensive care patients were enrolled in this study. Based on the RIFLE classification, which was the ratio of the serum creatinine value recorded on admission to the baseline creatinine value, the patients were assigned to a no-AKI (n = 349) or AKI (Class R [n = 83], Class I [n = 36] and Class F [n = 26]) group on admission. We evaluated the diagnostic value of the s-H-FABP level for detecting AKI and Class I/F. The mid-term prognosis, as all-cause death within 180 days, was also evaluated. Results The s-H-FABP levels were significantly higher in the Class F (79.2 [29.9 to 200.3] ng/mL) than in the Class I (41.5 [16.7 to 71.6] ng/mL), the Class R (21.1 [10.2 to 47.9] ng/mL), and no-AKI patients (8.8 [5.4 to 17.7] ng/mL). The most predictive values for detecting AKI were Q2 (odds ratio [OR]: 3.743; 95 % confidence interval [CI]: 1.693–8.274), Q3 (OR: 9.427; 95 % CI: 4.124–21.548), and Q4 (OR: 28.000; 95 % CI: 11.245–69.720), while those for Class I/F were Q3 (OR: 5.155; 95 % CI: 1.030–25.790) and Q4 (OR: 22.978; 95 % CI: 4.814–109.668). The s-HFABP level demonstrating an optimal balance between sensitivity and specificity (70.3 and 72.8 %, respectively; area under the curve: 0.774; 95 % CI: 0.728–0.819) was 15.7 ng/mL for AKI and 20.7 ng/mL for Class I/F (71.0 and 83.1 %, respectively; area under the curve: 0.818; 95 % CI: 0.763–0.873). The prognosis was significantly poorer in the high serum HFABP with AKI group than in the other groups. Conclusions The s-H-FABP level is an effective biomarker for detecting AKI in non-surgical intensive care patients.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Takuro Shinada
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kazunori Tomita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masafumi Tsurumi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yoshiya Yamamoto
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Shinya Yokoyama
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Jujo K, Saito K, Ishida I, Furuki Y, Kim A, Suzuki Y, Sekiguchi H, Yamaguchi J, Ogawa H, Hagiwara N. Randomized pilot trial comparing tolvaptan with furosemide on renal and neurohumoral effects in acute heart failure. ESC Heart Fail 2016; 3:177-188. [PMID: 27818782 PMCID: PMC5071712 DOI: 10.1002/ehf2.12088] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 01/11/2023] Open
Abstract
AIMS Loop diuretics are first-line medications for congestive heart failure (CHF); however, they are associated with serious adverse effects, including decreased renal function, and sympathetic nervous and renin-angiotensin system activation. We tested whether tolvaptan, a vasopressin V2-receptor antagonist, could reduce unfavourable furosemide-induced effects during CHF treatment. METHODS AND RESULTS Sixty patients emergently hospitalized owing to CHF-induced dyspnea were randomly assigned to receive either 40 mg intravenous furosemide daily or 7.5 mg oral tolvaptan for 5 days after admission. Both groups also received intravenous carperitide and canrenoate potassium. As results, baseline patient characteristics were similar between the furosemide (n = 30) and the tolvaptan (n = 30) groups, with no significant difference in 5 day urine volume or fluid balance. Brain natriuretic peptide and body weight improvements were similar between groups. However, serum creatinine (Cr) level did not increase, and the incidence of worsening renal function was significantly lower in the tolvaptan group. Consequently, the Cr increase to gain 1000 mL urine was 2.5-fold lower in the tolvaptan group. Furthermore, the blood urea nitrogen (BUN)/Cr ratio significantly decreased in the tolvaptan group, suggesting that renal perfusion was preserved, and urea reuptake and passive water reabsorption were suppressed following tolvaptan treatment. Although catecholamine improvements after treatment were not significantly different, plasma renin activity was enhanced in the furosemide group. CONCLUSIONS As compared with furosemide, tolvaptan in patients with acute heart failure is associated with comparable decongestion, better preservation of renal function and less activation of renin-angiotensin system. (UMIN 000014134).
