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. 2019 Dec;21(12):1553-1560.
doi: 10.1002/ejhf.1627. Epub 2019 Nov 25.

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

Nicholas Wettersten  1   2 , Yu Horiuchi  1   2 , Dirk J van Veldhuisen  3 , Christian Mueller  4 , Gerasimos Filippatos  5 , Richard Nowak  6 , Christopher Hogan  7 , Michael C Kontos  8 , Chad M Cannon  9 , Gerhard A Müeller  10 , Robert Birkhahn  11 , Pam Taub  1 , Gary M Vilke  12 , Olga Barnett  13 , Kenneth McDonald  14   15 , Niall Mahon  14 , Julio Nuñez  16 , Carlo Briguori  17 , Claudio Passino  18 , Patrick T Murray  14 , Alan Maisel  1
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Free article

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

Nicholas Wettersten et al. Eur J Heart Fail. 2019 Dec.
Free article

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.

Keywords: Acute heart failure; B-type natriuretic peptide; Mortality; Worsening renal function.

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References

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