Fractional excretion of urea nitrogen can identify true worsening renal function in patients with heart failure

Yukihiro Watanabe; Yoshiaki Kubota; Takuya Nishino; Shuhei Tara; Katsuhito Kato; Daisuke Hayashi; Junya Matsuda; Hideki Miyachi; Yukichi Tokita; Yu-Ki Iwasaki; Kuniya Asai

doi:10.1002/ehf2.14755

Fractional excretion of urea nitrogen can identify true worsening renal function in patients with heart failure

ESC Heart Fail. 2024 Mar 24. doi: 10.1002/ehf2.14755. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
² Department of Health Care Administration, Nippon Medical School, Tokyo, Japan.
³ Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.
⁴ Department of Pharmaceutical Service, Nippon Medical School Hospital, Tokyo, Japan.
⁵ Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo, Japan.

PMID: 38522427
DOI: 10.1002/ehf2.14755

Abstract

Aims: Fractional excretion of urea nitrogen (FEUN), used to differentiate the cause of acute kidney injury, has emerged as a useful fluid index in patients with heart failure (HF). We hypothesized that FEUN could be useful in identifying worsening renal function (WRF) associated with poor outcomes in patients with acute HF (AHF).

Methods and results: Overall, 1103 patients with AHF (median age, 78 years; male proportion, 60%) were categorized into six groups according to the presence of WRF and FEUN values (low, ≤32.1%; medium, >32.1% and ≤38.0%; and high, >38.0%) at discharge. WRF was defined as an increase of ≥0.3 mg/dL in the serum creatinine level from admission to discharge. FEUN was calculated by the following formula: (urinary urea × serum creatinine) × 100/(serum urea × urinary creatinine). The cut-off values for low, medium, and high FEUN were based on a previous study. The primary outcome of this study was HF readmission after hospital discharge. During the 1 year follow-up, 170 HF readmissions occurred. Kaplan-Meier analysis revealed significantly higher HF readmission rates in patients with WRF than in those without WRF (log-rank test, P < 0.001). Additionally, among patients with WRF, HF readmission rates were lowest in those with medium FEUN values, followed by those with low FEUN values and those with high FEUN values. On multivariable analysis, the presence of WRF with low or high FEUN values was independently associated with increased HF readmission, as compared with the absence of WRF with medium FEUN values. Notably, no association was noted between WRF with medium FEUN values and HF readmission.

Conclusions: The prognostic impact of WRF was significantly mediated by the FEUN values and was associated with worse outcomes only when the FEUN values were either low or high. Our study suggests that FEUN can identify prognostically relevant WRF in patients with AHF.

Keywords: Acute decompensated heart failure; Biomarker; Cardiorenal syndrome; Renal dysfunction.