Open AccessHemoconcentration of Creatinine Minimally Contributes to Changes in Creatinine during the Treatment of Decompensated Heart Failure
Author(s) -
Christopher Maulion,
Sheldon Chen,
Veena S. Rao,
Juan B. IveyMiranda,
Zachary L. Cox,
Devin Mahoney,
Steven G. Coca,
Dan Negoianu,
Jennifer Asher,
Jeffrey M. Turner,
Lesley A. Inker,
F. Perry Wilson,
Jeffrey M. Testani
Publication year - 2022
Publication title -
kidney360
Language(s) - English
Resource type - Journals
ISSN - 2641-7650
DOI - 10.34067/kid.0007582021
Subject(s) - creatinine , renal function , acute decompensated heart failure , medicine , diuresis , urology , heart failure , endocrinology , cardiology
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 non-filtration 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 to 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, -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=.003). Overall, -3.3% of the change in Cr72HR Kinetic was attributable to the change in VD. A ≥0.3 mg/dL rise in Cr72HR Kinetic was not associated with worsening of KIM-1, NGAL, NAG, or post discharge survival (p>.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.