title: Biochemical evidence of mild hepatic dysfunction identifies decompensated heart failure patients with reversible renal dysfunction.
abstract: BACKGROUND
  Differentiation of HF-induced renal dysfunction (RD) from irreversible intrinsic kidney disease is challenging, likely related to the multifactorial pathophysiology underlying HF-induced RD. In contrast, HF-induced liver dysfunction results in characteristic laboratory abnormalities. Given that similar pathophysiologic factors are thought to underlie both conditions, and that the liver and kidneys share a common circulatory environment, patients with laboratory evidence of HF-induced liver dysfunction may also have a high incidence of potentially reversible HF-induced RD.
  
  
  RESULTS
  Hospitalized patients with a discharge diagnosis of HF were reviewed (n = 823). Improvement in renal function (IRF) was defined as a 20% improvement in estimated glomerular filtration rate (eGFR). An elevated international normalized ratio (INR; odds ratio [OR] 2.8; P < .001), bilirubin (BIL; OR 2.2; P < .001), aspartate aminotransferase (AST; OR 1.8; P = .004), and alanine aminotransferase (ALT; OR 2.1; P = .001) were all significantly associated with IRF. Among patients with baseline RD (eGFR ≤45 mL min(-1) 1.73 m(-2)), associations between liver dysfunction and IRF were particularly strong (INR: OR 5.7 [P < .001]; BIL: OR 5.1 [P < .001]; AST: OR 2.9 [P = .005]; ALT: OR 4.8 [P < .001]).
  
  
  CONCLUSIONS
  Biochemical evidence of mild liver dysfunction is associated with reversible RD in decompensated HF patients. In the absence of methodology to directly identify HF-induced RD, signs of HF-induced dysfunction of other organs may serve as an accessible method by which HF-induced RD is recognized.
authors.affiliation: Cardiovascular Division, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Brisco
authors.forename: Brian D
authors.initials: BD
authors.lastname: McCauley
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chen
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D007677:Kidney Function Tests / Q000639:trends; D007902:Length of Stay / Q000639:trends; D008107:Liver Diseases / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
keywords: Cardiorenal syndrome; congestive hepatopathy; decompensated heart failure; improved renal function