title: Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction.
abstract: Renal dysfunction (RD) and venous congestion are related and common in heart failure (HF). Studies suggest that venous congestion may be the primary driver of RD in HF. In this study, we sought to investigate retrospectively the relationship between common measures of renal function with caval congestion and mortality among outpatients with HF and RD. We reviewed data from 103 HF outpatients (45 males, mean age 74 years, ejection fraction 41.8 ± 11.6 %) with estimated glomerular filtration rate (eGFR) of < 60 ml/min in a single centre. During an ambulatory visit, all patients underwent blood test and ultrasonography of the inferior vena cava (IVC). Caval congestion was defined as IVC with both dilatation and impaired collapsibility. The best values of renal metrics in predicting caval congestion were determined with receiver-operating characteristic analysis. The BUN/Cr ratio is moderately correlated with IVC expiratory maximum diameter (r = 0.31, p < 0.0007). In a multiple logistic regression model, BUN/Cr > 25.5 (adjusted OR 2.98, p 0.015) and eGFR ≤ 45.8 (adjusted OR 5.38, p 0.002) identify patients at risk for caval congestion; a BUN/Cr > 23.7 was the best predictor of impaired collapsibility (adjusted OR 4.41, p 0.001). a BUN/Cr > 25.5 (HR 2.19, 95 % CI 1.21-3.94, p < 0.001) and NYHA class 3 (HR 2.91, 95 % CI 1.60-5.31, p < 0.0005) were independent risk factors associated with all-cause death during a median follow-up of 31 months. In outpatients with HF and RD, a higher BUN/Cr and lower eGFR are reliable renal biomarkers for caval congestion. The BUN/Cr is associated with long-term mortality and may help to stratify HF severity.
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy. gaspare.parrinello@unipa.it.
authors.forename: Gaspare
authors.initials: G
authors.lastname: Parrinello
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Torres
authors.affiliation: Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
authors.forename: Piero Luigi
authors.initials: PL
authors.lastname: Almasio
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bellanca
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Pizzo
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cuttitta
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Cardiology Division, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Paterna
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000401:mortality*; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging*; D007558:Italy; D008297:Male; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Collapse index; Congestion; Heart failure; Inferior vena cava; Outpatients; Renal dysfunction