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Affiliation(s)
- Kentaro Jujo
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan; Department of CardiologyNishiarai Heart Center HospitalTokyoJapan
| | - Katsumi Saito
- Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan
| | - Issei Ishida
- Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan
| | - Yuho Furuki
- Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan
| | - Ahsung Kim
- Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan
| | - Yuki Suzuki
- Department of Cardiology Nishiarai Heart Center Hospital Tokyo Japan
| | - Haruki Sekiguchi
- Department of Cardiology, Aoyama Hospital Tokyo Women's Medical University Tokyo Japan
| | - Junichi Yamaguchi
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Hiroshi Ogawa
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology Tokyo Women's Medical University Tokyo Japan
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Renal effects of added low-dose dopamine in acute heart failure patients with diuretic resistance to natriuretic peptide. J Cardiovasc Pharmacol 2016; 65:282-8. [PMID: 25748698 DOI: 10.1097/fjc.0000000000000193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Worsening renal function during the early phase of hospitalization is related to adverse outcomes in acute heart failure (AHF). This study aimed to clarify whether added low-dose dopamine (DA) is clinically beneficial for AHF patients with diuretic resistance to human atrial natriuretic peptide (hANP). Twenty-four AHF patients, who did not have adequate diuresis by 4 hours after administration of hANP, were randomized to a low dose of DA (1-3 μg·kg·min, n = 12) or a low dose of furosemide (10-30 mg injection, n = 12). The significant increase in mean hourly urine volume from baseline (265% ± 204% with hANP + DA; 187% ± 118% with hANP + furosemide) and improvement of dyspnea were similarly observed in both groups. Significant decreases in serum creatinine levels were observed by -14.0% ± 14.2% in the hANP + DA group compared with the hANP + furosemide group (4.5% ± 9.6%, P = 0.0011) without increases in the renotubular and myocardial markers. The incidence of worsening renal function defined as a rise in serum creatinine of >0.3 mg/dL was not observed within 3 days of admission in both groups. Added low-dose DA might not have a harmful effect on renal function and effects of diuresis and symptom relief without a significant increase in troponin-T in AHF patients with diuretic resistance to hANP.
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Grodin JL, Stevens SR, de las Fuentes L, Kiernan M, Birati EY, Gupta D, Bart BA, Felker GM, Chen HH, Butler J, Dávila-Román VG, Margulies KB, Hernandez AF, Anstrom KJ, Wilson Tang WH. Intensification of Medication Therapy for Cardiorenal Syndrome in Acute Decompensated Heart Failure. J Card Fail 2016; 22:26-32. [PMID: 26209004 PMCID: PMC4706474 DOI: 10.1016/j.cardfail.2015.07.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/26/2015] [Accepted: 07/09/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Worsening renal function in heart failure may be related to increased venous congestion, decreased cardiac output, or both. Diuretics are universally used in acute decompensated heart failure, but they may be ineffective and may lead to azotemia. We aimed to compare the decongestive properties of a urine output-guided diuretic adjustment and standard therapy for the management of cardiorenal syndrome in acute decompensated heart failure. METHODS AND RESULTS Data were pooled from subjects randomized to the stepwise pharmacologic care algorithm (SPCA) in the CARRESS-HF trial and those who developed cardiorenal syndrome (rise in creatinine >0.3 mg/dL) in the DOSE-AHF and ROSE-AHF trials. Patients treated with SPCA (n = 94) were compared with patients treated with standard decongestive therapy (SDT) that included intravenous loop diuretic use (DOSE-AHF and ROSE-AHF; n = 107) at the time of cardiorenal syndrome and followed for net fluid balance, weight loss, and changing renal function. The SPCA group had higher degrees of jugular venous pressure (P < .0001) at the time of cardiorenal syndrome. The group that received SPCA had more weight change (-3.4 ± 5.2 lb) and more net fluid loss (1.705 ± 1.417 L) after 24 hours than the SDT group (-0.8 ± 3.4 lb and 0.892 ± 1.395 L, respectively; P < .001 for both) with a slight improvement in renal function (creatinine change -0.1 ± 0.3 vs 0.0 ± 0.3 mg/dL, respectively; P = .03). CONCLUSIONS Compared with SDT, patients who received an intensification of medication therapy for treating persisting congestion had greater net fluid and weight loss without being associated with renal compromise.
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Affiliation(s)
- Justin L. Grodin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Susanna R. Stevens
- Duke Clinical Research Institute, Room 0311 Terrace Level, 2400 Pratt Street, Durham, NC 27705
| | - Lisa de las Fuentes
- Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110
| | - Michael Kiernan
- The Cardiovascular Center, Tufts Medical Center,800 Washington St, Boston, MA 02111
| | - Edo Y. Birati
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, bldg 421 5162, 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Divya Gupta
- Cardiology Division, Emory University,201 Dowman Drive, Atlanta, GA 30322
| | - Bradley A. Bart
- Hennepin County Medical Center,701 Park Avenue, Minneapolis, MN 55415
| | - G. Michael Felker
- Duke University Medical Center and Duke Heart Center, 2301 Erwin Road Durham, NC 27710
| | | | - Javed Butler
- Cardiology Division, Emory University,201 Dowman Drive, Atlanta, GA 30322
| | | | - Kenneth B. Margulies
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, bldg 421 5162, 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Adrian F. Hernandez
- Duke University Medical Center and Duke Heart Center, 2301 Erwin Road Durham, NC 27710
| | - Kevin J. Anstrom
- Duke Clinical Research Institute, Room 0311 Terrace Level, 2400 Pratt Street, Durham, NC 27705
| | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
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Vandenberghe W, Gevaert S, Kellum JA, Bagshaw SM, Peperstraete H, Herck I, Decruyenaere J, Hoste EAJ. Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis. Cardiorenal Med 2015; 6:116-28. [PMID: 26989397 DOI: 10.1159/000442300] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). SUMMARY We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOSICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOShosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOSICU = 10.6 days and that of LOShosp = 20.2 days). KEY MESSAGES Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.
