title: Novel markers and therapies for patients with acute heart failure and renal dysfunction.
abstract: BACKGROUND
  Acute kidney injury complicates decompensated heart failure in ∼33% of cases and is associated with morbidity and mortality; thus, we sought to systematically review this topic in order to summarize novel diagnostic and therapeutic approaches.
  
  
  METHODS
  Structured PubMed searches on these topics were conducted in February 2014 and relevant literature was identified. The PubMed search identified a total of 192 articles that were individually screened for inclusion in this analysis, and 58 were included.
  
  
  RESULTS
  Acute kidney injury, defined by substantial increases in serum creatinine, is associated consistently with prolonged length of stay, rehospitalization, and mortality. Biomarker studies suggested that natriuretic peptides are prognostic for shorter- and longer-term mortality. Novel proteins indicating kidney damage and albumin in the urine are associated with acute kidney injury. The most promising acute pharmacologic treatment appears to be serelaxin, which has been shown to improve acute heart failure symptoms, hemodynamic parameters, and renal function.
  
  
  CONCLUSIONS
  The presence of acute kidney injury results in worse clinical outcomes for patients with acute heart failure. Novel biomarkers and therapies hold the promise of improving both cardiac and renal outcomes in these patients.
authors.affiliation: Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Tex; The Heart Hospital, Plano, Tex. Electronic address: peteramccullough@gmail.com.
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: John L
authors.initials: JL
authors.lastname: Jefferies
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000494:pharmacology; D003404:Creatinine / Q000097:blood*; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D007677:Kidney Function Tests; D045265:Natriuretic Peptides / Q000097:blood*; D011379:Prognosis; D011994:Recombinant Proteins / Q000494:pharmacology; D012065:Relaxin / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D045265:Natriuretic Peptides; D011994:Recombinant Proteins; C577649:serelaxin protein, human; D012065:Relaxin; D003404:Creatinine
keywords: Acute kidney injury; Biomarker; Clinical outcomes; Systematic review