title: Prognostic Impact of BNP Variations in Patients Admitted for Acute Decompensated Heart Failure with In-Hospital Worsening Renal Function.
abstract: BACKGROUND
  The significance of worsening renal function (WRF) in patients admitted for acute decompensated heart failure (ADHF) is still controversial. We hypothesised that changes in brain natriuretic peptide (BNP) might identify patients with optimal diuretic responsiveness resulting in transient WRF, not negatively affecting the prognosis. Our aim was to verify if in-hospital trends of BNP might be helpful in the stratification of patients with WRF after treatment for ADHF.
  
  
  METHODS
  122 consecutive patients admitted for ADHF were enrolled. Brain natriuretic peptide and eGFR were evaluated at admission and discharge. A 20% relative decrease in eGFR defined WRF, whereas a BNP reduction ≥40% was considered significant. The primary combined endpoint was death/urgent heart transplantation and re-hospitalisation for ADHF.
  
  
  RESULTS
  Worsening renal function occurred in 23% of patients without differences in outcome between patients with and without WRF (43% vs. 45%, p=0.597). A significant reduction in BNP levels over the hospitalisation occurred in 59% of the overall population and in 71% of patients with WRF. At a median follow-up of 13.0 (IQR 6-36) months, WRF patients with ≥40% BNP reduction had a lower rate of death/urgent heart transplantation/re-hospitalisation compared to WRF patients without BNP reduction (30% and 75%, respectively; p=0.007). Favourable BNP trend was the strongest variable in predicting the outcome in WRF patients (HR 0.222, 95% CI 0.066-0.753, p=0.016).
  
  
  CONCLUSIONS
  Worsening renal function does not affect the prognosis of ADHF and, when associated with a significant BNP reduction, identifies patients with adequate decongestion at discharge and favourable outcome.
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy. Electronic address: davide.stolfo@gmail.com.
authors: D
authors: D
authors: Stolfo
authors: Laboratory Medicine Department, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Trieste, Trieste, Italy.
authors: E
authors: E
authors: Stenner
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: M
authors: M
authors: Merlo
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: A G
authors: AG
authors: Porto
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: C
authors: C
authors: Moras
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: G
authors: G
authors: Barbati
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: A
authors: A
authors: Aleksova
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: A
authors: A
authors: Buiatti
authors: Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors: G
authors: G
authors: Sinagra
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D015996:Survival Rate
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Diuretics; Heart failure; Natriuretic peptides; Worsening renal function