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Affiliation(s)
- Wim Vandenberghe
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Sofie Gevaert
- Departments of Cardiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - John A Kellum
- Centre for Critical Care Nephrology, University of Pittsburgh, Pa., USA; The Clinical Research, Investigation, and Systems Modelling of Acute Illness (CRISMA) Centre, Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pa., USA
| | - Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta., Canada
| | - Harlinde Peperstraete
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ingrid Herck
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Johan Decruyenaere
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Eric A J Hoste
- Departments of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium; The Clinical Research, Investigation, and Systems Modelling of Acute Illness (CRISMA) Centre, Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pa., USA
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Yamagishi T, Matsushita K, Minamishima T, Goda A, Sakata K, Satoh T, Yoshino H. Comparison of risk factors for acute worsening renal function in heart failure patients with and without preserved ejection fraction. Eur J Intern Med 2015; 26:599-602. [PMID: 26298856 DOI: 10.1016/j.ejim.2015.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We compared the risk factors for acute worsening renal function (AWRF) in patients with acute decompensated heart failure with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF). METHODS We retrospectively studied 181 consecutive patients. AWRF was defined as a rise in serum creatinine of ≥0.3 mg/dL from admission to day 3. Potential risk factors of AWRF were identified in univariate analyses; then logistic regression analysis with backward stepwise selection was performed. RESULTS In the present study of limited sample size, 46% had HFpEF (EF≥50%) and 54% had HFrEF (EF<50%). In the HFpEF group, history of hypertension (odds ratio [OR] 32.46, 95% CI 2.39-440.12, P=0.009), the increased serum potassium value at admission (OR 4.61, 95% CI 1.14-18.73, P=0.032), and the pretreatment with calcium channel blocker (OR 8.52, 95% CI 1.21-60.09, P=0.032) were independent risk factors (defined as P<0.05 and OR>1.01) for AWRF. In contrast, diastolic blood pressure at admission (OR 1.07, 95% CI 1.02-1.13, P=0.004) was the sole independent risk factor for AWRF in the HFrEF group. CONCLUSIONS Hypertension was associated with AWRF in both HFpEF and HFrEF patients. A history of hypertension was more important than elevated blood pressure at admission as a risk factor for AWRF in HFpEF, whereas the reverse was observed for HFrEF. Among antihypertensive drugs, pretreatment with calcium channel blocker was an independent risk factor for AWRF in HFpEF, but not in HFrEF.
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Affiliation(s)
- Tamiharu Yamagishi
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kenichi Matsushita
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
| | - Toshinori Minamishima
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Ayumi Goda
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Konomi Sakata
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Toru Satoh
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Hideaki Yoshino
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
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Chang CH, Yang CH, Yang HY, Chen TH, Lin CY, Chang SW, Chen YT, Hung CC, Fang JT, Yang CW, Chen YC. Urinary Biomarkers Improve the Diagnosis of Intrinsic Acute Kidney Injury in Coronary Care Units. Medicine (Baltimore) 2015; 94:e1703. [PMID: 26448023 PMCID: PMC4616771 DOI: 10.1097/md.0000000000001703] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Acute kidney injury (AKI) is associated with increased morbidity and mortality and is frequently encountered in coronary care units (CCUs). Its clinical presentation differs considerably from that of prerenal or intrinsic AKI. We used the biomarkers calprotectin and neutrophil gelatinase-associated lipocalin (NGAL) and compared their utility in predicting and differentiating intrinsic AKI. This was a prospective observational study conducted in a CCU of a tertiary care university hospital. Patients who exhibited any comorbidity and a kidney stressor were enrolled. Urinary samples of the enrolled patients collected between September 2012 and August 2013 were tested for calprotectin and NGAL. The definition of AKI was based on Kidney Disease Improving Global Outcomes classification. All prospective demographic, clinical, and laboratory data were evaluated as predictors of AKI. A total of 147 adult patients with a mean age of 67 years were investigated. AKI was diagnosed in 71 (50.3%) patients, whereas intrinsic AKI was diagnosed in 43 (60.5%) of them. Multivariate logistic regression analysis revealed urinary calprotectin and serum albumin as independent risk factors for intrinsic AKI. For predicting intrinsic AKI, both urinary NGAL and calprotectin displayed excellent areas under the receiver operating characteristic curve (AUROC) (0.918 and 0.946, respectively). A combination of these markers revealed an AUROC of 0.946. Our result revealed that calprotectin and NGAL had considerable discriminative powers for predicting intrinsic AKI in CCU patients. Accordingly, careful inspection for medication, choice of therapy, and early intervention in patients exhibiting increased biomarker levels might improve the outcomes of kidney injury.
