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B‐type natriuretic peptide trend predicts clinical significance of worsening renal function in acute heart failure
Author(s) -
Wettersten Nicholas,
Horiuchi Yu,
Veldhuisen Dirk J.,
Mueller Christian,
Filippatos Gerasimos,
Nowak Richard,
Hogan Christopher,
Kontos Michael C.,
Can Chad M.,
Müeller Gerhard A.,
Birkhahn Robert,
Taub Pam,
Vilke Gary M.,
Barnett Olga,
McDonald Kenneth,
Mahon Niall,
Nuñez Julio,
Briguori Carlo,
Passino Claudio,
Murray Patrick T.,
Maisel Alan
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1627
Subject(s) - medicine , natriuretic peptide , heart failure , cardiology , renal function , creatinine , acute decompensated heart failure , acute kidney injury , proportional hazards model , incidence (geometry) , physics , optics
Abstract Aims In acute heart failure (AHF), relationships between changes in B‐type natriuretic peptide (BNP) and worsening renal function (WRF) and its prognostic implications have not been fully determined. We investigated the relationship between WRF and a decrease in BNP with in‐hospital and 1‐year mortality in AHF. Methods and results The Acute Kidney Injury NGAL Evaluation of Symptomatic heart faIlure Study (AKINESIS) was a prospective, international, multicentre study of AHF patients. Severe WRF (sWRF) was a sustained increase of ≥44.2 μmol/L (0.5 mg/dL) or ≥50% in creatinine, non‐severe WRF (nsWRF) was a non‐sustained increase of ≥26.5 μmol/L (0.3 mg/dL) or ≥50% in creatinine, and WRF with clinical deterioration was nsWRF with renal replacement therapy, inotrope use, or mechanical ventilation. Decreased BNP was defined as a ≥30% reduction in the last measured BNP compared to admission BNP. Among 814 patients, the incidence of WRF was not different between patients with or without decreased BNP (nsWRF: 33% vs. 31%, P = 0.549; sWRF: 11% vs. 9%, P = 0.551; WRF with clinical deterioration: 8% vs. 10%, P = 0.425). Decreased BNP was associated with better in‐hospital and 1‐year mortality regardless of WRF, while WRF was associated with worse outcomes only in patients without decreased BNP. In multivariate Cox regression analysis, decreased BNP, sWRF, and WRF with clinical deterioration were significantly associated with 1‐year mortality. Conclusions Decreased BNP was associated with better in‐hospital and long‐term outcomes. WRF was only associated with adverse outcomes in patients without decreased BNP.