Abstract 18113: Persistent High Blood Urea Nitrogen Level is Associated With Increased Cardiovascular Mortality in Acute Heart Failure Patients

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-11, Vol.134 (Suppl_1 Suppl 1), p.A18113-A18113
• Main Authors: Jujo, Kentaro, Tanigaito, Yusuke, Minami, Yuichiro, Yoshida, Ayano, Kikuchi, Yasuhiro, Haruki, Shintaro, Shimazaki, Kensuke, Itani, Ryosuke, Arashi, Hiroyuki, Shibahashi, Eiji, Yamaguchi, Junichi, Ogawa, Hiroshi, Hagiwara, Nobuhisa
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionRecent clinical trials and observations demonstrated in patients with congestive heart failure (CHF) that high blood urea nitrogen (BUN) on admission was associated with poor cardiovascular outcomes. However, the impact of baseline values and changes in BUN level during hospitalization on long-term prognosis in CHF patients has not been fully evaluated.MethodS and ResultsThis study initially included 403 consecutive patients without regular hemodialysis who were urgently hospitalized due to worsening of CHF. After the exclusion of patients who died in hospital and patients without BUN data at discharge, total of 353 patients were divided into 4 subgroups depending on BUN at admission and discharge with cut-off of 21.0 mg/dL, referring to previous reports. Among 206 patients with high baseline BUN, 46 (22%) had normal BUN and 160 (78%) had persistent high BUN at discharge. In contrast, of 147 patients with normal baseline BUN, 55 patients (37%) had high BUN and 92 patients (63%) had normal BUN at discharge. During 330 days of median follow-up period, Kaplan-Meier analysis showed the highest cardiovascular mortality in persistent high BUN patients (1-year rate87%, Log-rank testp=0.010, Figure). However, normalized BUN patients achieved similar outcomes to normal baseline BUN patients (p=0.96). Among high baseline BUN patients as high-risk population, logistic regression analysis revealed that high BUN and low hemoglobin on admission were independent predictors for persistent high BUN (BUNcut-off 26.5 mg/dL, Relative risk5.09 (95%Confidence interval2.06-12.6); hemoglobincut-off 11.4 g/dL, 2.67 (1.16-6.14)). Moreover, persistent high BUN patients showed significantly longer hospital stay than normalized BUN patients (30 vs. 22 days, p=0.003).ConclusionPersistent high BUN level is associated with increased cardiovascular mortality. Normalization of BUN during hospitalization may improve long-term clinical outcomes.