Improvement in Renal Function During the Treatment of Acute Decompensated Heart Failure: Relationship With Markers of Renal Tubular Injury and Prognostic Importance.
Improvement in Renal Function During the Treatment of Acute Decompensated Heart Failure: Relationship With Markers of Renal Tubular Injury and Prognostic Importance.
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急性失代偿性心力衰竭治疗期间肾功能的改善：与肾小管损伤标志物和预后重要性的关系。
DOI：
10.1161/circheartfailure.122.009776
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Testani,JeffreyM
中科院分区：
文献类型：
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作者：
Natov,PeterS;Ivey-Miranda,JuanB;Cox,ZacharyL;Moreno-Villagomez,Julieta;Maulion,Christopher;Bellumkonda,Lavanya;Shlipak,MichaelG;Estrella,MichelleM;Borlaug,BarryA;Rao,VeenaS;Testani,JeffreyM
急性失代偿性心力衰竭患者肾功能改善与不良结局相关。导致这一矛盾的机制尚不清楚。（肾脏优化策略评价-急性心力衰竭），根据肾功能对277例患者进行分组，IRF定义为增加≥20%（N=75），肾功能恶化定义为下降≥20%（N=53），和稳定的肾功能（SRF），在基线和72小时之间估计的肾小球滤过率变化<20%（N=149）。在基线和72小时评价了三种经过充分验证的肾小管损伤标志物NGAL（中性粒细胞明胶酶相关脂质运载蛋白）、NAG（N-乙酰-β-d-氨基葡萄糖苷酶）和KIM-1（肾损伤分子1）。患者还根据这些标志物的变化模式进行分类。结果IRF患者的入院估计肾小球滤过率最低（IRF，37 [28至51] mL/min/1.73 m2;肾功能恶化，43 [35至55] mL/min/1.73 m2; SRF，43 [32至55] mL/min/1.73 m2; P趋势=0.032），但累积尿量更大（IRF，8780 [7025至11 208] mL;肾功能恶化，7860 [5555至9765] mL; SRF，8150 [6325至10 456] mL; P趋势=0.024）和体重减轻（IRF，-9.0 [-12.4至-5.3] lb;肾功能恶化，-5.1 [-8.1至-1.3] lb; SRF，-7.1 [-11.9至-3.2] lb; P趋势<0.001），尽管利尿剂剂量相似（P趋势=0.16）。肾功能组间NGAL、NAG或KIM-1的相对变化无差异（P趋势均>0.19）。IRF患者的生存率低于SRF患者（27%对54%;风险比，1.98 [1.10-3.58]; P=0.024）。结论急性失代偿性心力衰竭减充血治疗期间IRF与肾小管损伤标志物的改善无关，与生存率恶化相关，可能是由于存在更大的潜在心肾功能障碍和更严重的充血。
BackgroundImprovement in renal function (IRF) in acute decompensated heart failure is associated with adverse outcomes. The mechanisms driving this paradox remain undefined.MethodsUsing the ROSE-AHF study (Renal Optimization Strategies Evaluation–Acute Heart Failure), 277 patients were grouped according to renal function, with IRF defined by a ≥20% increase (N=75), worsening renal function by a ≥20% decline (N=53), and stable renal function (SRF) by a <20% change (N=149) in estimated glomerular filtration rate between baseline and 72 hours. Three well-validated renal tubular injury markers, NGAL (neutrophil gelatinase-associated lipocalin), NAG (N-acetyl-β-d-glucosaminidase), and KIM-1 (kidney injury molecule 1), were evaluated at baseline and 72 hours. Patients were also classified by the pattern of change in these markers.ResultsPatients with IRF had the lowest admission estimated glomerular filtration rate (IRF, 37 [28 to 51] mL/min per 1.73 m2; worsening renal function, 43 [35 to 55] mL/min per 1.73 m2; and SRF, 43 [32 to 55] mL/min per 1.73 m2;Ptrend=0.032) but greater cumulative urine output (IRF, 8780 [7025 to 11 208] mL; worsening renal function, 7860 [5555 to 9765] mL; and SRF, 8150 [6325 to 10 456] mL;Ptrend=0.024) and weight loss (IRF, –9.0 [–12.4 to –5.3] lb; worsening renal function, –5.1 [–8.1 to –1.3] lb; and SRF, –7.1 [–11.9 to –3.2] lb;Ptrend<0.001) despite similar diuretic doses (Ptrend=0.16). There were no differences in the relative change in NGAL, NAG, or KIM-1 between renal function groups (Ptrend>0.19 for all). Patients with IRF had worse survival than patients with SRF (27% versus 54%; hazard ratio, 1.98 [1.10–3.58];P=0.024).ConclusionsIRF during decongestive therapy for acute decompensated heart failure was not associated with improved markers of renal tubular injury and was associated with worsened survival, likely driven by the presence of greater underlying cardiorenal dysfunction and more severe congestion.