title: Renal function trajectories and clinical outcomes in acute heart failure.
abstract: BACKGROUND
  Prior studies have demonstrated adverse risk associated with baseline and worsening renal function in acute heart failure, but none has modeled the trajectories of change in renal function and their impact on outcomes.
  
  
  RESULTS
  We used linear mixed models of serial measurements of blood urea nitrogen and creatinine to describe trajectories of renal function in 1962 patients with acute heart failure and renal dysfunction enrolled in the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function study. We assessed risk of 180-day mortality and 60-day cardiovascular or renal readmission and used Cox regression to determine association between renal trajectories and outcomes. Compared with patients alive at 180 days, patients who died were older, had lower blood pressure and ejection fraction, and higher creatinine levels at baseline. On average for the entire cohort, creatinine rose from days 1 to 3 and increased further after discharge, with the trajectory dependent on the day of discharge. Blood urea nitrogen, creatinine, and the rate of change in creatinine from baseline were the strongest independent predictors of 180-day mortality and 60-day readmission, whereas the rate of change of blood urea nitrogen from baseline was not predictive of outcomes. Baseline blood urea nitrogen>35 mg/dL and increase in creatinine>0.1 mg/dL per day increased the risk of mortality, whereas stable or decreasing creatinine was associated with reduced risk.
  
  
  CONCLUSIONS
  Patients with acute heart failure and renal dysfunction demonstrate variable rise and fall in renal indices during and immediately after hospitalization. Risk of morbidity and mortality can be predicted based on baseline renal function and creatinine trajectory during the first 7 days.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.forename: Douwe
authors.initials: D
authors.lastname: Postmus
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: George A
authors.initials: GA
authors.lastname: Mansoor
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Howard C
authors.initials: HC
authors.lastname: Dittrich
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D058915:Purinergic P1 Receptor Antagonists / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome; D014970:Xanthines / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D058915:Purinergic P1 Receptor Antagonists; D014970:Xanthines; C073525:rolofylline; D003404:Creatinine
keywords: cardiorenal syndrome; heart failure; hospitalization; mortality