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Published in: Current Heart Failure Reports 6/2019

01-12-2019 | Kidney Injury | Biomarkers of Heart Failure (WH Tang & J Grodin, Section Editors)

Synthesizing Markers of Kidney Injury in Acute Decompensated Heart Failure: Should We Even Keep Looking?

Authors: Alexander S. Manguba Jr, Xavier Vela Parada, Steven G. Coca, Anuradha Lala

Published in: Current Heart Failure Reports | Issue 6/2019

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Abstract

Purpose of Review

This review discusses evidence that has accumulated over the years on the diagnostic and prognostic utility of biomarkers of kidney injury in the setting of acute decompensated heart failure.

Recent Findings

Despite numerous studies evaluating several different biomarkers both in the serum and urine, the current body of evidence does not support routine use of any of these biomarkers for the purposes of diagnosis of acute kidney injury or for prognosis after hospitalization for acute decompensated heart failure. All studies are observational in nature and, as such, are likely limited by numerous confounders, the most important of which is modification of decongestive therapy in response to worsening renal function. More recent evidence suggests that worsening renal function or kidney injury does not always portend poor outcomes after hospitalization for heart failure.

Summary

There is currently no conclusive evidence to recommend the routine use of biomarkers of kidney injury in acute decompensated heart failure.
Literature
19.
23.
go back to reference •• Ahmad T, Jackson K, Rao VS, WHW T, Brisco-Bacik MA, Chen HH, et al. Worsening renal function in patients with acute heart failure undergoing aggressive diuresis is not associated with tubular injury. Circulation. 2018;137(19):2016–28. https://doi.org/10.1161/CIRCULATIONAHA.117.030112This study provides evidence that that worsening renal function in the setting of decongestive therapy for heart failure is not always associated with tubular injury, and that patients with an increase in tubular injury markers have paradoxically improved outcomes. CrossRefPubMedPubMedCentral •• Ahmad T, Jackson K, Rao VS, WHW T, Brisco-Bacik MA, Chen HH, et al. Worsening renal function in patients with acute heart failure undergoing aggressive diuresis is not associated with tubular injury. Circulation. 2018;137(19):2016–28. https://​doi.​org/​10.​1161/​CIRCULATIONAHA.​117.​030112This study provides evidence that that worsening renal function in the setting of decongestive therapy for heart failure is not always associated with tubular injury, and that patients with an increase in tubular injury markers have paradoxically improved outcomes. CrossRefPubMedPubMedCentral
29.
go back to reference Murray PT, Wettersten N, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, et al. Utility of urine neutrophil gelatinase-associated lipocalin for worsening renal function during hospitalization for acute heart failure: primary findings for urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic heart faIlure Study (AKINESIS). J Card Fail. 2019. https://doi.org/10.1016/j.cardfail.2019.05.009.CrossRefPubMed Murray PT, Wettersten N, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, et al. Utility of urine neutrophil gelatinase-associated lipocalin for worsening renal function during hospitalization for acute heart failure: primary findings for urine N-gal Acute Kidney Injury N-gal Evaluation of Symptomatic heart faIlure Study (AKINESIS). J Card Fail. 2019. https://​doi.​org/​10.​1016/​j.​cardfail.​2019.​05.​009.CrossRefPubMed
30.
go back to reference Nakada Y, Kawakami R, Matsui M, Ueda T, Nakano T, Takitsume A, et al. Prognostic value of urinary neutrophil gelatinase-associated lipocalin on the first day of admission for adverse events in patients with acute decompensated heart failure. J Am Heart Assoc. 2017;6(5). https://doi.org/10.1161/JAHA.116.004582. Nakada Y, Kawakami R, Matsui M, Ueda T, Nakano T, Takitsume A, et al. Prognostic value of urinary neutrophil gelatinase-associated lipocalin on the first day of admission for adverse events in patients with acute decompensated heart failure. J Am Heart Assoc. 2017;6(5). https://​doi.​org/​10.​1161/​JAHA.​116.​004582.
40.
go back to reference Maisel AS, Mueller C, Fitzgerald R, Brikhan R, Hiestand BC, Iqbal N, et al. Prognostic utility of plasma neutrophil gelatinase-associated lipocalin in patients with acute heart failure: the NGAL EvaLuation Along with B-type NaTriuretic Peptide in acutely decompensated heart failure (GALLANT) trial. Eur J Heart Fail. 2011;13(8):846–51. https://doi.org/10.1093/eurjhf/hfr087.CrossRefPubMedPubMedCentral Maisel AS, Mueller C, Fitzgerald R, Brikhan R, Hiestand BC, Iqbal N, et al. Prognostic utility of plasma neutrophil gelatinase-associated lipocalin in patients with acute heart failure: the NGAL EvaLuation Along with B-type NaTriuretic Peptide in acutely decompensated heart failure (GALLANT) trial. Eur J Heart Fail. 2011;13(8):846–51. https://​doi.​org/​10.​1093/​eurjhf/​hfr087.CrossRefPubMedPubMedCentral
