title: Antigen carbohydrate 125 and creatinine on admission for prediction of renal function response following loop diuretic administration in acute heart failure.
abstract: BACKGROUND
  The use of loop diuretics in acute heart failure (AHF) is largely empirical and has been associated with renal function impairment by reducing renal perfusion but also renal improvement by decreasing renal venous congestion. Antigen carbohydrate 125 (CA125) has emerged as a proxy for fluid overload. We sought to evaluate whether the early changes in creatinine (ΔCr) induced by intravenous furosemide doses (ivFD) differ among clinical groups defined by overload status (CA125) and creatinine on admission (Cr).
  
  
  RESULTS
  We included 526 consecutive patients admitted for AHF. All patients received intravenous furosemide for the first 48 hours. CA125 and Cr were dichotomized at 35 U/ml and 1.4 mg/dl, respectively, and grouped as follows: C1 [Cr <1.4, CA125 ≤ 35 (n=151)]; C2 [Cr <1.4, CA125 >35 (n=241)]; C3 [Cr ≥ 1.4, CA125 ≤ 35 (n=45)]; and C4 [Cr ≥ 1.4, CA125 >35 (n=89)]. Clinicians in charge of the management of patients were blind to CA125 values. ΔCr was estimated as the absolute difference in Cr between admission and 48-72 hours. Multivariable linear regression analysis was used for modeling purposes. The adjusted analysis showed a differential effect of ivFD on ΔCr. Per increase in 20mg/day of ivFD, the mean ΔCr was 0.010 mg/dl (p=0.464) in C1, 0.002 mg/dl (p=0.831) in C2, 0.045 mg/dl (p=0.032) in C3, and -0.045 mg/dl (p<0.001) in C4 (omnibus p<0.001). A similar pattern of response was observed in a validation cohort.
  
  
  CONCLUSIONS
  In patients with AHF, the magnitude and direction of ΔCr attributable to ivFD were differentially associated with values of CA125 and Cr on admission.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain. Electronic address: yulnunez@gmail.com.
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.affiliation: Servicio de Medicina Interna, Hospital de Manises, Valencia, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Llàcer
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ventura
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Bonanad
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.affiliation: Servicio de Cardiología, Hospital de Manises, Valencia, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Santas
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mascarell
authors.affiliation: UCLA Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, CA, USA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends; D011237:Predictive Value of Tests; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage*
chemical_list: D015415:Biomarkers; D018394:CA-125 Antigen; D049994:Sodium Potassium Chloride Symporter Inhibitors; D003404:Creatinine
keywords: Acute heart failure; Antigen carbohydrate 125; Loop diuretics; Renal Failure