title: Risk Stratification of Acute Kidney Injury Using the Blood Urea Nitrogen/Creatinine Ratio in Patients With Acute Decompensated Heart Failure.
abstract: BACKGROUND
  Risk stratification of acute kidney injury (AKI) is important for acute decompensated heart failure (ADHF). The aim of this study was to determine whether clinical markers, such as the blood urea nitrogen/creatinine ratio (BUN/Cr) or BUN or creatinine values alone, stratify the risk of AKI for mortality.
  
  
  RESULTS
  In all, 371 consecutive ADHF patients were enrolled in the study. AKI was defined as serum creatinine ≥0.3 mg/dl or a 1.5-fold increase in serum creatinine levels within 48 h. During ADHF therapy, AKI occurred in 99 patients; 55 patients died during the 12-month follow-up period. Grouping patients according to AKI and a median BUN/Cr at admission of 22.1 (non-AKI+low BUN/Cr, non-AKI+high BUN/Cr, AKI+low BUN/Cr, and AKI+high BUN/Cr groups) revealed higher mortality in the AKI+high BUN/Cr group (log-rank test, P<0.001). Cox's proportional hazard analysis revealed an association between AKI+high BUN/Cr and mortality, whereas the association with AKI+low BUN/Cr did not reach statistical significance. When patients were grouped according to AKI and median BUN or creatinine values at admission, AKI was associated with mortality, regardless of BUN or creatinine.
  
  
  CONCLUSIONS
  The combination of AKI and elevated BUN/Cr, but not BUN or creatinine individually, is linked with an increased risk of mortality in ADHF patients, suggesting that the BUN/Cr is useful for risk stratification of AKI.
authors: Department of Cardiology, National Cerebral and Cardiovascular Center.
authors: Yoichi
authors: Y
authors: Takaya
authors: Fumiki
authors: F
authors: Yoshihara
authors: Hiroyuki
authors: H
authors: Yokoyama
authors: Hideaki
authors: H
authors: Kanzaki
authors: Masafumi
authors: M
authors: Kitakaze
authors: Yoichi
authors: Y
authors: Goto
authors: Toshihisa
authors: T
authors: Anzai
authors: Satoshi
authors: S
authors: Yasuda
authors: Hisao
authors: H
authors: Ogawa
authors: Yuhei
authors: Y
authors: Kawano
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000097:blood*; D018570:Risk Assessment; D014508:Urea / Q000097:blood*
chemical_list: D015415:Biomarkers; D014508:Urea; D003404:Creatinine; D009584:Nitrogen