Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure

• Published in: PloS one 2020-06, Vol.15 (6), p.e0235493-e0235493
• Main Authors: Yoshioka, Kenji, Matsue, Yuya, Okumura, Takahiro, Kida, Keisuke, Oishi, Shogo, Akiyama, Eiichi, Suzuki, Satoshi, Yamamoto, Masayoshi, Mizukami, Akira, Kuroda, Shunsuke, Kagiyama, Nobuyuki, Yamaguchi, Tetsuo, Sasano, Tetsuo, Matsumura, Akihiko, Kitai, Takeshi
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Blood pressure; Brain; Brain natriuretic peptide; Cardiology; Care and treatment; Complications and side effects; Congestive heart failure; Creatinine; Ejection fraction; Health aspects; Heart failure; Hemoglobin; Kidney diseases; Medical prognosis; Medicine; Medicine and Health Sciences; Mortality; Patients; Peptides; Physical Sciences; Physiological aspects; Prognosis; Reduction; Regression analysis; Renal function; Research and Analysis Methods; Studies; University graduates
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0235493

Aims The prognostic impact of worsening renal function (WRF) in patients with acute heart failure (AHF) remains under debate. Successful decongestion might offset the negative impact of WRF, but little is known about indicators of successful decongestion in the very acute phase of AHF. We hypothesized that decongestion as evaluated by the percent reduction in brain natriuretic peptide (BNP) could identify relevant prognostic implications of WRF in the very acute phase of AHF. Methods and results Data on 907 consecutive hospitalized patients with AHF in the REALITY-AHF study (age: 78±12 years; 55.1% male) were analyzed. Creatinine and BNP were measured at baseline and 48 hours from admission. WRF was defined as an increase in creatinine >0.3 mg at 48 hours from admission. The primary endpoint was 1-year all-cause mortality. Patients were divided into four groups according to the presence/absence of WRF and a BNP reduction higher/lower than the median: no-WRF/higher-BNP-reduction (n = 390), no-WRF/lower-BNP-reduction (n = 397), WRF/higher-BNP-reduction (n = 63), and WRF/lower-BNP-reduction groups (n = 57). Kaplan-Meier curve analysis showed that the WRF/lower-BNP-reduction group had a worse prognosis than the other groups. In a Cox regression analysis, only the WRF/lower-BNP-reduction group had higher mortality compared to the no-WRF/higher-BNP-reduction group (hazard ratio: 3.34, p