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Affiliation(s)
- Chih-Hsiang Chang
- From the Department of Nephrology, Kidney Research Center, Taipei, Taiwan (C-HC, H-YY, C-YL, C-CH, J-TF, C-WY, Y-CC); Department of Cardiology, Chang Gung Memorial Hospital, Taipei, Taiwan (C-HY, T-HC); Clinical Informatics and Medical Statistics Research Center, Taipei, Taiwan (S-WC); Department of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan (Y-TC); and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C-HC, H-YY, C-YL, C-CH, J-TF, C-WY, Y-CC)
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49
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Spinar J, Jarkovsky J, Spinarova L, Mebazaa A, Gayat E, Vitovec J, Linhart A, Widimsky P, Miklik R, Zeman K, Belohlavek J, Malek F, Felsoci M, Kettner J, Ostadal P, Cihalik C, Vaclavik J, Taborsky M, Dusek L, Littnerova S, Parenica J. AHEAD score--Long-term risk classification in acute heart failure. Int J Cardiol 2015; 202:21-6. [PMID: 26386914 DOI: 10.1016/j.ijcard.2015.08.187] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/22/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND The role of co-morbidities in the prognosis of patients hospitalized for AHF was examined using the AHEAD (A--atrial fibrillation, H--haemoglobin<130 g/l for men and 120 g/l for women (anaemia), E--elderly (age>70years), A--abnormal renal parameters (creatinine>130 μmol/l), D--diabetes mellitus) scoring system. METHODS AHEAD--multicentre prospective Czech registry of AHF patients; GREAT registry--international cohort of AHF patients. Data from 5846 consecutive patients hospitalized for AHF (AHEAD registry; derivation cohort) were analysed to build the AHEAD score. Each risk factor of the AHEAD score was counted as 1 point. The model was validated externally using an international cohort of similar patients in the GREAT registry (6315). RESULTS Main outcome was one year all-cause mortality. The mean age of patients was 72±12 years, with 61.6% of patients aged >70 years; 43.4% were women. Atrial fibrillation was present in 30.7%, anaemia in 38.2%, creatinine>130 mmol/l (abnormal renal parameters) in 30.1%, and diabetes mellitus in 44.0%. The mean AHEAD score was 2.1. In patients with AHEAD scores of 0-5, the one-year mortality rates were 13.6%, 23.4%, 32.0%, 41.1%, 47.7%, and 58.2%, respectively (p<0.001), and the 90 month mortality rates were 35.1%, 57.3%, 73.5%, 84.8%, 88.0%, and 91.7%, respectively (p<0.001). CONCLUSION The AHEAD is a simple scoring system based on the analysis of co-morbidities for the estimation of the short and long term prognosis of patients hospitalized for AHF.
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Affiliation(s)
- Jindrich Spinar
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Spinarova
- Medical Faculty, Masaryk University, Brno, Czech Republic; First Department of Cardiovascular Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisiere University Hospital, Paris, France; UMR-S 942, Inserm, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisiere University Hospital, Paris, France; UMR-S 942, Inserm, Paris, France
| | - Jiri Vitovec
- Medical Faculty, Masaryk University, Brno, Czech Republic; First Department of Cardiovascular Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Ales Linhart
- 2nd Department of Cardiovascular Internal Medicine, First Medical Faculty, Charles University, Prague and General Teaching Hospital of Prague, Prague, Czech Republic
| | - Petr Widimsky
- Kralovske Vinohrady University Hospital and the 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roman Miklik
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Kamil Zeman
- Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Cardiovascular Internal Medicine, First Medical Faculty, Charles University, Prague and General Teaching Hospital of Prague, Prague, Czech Republic
| | - Filip Malek
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Marian Felsoci
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Ostadal
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Cestmir Cihalik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Miloš Taborsky
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Simona Littnerova
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic.
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50
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Soyler C, Tanriover MD, Ascioglu S, Aksu NM, Arici M. Urine neutrophil gelatinase-associated lipocalin levels predict acute kidney injury in acute decompensated heart failure patients. Ren Fail 2015; 37:772-6. [DOI: 10.3109/0886022x.2015.1033324] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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