Evidence of uncoupling between renal dysfunction and injury in cardiorenal syndrome: insights from the BIONICS study.
OBJECTIVE
The objective of the study was to assess urinary biomarkers of renal injury for their individual or collective ability to predict Worsening renal function (WRF) in patients with acutely decompensated heart failure (ADHF).


METHODS
In a prospective, blinded international study, 87 emergency department (ED) patients with ADHF were evaluated with biomarkers of cardiac stretch (B type natriuretic peptide [BNP] and its amino terminal equivalent [NT-proBNP], ST2), biomarkers of renal function (creatinine, estimated glomerular filtration rate [eGFR]) and biomarkers of renal injury (plasma neutrophil gelatinase associated lipocalin [pNGAL], urine kidney injury molecule-1 [KIM-1], urine N-acetyl-beta-D-glucosaminidase [NAG], urine Cystatin C, urine fibrinogen). The primary endpoint was WRF.


RESULTS
26% developed WRF; baseline characteristics of subjects who developed WRF were generally comparable to those who did not. Biomarkers of renal function and urine biomarkers of renal injury were not correlated, while urine biomarkers of renal injury correlated between each other. Biomarker concentrations were similar between patients with and without WRF except for baseline BNP. Although plasma NGAL was associated with the combined endpoint, none of the biomarker showed predictive accuracy for WRF.


CONCLUSIONS
In ED patients with ADHF, urine biomarkers of renal injury did not predict WRF. Our data suggest that a weak association exists between renal dysfunction and renal injury in this setting (Clinicaltrials.gov NCT#0150153).
AP-HP, Groupe hospitalier St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn unit, F-75475, Paris, France; Univ Paris Diderot, Paris, France; U942 Inserm F-75475, Paris, France.
Matthieu
M
Legrand
Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Roma, Italy.
Benedetta
B
De Berardinis
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
Hanna K
HK
Gaggin
Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Roma, Italy.
Laura
L
Magrini
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
Arianna
A
Belcher
Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Roma, Italy.
Benedetta
B
Zancla
U942 Inserm F-75475, Paris, France.
Alexandra
A
Femia
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
Mandy
M
Simon
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
Shweta
S
Motiwala
Harvard Medical School and Harvard School of Public Health, Boston, MA, United States of America.
Rasika
R
Sambhare
Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Roma, Italy.
Salvatore
S
Di Somma
AP-HP, Groupe hospitalier St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn unit, F-75475, Paris, France; Univ Paris Diderot, Paris, France; U942 Inserm F-75475, Paris, France.
Alexandre
A
Mebazaa
Harvard Medical School and Harvard School of Public Health, Boston, MA, United States of America.
Vishal S
VS
Vaidya
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
James L
JL
Januzzi
AP-HP, Groupe hospitalier St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn unit, F-75475, Paris, France.
D000118:Acetylglucosaminidase / Q000652:urine*; D058186:Acute Kidney Injury / Q000473:pathology / Q000652:urine*; D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D059347:Cardio-Renal Syndrome / Q000473:pathology / Q000652:urine*; D055316:Cystatin C / Q000652:urine*; D005260:Female; D005340:Fibrinogen / Q000652:urine*; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007674:Kidney Diseases / Q000473:pathology / Q000652:urine*; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D008875:Middle Aged; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood; D011991:Receptors, Virus
D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus; D005340:Fibrinogen; D000118:Acetylglucosaminidase