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Urinary levels of novel kidney biomarkers and risk of true worsening renal function and mortality in patients with acute heart failure
Author(s) -
Sokolski Mateusz,
Zymliński Robert,
Biegus Jan,
Siwołowski Paweł,
NawrockaMillward Sylwia,
Todd John,
Yerramilli Malli Rama,
Estis Joel,
Jankowska Ewa Anita,
Banasiak Waldemar,
Ponikowski Piotr
Publication year - 2017
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.746
Subject(s) - cystatin c , medicine , renal function , creatinine , weather research and forecasting model , acute kidney injury , heart failure , biomarker , urology , cardiology , climatology , biochemistry , chemistry , geology
Aims Recent studies indicate the need to redefine worsening renal function ( WRF ) in acute heart failure ( AHF ), linking a rise in creatinine with clinical status to identify patients who develop ‘true WRF ’. We evaluated the usefulness of serial assessment of urinary levels of neutrophil gelatinase‐associated lipocalin ( uNGAL ), kidney injury molecule‐1 ( uKIM ‐1), and cystatin C ( uCysC ) for prediction of ‘true WRF ’. Methods and results In 132 patients with AHF , uNGAL , uKIM ‐1, and uCysC were measured using a highly sensitive immunoassay based on a single‐molecule counting technology (Singulex, Alameda, CA, USA ) at baseline, day 2, and day 3. Patients who developed WRF (a ≥0.3 mg/ dL increase in serum creatinine or a >25% decrease in the estimated glomerular filtration rate from the baseline value) were differentiated into those ‘true WRF ’ (presence of deterioration/no improvement in clinical status during hospitalization) vs. ‘pseudo‐ WRF ’ (uneventful clinical course). ‘True WRF ’ occurred in 13 (10%), ‘pseudo‐ WRF ’ in 15 (11%), whereas the remaining 104 (79%) patients did not develop WRF . Patients with ‘true WRF ’ were more often females, had higher levels of NT‐proBNP , creatinine, and urea on admission, higher urine albumin to creatinine ratio at day 2, higher uNGAL at baseline, day 2, and day 3, and higher KIM ‐1 at day 2 (vs. pseudo‐ WRF vs. without WRF , all P < 0.05). Patients with pseudo‐ WRF did not differ from those without WRF . In the multivariable model, elevated uNGAL at all time points and uKIM ‐1 at day 2 remained independent predictors of ‘true WRF ’. Conclusion Elevated levels of uNGAL and uKIM ‐1 may predict development of ‘true WRF ’ in AHF .