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B‐type natriuretic peptide trend predicts clinical significance of worsening renal function in acute heart failure

2019; Elsevier BV; Volume: 21; Issue: 12 Linguagem: Inglês

10.1002/ejhf.1627

1879-0844

Nicholas Wettersten, Yu Horiuchi, Dirk J. van Veldhuisen, Christian Mueller, Gerasimos Filippatos, Richard M. Nowak, Christopher J. Hogan, Michael C. Kontos, Chad Cannon, Gerhard Mueller, Robert Birkhahn, Pam R. Taub, Gary M. Vilke, Olga Barnett, Kenneth McDonald, Niall Mahon, Julio Núñez, Carlo Briguori, Claudio Passino, Patrick Murray, Alan S. Maisel,

Renal function and acid-base balance

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.