title: Transtubular Potassium Concentration Gradient as a Surrogate Measure of Arterial Underfilling in Acute Decompensated Heart Failure.
abstract: BACKGROUND
  The monitoring of tissue hypoperfusion and the subsequent neurohumoral activation (ie, arterial underfilling) during decongestion is important for the management of acute decompensated heart failure (ADHF). The transtubular potassium concentration gradient (TTKG) has been reported to be a marker of renal aldosterone bioactivity. This study tested the hypothesis that TTKG can be a surrogate of arterial underfilling in patients with ADHF.
  
  
  RESULTS
  We measured TTKG at discharge in 100 ADHF patients. The primary outcome measure was the occurrence of tissue hypoperfusion events (defined according to the "Cold Modified 2014" definition criteria) within 1 month after discharge. The secondary outcome measure was the occurrence of cardiac death or ADHF readmission within 3 months after discharge. On receiver operating characteristic curve analysis, TTKG predicted tissue hypoperfusion events with high accuracy (C-statistic, 0.889) for a cut-off of 6.0. Multivariate Cox regression analyses demonstrated independent relationships between TTKG and both the primary and secondary outcomes.
  
  
  CONCLUSIONS
  TTKG has utility as a surrogate of arterial underfilling, and spot TTKG at discharge may be a prognostic marker in ADHF patients. (Circ J 2016; 80: 1965-1970).
authors.affiliation: Institute for Clinical Research, National Hospital Organization Osaka National Hospital.
authors.forename: Taiki
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Akio
authors.initials: A
authors.lastname: Hirata
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kashiwase
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Higuchi
authors.forename: Tomohito
authors.initials: T
authors.lastname: Ohtani
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Koretsune
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yasumura
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000652:urine; D015415:Biomarkers / Q000652:urine; D006333:Heart Failure / Q000503:physiopathology* / Q000652:urine*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000652:urine*
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D011188:Potassium