48.
go back to reference Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, et al. Clinical usefulness of urinary liver fatty acid-binding protein excretion for predicting acute kidney injury during the first 7 days and the short-term prognosis in acute heart failure patients with non-chronic kidney disease. Cardiorenal Med. 2017;7(4):301–15. https://doi.org/10.1159/000477825.CrossRefPubMedPubMedCentral Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, et al. Clinical usefulness of urinary liver fatty acid-binding protein excretion for predicting acute kidney injury during the first 7 days and the short-term prognosis in acute heart failure patients with non-chronic kidney disease. Cardiorenal Med. 2017;7(4):301–15. https://​doi.​org/​10.​1159/​000477825.CrossRefPubMedPubMedCentral
51.
go back to reference Parikh CR, Jani A, Melnikov VY, Faubel S, Edelstein CL. Urinary interleukin-18 is a marker of human acute tubular necrosis. Am J Kidney Dis. 2004;43(3):405–14.CrossRefPubMed Parikh CR, Jani A, Melnikov VY, Faubel S, Edelstein CL. Urinary interleukin-18 is a marker of human acute tubular necrosis. Am J Kidney Dis. 2004;43(3):405–14.CrossRefPubMed
66.
71.
go back to reference Ruan ZB, Zhu L, Yin YG, Chen GC. Cystatin C, N-terminal probrain natriuretic peptides and outcomes in acute heart failure with acute kidney injury in a 12-month follow-up: insights into the cardiorenal syndrome. J Res Med Sci. 2014;19(5):404–9.PubMedPubMedCentral Ruan ZB, Zhu L, Yin YG, Chen GC. Cystatin C, N-terminal probrain natriuretic peptides and outcomes in acute heart failure with acute kidney injury in a 12-month follow-up: insights into the cardiorenal syndrome. J Res Med Sci. 2014;19(5):404–9.PubMedPubMedCentral
80.••
86.••
go back to reference Rao VS, Ahmad T, Brisco-Bacik MA, Bonventre JV, Wilson FP, Siew ED, et al. Renal effects of intensive volume removal in heart failure patients with preexisting worsening renal function. Circ Heart Fail. 2019;12(6):e005552. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005552This study showed that aggressive diuresis in patients with preexisting worsening renal function does not always lead to further worsening of renal function, and that those who had increase in biomarkers of tubular injury tended to have better improvement in renal function. CrossRefPubMedPubMedCentral Rao VS, Ahmad T, Brisco-Bacik MA, Bonventre JV, Wilson FP, Siew ED, et al. Renal effects of intensive volume removal in heart failure patients with preexisting worsening renal function. Circ Heart Fail. 2019;12(6):e005552. https://​doi.​org/​10.​1161/​CIRCHEARTFAILURE​.​118.​005552This study showed that aggressive diuresis in patients with preexisting worsening renal function does not always lead to further worsening of renal function, and that those who had increase in biomarkers of tubular injury tended to have better improvement in renal function. CrossRefPubMedPubMedCentral
90.
go back to reference Voors AA, Dittrich HC, Massie BM, DeLucca P, Mansoor GA, Metra M, et al. Effects of the adenosine A1 receptor antagonist rolofylline on renal function in patients with acute heart failure and renal dysfunction: results from PROTECT (Placebo-Controlled Randomized Study of the Selective Adenosine A1 Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function). J Am Coll Cardiol. 2011;57(19):1899–907. https://doi.org/10.1016/j.jacc.2010.11.057.CrossRefPubMed Voors AA, Dittrich HC, Massie BM, DeLucca P, Mansoor GA, Metra M, et al. Effects of the adenosine A1 receptor antagonist rolofylline on renal function in patients with acute heart failure and renal dysfunction: results from PROTECT (Placebo-Controlled Randomized Study of the Selective Adenosine A1 Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function). J Am Coll Cardiol. 2011;57(19):1899–907. https://​doi.​org/​10.​1016/​j.​jacc.​2010.​11.​057.CrossRefPubMed
Metadata
Title
Synthesizing Markers of Kidney Injury in Acute Decompensated Heart Failure: Should We Even Keep Looking?
Authors
Alexander S. Manguba Jr
Xavier Vela Parada
Steven G. Coca
Anuradha Lala
Publication date
01-12-2019
Publisher
Springer US
Published in
Current Heart Failure Reports / Issue 6/2019
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-019-00448-9

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