eGFR and Outcomes in Patients with Acute Decompensated Heart Failure with or without Elevated BUN

Q: What are the key findings of this study?

An eGFR <45 ml/min/1.73 m2 at discharge was associated with a higher risk of all-cause mortality only when accompanied by BUN ≥25 mg/dl (HR 1.58; 95% CI 1.33-1.88; P<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute decompensated heart failure (n=4449). Intervention: eGFR <45 ml/min per 1.73 m2 and BUN ≥25 mg/dl vs. eGFR ≥45 ml/min per 1.73 m2 and BUN <25 mg/dl. Primary outcome: All-cause mortality (HR 1.58, 95% CI 1.33 to 1.88, p=<0.001).

Key Result

An eGFR <45 ml/min/1.73 m2 at discharge was associated with a higher risk of all-cause mortality only when accompanied by BUN ≥25 mg/dl (HR 1.58; 95% CI 1.33-1.88; P<0.001).

Study Design

Type

Cohort (n=4,449)

Structured PICO

Does eGFR <45 ml/min per 1.73 m² combined with BUN ≥25 mg/dl increase all-cause mortality in patients discharged after acute decompensated heart failure?

Population

4,449 patients discharged alive after hospitalization for acute decompensated heart failure (from 4,842 enrolled in the Acute Decompensated Heart Failure Syndromes Registry)

Intervention

Discharge eGFR <45 ml/min per 1.73 m² and BUN ≥25 mg/dl

Comparator

Discharge eGFR ≥45 ml/min per 1.73 m² and BUN <25 mg/dl

Outcome

All-cause mortality after dischargehard clinical

The prognostic value of reduced eGFR in acute decompensated heart failure is largely dependent on concomitant elevation of BUN.

Main Result

Effect estimate: HR 1.58 (95% CI 1.33 to 1.88)

p-value: p=<0.001

Abstract

BACKGROUND AND OBJECTIVES: In patients with heart failure, the association of renal dysfunction and BUN levels with outcomes is unclear. The aim of our study was to investigate the association between the eGFR at discharge and outcomes in patients with heart failure with or without an elevated BUN level at discharge. DESIGN, SETTING, PARTICIPANTS, 95% confidence interval, 1.33 to 1.88; P<0.001) but not in patients with a BUN<25 mg/dl (hazard ratio, 0.97; 95% confidence interval, 0.76 to 1.26; P=0.84) relative to those with an eGFR≥45 ml/min per 1.73 m(2) and a BUN<25 mg/dl. Among patients with an eGFR≥45 ml/min per 1.73 m(2), a BUN≥25 mg/dl was associated with a significantly higher risk of all-cause mortality than a BUN<25 mg/dl (hazard ratio, 1.34; 95% confidence interval, 1.04 to 1.73; P=0.02). CONCLUSIONS: We showed that elevation of BUN at discharge significantly modified the relation between eGFR at discharge and the risk of all-cause mortality after discharge, suggesting that the association between eGFR and outcomes may be largely dependent on concomitant elevation of BUN.

Bookmark

View Full Paper

Bookmark

View Full Paper

Cite This Study

Kajimoto et al. (Fri,) conducted a cohort in Acute decompensated heart failure (n=4,449). eGFR <45 ml/min per 1.73 m2 and BUN ≥25 mg/dl vs. eGFR ≥45 ml/min per 1.73 m2 and BUN <25 mg/dl was evaluated on All-cause mortality (HR 1.58, 95% CI 1.33 to 1.88, p=<0.001). An eGFR <45 ml/min/1.73 m2 at discharge was associated with a higher risk of all-cause mortality only when accompanied by BUN ≥25 mg/dl (HR 1.58; 95% CI 1.33-1.88; P<0.001).

synapsesocial.com/papers/6a159ef2cb801b7f954eb9e4 https://doi.org/https://doi.org/10.2215/cjn.08210815

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: