title: Competing Risk of Cardiac Status and Renal Function During Hospitalization for Acute Decompensated Heart Failure.
abstract: OBJECTIVE
  The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF).
  
  
  BACKGROUND
  Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters.
  
  
  METHODS
  This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge.
  
  
  RESULTS
  A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables.
  
  
  CONCLUSIONS
  When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe WRF is a measure of prognosis, but is of lesser value than, and independent of the prognostic changes induced by adequate NT-proBNP reduction. This suggests that in ADHF patients it may be warranted to strive for an optimal decrease in NT-proBNP, even if this induces WRF.
authors.affiliation: Heart Failure Research Center and Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Khibar
authors.initials: K
authors.lastname: Salah
authors.affiliation: Heart Failure Research Center and Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Wouter E
authors.initials: WE
authors.lastname: Kok
authors.affiliation: Department of Cardiology, University Hospital Maastricht, Maastricht, the Netherlands.
authors.forename: Luc W
authors.initials: LW
authors.lastname: Eurlings
authors.affiliation: Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.affiliation: Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal.
authors.forename: Joana M
authors.initials: JM
authors.lastname: Pimenta
authors.affiliation: Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Verdiani
authors.affiliation: Heart Failure Research Center and Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Heart Failure Research Center and Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: y.pinto@amc.uva.nl.
authors.forename: Yigal M
authors.initials: YM
authors.lastname: Pinto
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D059347:Cardio-Renal Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: NT-proBNP; WRF; heart failure; prognosis; renal function