Year: 2021
Type: article
Abstract: BACKGROUND: For patients with acute heart failure (AHF), substantial diuresis after administration of loop diuretics is generally associated with better clinical outcomes but may cause creatinine to rise, suggesting renal function decline. We investigated the interaction between diuretic response and worsening renal function (WRF) on clinical outcomes in patients with AHF. METHODS AND RESULTS: In two AHF cohorts (PROTECT, n = 1698 and RELAX-AHF-2, n = 5586 in current analysis), the prognostic impact of WRF (creatinine ≥0.3 mg/dl increase baseline-day 4; sensitivity analyses incorporated baseline renal function) by diuretic response (kg weight loss/40 mg furosemide equivalent baseline-day 4) was investigated with regard to (cardiovascular) death or cardiovascular/renal hospitalization using subpopulation treatment effect pattern plots (STEPP) and survival analyses. WRF occurred in 286 (16.8%) and 1031 (18.5%) patients in PROTECT and RELAX-AHF-2, respectively. Patients with WRF had higher left ventricular ejection fraction and lower estimated glomerular filtration rate at baseline (p < 0.05), and received higher doses of loop diuretics and had a worse diuretic response (p < 0.001). In patients with a poor diuretic response (≤0.35 kg weight loss/40 mg furosemide equivalent as identified by STEPP), WRF was associated with higher risk of (cardiovascular) death or cardiovascular/renal hospitalization (p < 0.001 both cohorts), but this was not the case for patients with a good diuretic response (p = 0.900 both cohorts). CONCLUSION: In two large cohorts of patients with AHF, WRF in the first 4 days was not associated with worse outcomes when patients had a good diuretic response. The occurrence of WRF in patients with AHF should therefore be considered in the context of diuretic response.
DOI: 10.1002/ejhf.2384
Authors: Johanna E. Emmens, Jozine M. ter Maaten, Yuya Matsue, Sylwia M. Figarska, Iziah E. Sama, Gad Cotter, John G.F. Cleland, Beth A. Davison, G. Michael Felker, Michael M. Givertz, Barry Greenberg, Peter S. Pang, Thomas Severin, Claudio Gimpelewicz, Marco Metra, Adriaan A. Voors, John R. Teerlink
Institutions: University Medical Center Groningen, University of Groningen, Juntendo University, Inserm, Marqueurs cardiovasculaires en situation de stress, Glasgow Royal Infirmary, Imperial College London, University of Glasgow, Duke University, Duke Medical Center, Duke Clinical Research Institute, Brigham and Women's Hospital, UC San Diego Health System, University of California San Diego, Indiana University Indianapolis, Indiana University School of Medicine, Novartis (Switzerland), University of Brescia, San Francisco VA Medical Center, University of California, San Francisco
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,700
OpenAlex ID: W3213007181