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Randomized Controlled Trial
. 2020 Mar;133(3):370-380.e4.
doi: 10.1016/j.amjmed.2019.07.041. Epub 2019 Aug 15.

CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

Julio Núñez  1 , Pau Llàcer  2 , Sergio García-Blas  3 , Clara Bonanad  4 , Silvia Ventura  5 , José María Núñez  6 , Ruth Sánchez  7 , Lorenzo Fácila  8 , Rafael de la Espriella  4 , Juana María Vaquer  9 , Alberto Cordero  10 , Mercè Roqué  11 , Carlos Chamorro  7 , Vicent Bodi  3 , Ernesto Valero  3 , Enrique Santas  4 , María Del Carmen Moreno  2 , Gema Miñana  3 , Arturo Carratalá  9 , Enrique Rodríguez  9 , Anna Mollar  4 , Patricia Palau  12 , María José Bosch  5 , Vicente Bertomeu-González  10 , Josep Lupón  13 , Jorge Navarro  14 , Francisco J Chorro  3 , Jose L Górriz  15 , Juan Sanchis  3 , Adriaan A Voors  16 , Antoni Bayés-Genís  13
Affiliations
Randomized Controlled Trial

CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

Julio Núñez et al. Am J Med. 2020 Mar.

Abstract

Background: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation.

Methods: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively.

Results: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391).

Conclusion: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.

Keywords: Acute heart failure; Biomarker guided-therapy; Carbohydrate antigen 125; Clinical trial; Diuretic treatment; Renal failure.

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