Interaction between loop diuretic-associated mortality and blood urea nitrogen concentration in chronic heart failure.
Interaction between loop diuretic-associated mortality and blood urea nitrogen concentration in chronic heart failure.
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DOI：
10.1016/j.jacc.2011.01.052
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发表时间：
2011-07-19
影响因子：
24
通讯作者：
Kimmel SE
中科院分区：
文献类型：
--
作者：
Testani JM;Cappola TP;Brensinger CM;Shannon RP;Kimmel SE
本研究的目的是研究肾神经激素激活的替代物血尿素氮（BUN）是否可以识别注定会发生与使用高剂量袢利尿剂（HDLD）相关的不良结局的患者。袢利尿剂通常用于控制心力衰竭的充血症状;然而，这些药物会引起神经激素激活，并与生存恶化相关。对基线时接受袢利尿剂的β受体阻滞剂生存评价试验中的受试者进行了分析（n=2456）。主要结局是BUN和HDLD相关死亡率之间的相互作用。在整个队列中，HDLD使用（≥160 mg/天）与死亡率增加相关（HR=1.56，95% CI 1.35 - 1.80）。然而，在广泛控制基线特征后，这种相关性并不持续（HR=1.06，95% CI 0.89 - 1.25）。在BUN水平高于中位数（21.0 mg/dl）的受试者中，HDLD组的未校正（HR=1.59，95% CI 1.34 - 1.88）和校正（HR=1.29，95% CI 1.07 - 1.60）死亡风险均较高。在BUN水平低于中位数的患者中，HDLD无相关风险（HR= 0. 99，95% CI 0. 75 - 1. 34），在控制基线特征后，HDLD组的生存率显著改善（HR= 0. 71，95% CI 0. 49 - 0. 96）（p相互作用= 0. 018）。与HDLD使用相关的风险在很大程度上取决于BUN浓度，BUN升高患者的生存率降低，BUN正常患者的生存率提高。这些数据表明神经激素激活在袢利尿剂相关死亡率中的作用。
The purpose of this study was to investigate if a surrogate for renal neurohormonal activation, blood urea nitrogen (BUN), could identify patients destined to experience adverse outcomes associated with the use of high dose loop diuretics (HDLD). Loop diuretics are commonly used to control congestive symptoms in heart failure; however, these agents cause neurohormonal activation and are associated with worsened survival. Subjects in the Beta-Blocker Evaluation of Survival Trial receiving loop diuretics at baseline were analyzed (n=2456). The primary outcome was the interaction between BUN and HDLD associated mortality. In the overall cohort, HDLD use (≥160 mg/day) was associated with increased mortality (HR=1.56, 95% CI 1.35 to 1.80). However, after extensively controlling for baseline characteristics, this association did not persist (HR=1.06, 95% CI 0.89 to 1.25). In subjects with BUN levels above the median (21.0 mg/dl), both the unadjusted (HR=1.59, 95% CI 1.34 to 1.88) and adjusted (HR=1.29, 95% CI 1.07 to 1.60) risk for death was higher in the HDLD group. In patients with BUN levels below the median, there was no associated risk with HDLD (HR=0.99, 95% CI 0.75 to 1.34) and after controlling for baseline characteristics, the HDLD group had significantly improved survival (HR=0.71, 95% CI 0.49 to 0.96) (p interaction=0.018). The risk associated with HDLD use is strongly dependent on BUN concentrations with reduced survival in patients with elevated BUN and improved survival in patients with normal BUN. These data suggest a role for neurohormonal activation in loop diuretic associated mortality.
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DOI：
10.1152/ajprenal.2000.279.5.f835
发表时间：
2000-11-01
影响因子：
4.2
作者：
Kato, A;Klein, JD;Sands, JM
通讯作者：
Sands, JM
影响因子：
37.8
作者：
Cooper, HA;Dries, DL;Domanski, MJ
通讯作者：
Domanski, MJ
DOI：
10.1016/s0735-1097(03)00765-4
发表时间：
2003-08-20
影响因子：
24
作者：
Domanski, M;Norman, J;Peyster, E
通讯作者：
Peyster, E
影响因子：
4.5
作者：
Fenton, Robert A.
通讯作者：
Fenton, Robert A.
影响因子：
39.2
作者：
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通讯作者：
Van Lente, Frederick