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10.1161/CIRCHEARTFAILURE.112.968230

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C4067251!4067251 !23325460
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suck abstract from ncbi


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pmid23325460
      Circ+Heart+Fail 2013 ; 6 (2 ): 233-9
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  • 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.
  • |*Blood Urea Nitrogen [MESH]
  • |Aged [MESH]
  • |Aged, 80 and over [MESH]
  • |Biomarkers/blood [MESH]
  • |Cardio-Renal Syndrome/blood/*etiology/mortality/physiopathology [MESH]
  • |Chi-Square Distribution [MESH]
  • |Creatinine/*blood [MESH]
  • |Female [MESH]
  • |Glomerular Filtration Rate [MESH]
  • |Heart Failure/blood/*complications/mortality/physiopathology [MESH]
  • |Humans [MESH]
  • |Kaplan-Meier Estimate [MESH]
  • |Kidney/metabolism/*physiopathology [MESH]
  • |Logistic Models [MESH]
  • |Male [MESH]
  • |Middle Aged [MESH]
  • |Multivariate Analysis [MESH]
  • |Odds Ratio [MESH]
  • |Patient Admission [MESH]
  • |Prognosis [MESH]
  • |Proportional Hazards Models [MESH]
  • |Retrospective Studies [MESH]
  • |Risk Assessment [MESH]
  • |Risk Factors [MESH]
  • |Time Factors [MESH]


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