| Tubular damage in chronic systolic heart failure is associated with reduced survival independent of glomerular filtration rate. | |
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MedLine Citation:
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PMID: 20659949 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The prognostic impact of reduced glomerular filtration rate (GFR) in chronic heart failure (CHF) is increasingly recognised, but little is known about tubular damage in these patients. OBJECTIVE: To investigate the prevalence of tubular damage, and its association with GFR, and prognosis in patients with CHF. METHODS AND RESULTS: In 90 patients with CHF, GFR and effective renal plasma flow (ERPF) were measured ([(125)I]iothalamate and [(131)I]hippuran clearances). The tubular markers neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-beta-D-glucosaminidase (NAG) and kidney injury molecule 1 (KIM-1) as well as urinary albumin excretion were determined in 24 h urine collections. Mean GFR was 78+/-26 ml/min/1.73 m(2). Urinary NGAL (175 (70-346) microg/g creatinine (gCr)), NAG (12 (6-17) U/gCr) and KIM-1 (277 (188-537) ng/gCr) levels were increased compared with 20 healthy controls (all p<0.001). Urinary NAG, but not NGAL or KIM-1 correlated with GFR (r=-0.34, p=0.001) and ERPF (r=-0.29, p=0.006). Both NAG (r=0.21, p=0.048) and KIM-1 (r=0.23, p=0.033) correlated with plasma N-terminal pro-brain natriuretic peptide levels. Both urinary KIM-1 (HR=1.15 (95% CI 1.02 to 1.30) per 100 ng/gCr increase, p=0.025) and NAG (HR=1.42 (95% CI 1.02 to 1.94) per 5 U/gCr increase, p=0.039), were associated with an increased risk of death or heart failure hospitalisations, independent of GFR. CONCLUSION: Tubular damage, as indicated by increased urinary concentrations of NGAL, NAG and KIM-1 is common in patients with CHF and mildly reduced GFR. Both urinary KIM-1 and NAG showed prognostic information additional to GFR. These findings suggest an important role for tubular damage and tubular markers in cardiorenal interaction in heart failure. |
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Authors:
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Kevin Damman; Dirk J Van Veldhuisen; Gerjan Navis; Vishal S Vaidya; Tom D J Smilde; B Daan Westenbrink; Joseph V Bonventre; Adriaan A Voors; Hans L Hillege |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 96 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-07-27 Completed Date: 2010-08-19 Revised Date: 2013-02-19 |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: England |
Other Details:
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Languages: eng Pagination: 1297-302 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Biological Markers / blood, urine Chronic Disease Epidemiologic Methods Female Glomerular Filtration Rate / physiology Heart Failure, Systolic / complications*, mortality, physiopathology Humans Kidney Diseases / etiology*, mortality, physiopathology Kidney Tubules / physiopathology* Male Middle Aged Prognosis Renal Circulation / physiology Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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DK39773/DK/NIDDK NIH HHS; DK74099/DK/NIDDK NIH HHS; R00 ES016723-03S1/ES/NIEHS NIH HHS; R00 ES016723-04/ES/NIEHS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers |
| Comments/Corrections | |
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