Document Detail


Blood urea nitrogen/creatinine ratio identifies a high-risk but potentially reversible form of renal dysfunction in patients with decompensated heart failure.
MedLine Citation:
PMID:  23325460     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Identifying reversible renal dysfunction (RD) in the setting of heart failure is challenging. The goal of this study was to evaluate whether elevated admission blood urea nitrogen/creatinine ratio (BUN/Cr) could identify decompensated heart failure patients likely to experience improvement in renal function (IRF) with treatment.
METHODS AND RESULTS: Consecutive hospitalizations with a discharge diagnosis of heart failure were reviewed. IRF was defined as ≥20% increase and worsening renal function as ≥20% decrease in estimated glomerular filtration rate. IRF occurred in 31% of the 896 patients meeting eligibility criteria. Higher admission BUN/Cr was associated with in-hospital IRF (odds ratio, 1.5 per 10 increase; 95% confidence interval [CI], 1.3-1.8; P<0.001), an association persisting after adjustment for baseline characteristics (odds ratio, 1.4; 95% CI, 1.1-1.8; P=0.004). However, higher admission BUN/Cr was also associated with post-discharge worsening renal function (odds ratio, 1.4; 95% CI, 1.1-1.8; P=0.011). Notably, in patients with an elevated admission BUN/Cr, the risk of death associated with RD (estimated glomerular filtration rate <45) was substantial (hazard ratio, 2.2; 95% CI, 1.6-3.1; P<0.001). However, in patients with a normal admission BUN/Cr, RD was not associated with increased mortality (hazard ratio, 1.2; 95% CI, 0.67-2.0; P=0.59; p interaction=0.03).
CONCLUSIONS: An elevated admission BUN/Cr identifies decompensated patients with heart failure likely to experience IRF with treatment, providing proof of concept that reversible RD may be a discernible entity. However, this improvement seems to be largely transient, and RD, in the setting of an elevated BUN/Cr, remains strongly associated with death. Further research is warranted to develop strategies for the optimal detection and treatment of these high-risk patients.
Authors:
Meredith A Brisco; Steven G Coca; Jennifer Chen; Anjali Tiku Owens; Brian D McCauley; Stephen E Kimmel; Jeffrey M Testani
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-01-16
Journal Detail:
Title:  Circulation. Heart failure     Volume:  6     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-20     Completed Date:  2013-05-09     Revised Date:  2014-06-25    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  233-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Biological Markers / blood
Blood Urea Nitrogen*
Cardio-Renal Syndrome / blood,  etiology*,  mortality,  physiopathology
Chi-Square Distribution
Creatinine / blood*
Female
Glomerular Filtration Rate
Heart Failure / blood,  complications*,  mortality,  physiopathology
Humans
Kaplan-Meier Estimate
Kidney / metabolism,  physiopathology*
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Patient Admission
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Up-Regulation
Grant Support
ID/Acronym/Agency:
1K23HL11486-01/HL/NHLBI NIH HHS; 5T32HL007843-15/HL/NHLBI NIH HHS; 5T32HL007891/HL/NHLBI NIH HHS; K23 HL114868/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; AYI8EX34EU/Creatinine
Comments/Corrections

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