Competing Risk of Cardiac Status and Renal Function During Hospitalization for Acute Decompensated Heart Failure

JACC Heart Fail. 2015 Oct;3(10):751-61. doi: 10.1016/j.jchf.2015.05.009.

Abstract

Objectives: The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF).

Background: Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters.

Methods: This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge.

Results: A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables.

Conclusions: When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe WRF is a measure of prognosis, but is of lesser value than, and independent of the prognostic changes induced by adequate NT-proBNP reduction. This suggests that in ADHF patients it may be warranted to strive for an optimal decrease in NT-proBNP, even if this induces WRF.

Keywords: NT-proBNP; WRF; heart failure; prognosis; renal function.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Cardio-Renal Syndrome / diagnosis*
  • Cardio-Renal Syndrome / mortality
  • Cardio-Renal Syndrome / therapy
  • Cohort Studies
  • Confidence Intervals
  • Databases, Factual
  • Female
  • Glomerular Filtration Rate / physiology
  • Heart Failure / diagnosis*
  • Heart Failure / mortality
  • Heart Failure / therapy
  • Hospital Mortality / trends*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Function Tests
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Peptide Fragments / blood*
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain