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2013 ; 6
(2
): 233-9
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Blood urea nitrogen/creatinine ratio identifies a high-risk but potentially
reversible form of renal dysfunction in patients with decompensated heart
failure
#MMPMID23325460
Brisco MA
; Coca SG
; Chen J
; Owens AT
; McCauley BD
; Kimmel SE
; Testani JM
Circ Heart Fail
2013[Mar]; 6
(2
): 233-9
PMID23325460
show ga
BACKGROUND: Identifying reversible renal dysfunction (RD) in the setting of heart
failure is challenging. The goal of this study was to evaluate whether elevated
admission blood urea nitrogen/creatinine ratio (BUN/Cr) could identify
decompensated heart failure patients likely to experience improvement in renal
function (IRF) with treatment. METHODS AND RESULTS: Consecutive hospitalizations
with a discharge diagnosis of heart failure were reviewed. IRF was defined as
?20% increase and worsening renal function as ?20% decrease in estimated
glomerular filtration rate. IRF occurred in 31% of the 896 patients meeting
eligibility criteria. Higher admission BUN/Cr was associated with in-hospital IRF
(odds ratio, 1.5 per 10 increase; 95% confidence interval [CI], 1.3-1.8;
P<0.001), an association persisting after adjustment for baseline characteristics
(odds ratio, 1.4; 95% CI, 1.1-1.8; P=0.004). However, higher admission BUN/Cr was
also associated with post-discharge worsening renal function (odds ratio, 1.4;
95% CI, 1.1-1.8; P=0.011). Notably, in patients with an elevated admission
BUN/Cr, the risk of death associated with RD (estimated glomerular filtration
rate <45) was substantial (hazard ratio, 2.2; 95% CI, 1.6-3.1; P<0.001). However,
in patients with a normal admission BUN/Cr, RD was not associated with increased
mortality (hazard ratio, 1.2; 95% CI, 0.67-2.0; P=0.59; p interaction=0.03).
CONCLUSIONS: An elevated admission BUN/Cr identifies decompensated patients with
heart failure likely to experience IRF with treatment, providing proof of concept
that reversible RD may be a discernible entity. However, this improvement seems
to be largely transient, and RD, in the setting of an elevated BUN/Cr, remains
strongly associated with death. Further research is warranted to develop
strategies for the optimal detection and treatment of these high-risk patients.