title: Tubular damage and worsening renal function in chronic heart failure.
abstract: OBJECTIVE
  This study sought to investigate the relationship between tubular damage and worsening renal function (WRF) in chronic heart failure (HF) BACKGROUND: WRF is associated with poor outcome in chronic HF. It is unclear whether urinary tubular markers may identify patients at risk for WRF.
  
  
  METHODS
  In 2,011 patients with chronic HF, we evaluated the ability of urinary tubular markers (N-acetyl-beta-d-glucosaminidase (NAG), kidney injury molecule (KIM)-1, and neutrophil gelatinase-associated lipocalin (NGAL) to predict WRF. Finally, we assessed the prognostic importance of WRF.
  
  
  RESULTS
  A total of 290 patients (14.4%) experienced WRF during follow-up, and WRF was a strong and independent predictor of all-cause mortality and HF hospitalizations (hazard ratio [HR]: 2.87; 95% CI: 2.40 to 3.43; p < 0.001). Patients with WRF had lower baseline glomerular filtration rate and higher KIM-1, NAG, and NGAL levels. In a multivariable-adjusted model, KIM-1 was the strongest independent predictor of WRF (HR: 1.23; 95% CI: 1.09 to 1.39 per log increase; p = 0.001).
  
  
  CONCLUSIONS
  WRF was associated with strongly impaired outcome in patients with chronic HF. Increased level of urinary KIM-1 was the strongest independent predictor of WRF and could therefore be used to identify patients at risk for WRF and poor clinical outcome. (GISSI-HF-Effects of n-3 PUFA and Rosuvastatin on Mortality-Morbidity of Patients With Symptomatic CHF; NCT00336336).
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: k.damman@umcg.nl.
authors.forename: Kevin
authors.initials: K
authors.lastname: Damman
authors.affiliation: Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: INSERM, Centre d'Investigations Cliniques, and Université de Lorraine, INSERM U961, Nancy, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.affiliation: UO Cardiologia Territoriale, Ospedale di Terni, Terni, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Proietti
authors.affiliation: Servizio di Cardiologia, Ospedale di Venosa, Venosa, Italy.
authors.forename: Savino
authors.initials: S
authors.lastname: Barbuzzi
authors.affiliation: Azienda Ospedaliera Santa Maria degli Angeli, UO Cardiologia, Pordenone, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
authors.affiliation: GVM Care and Research, Ettore Sansavini Health Science Foundation-Maria Cecilia Hospital, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
mesh_terms: D000368:Aged; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D007684:Kidney Tubules; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies
keywords: heart failure; renal insufficiency; tubular damage; worsening renal function