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Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration
AIMS: The blood urea nitrogen (BUN)/creatinine ratio is a strong prognostic indicator in patients with acute decompensated heart failure (ADHF). However, the clinical impact of a high BUN/creatinine ratio at discharge with respect to renal dysfunction, neurohormonal hyperactivity, and different resp...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989280/ https://www.ncbi.nlm.nih.gov/pubmed/31814319 http://dx.doi.org/10.1002/ehf2.12531 |
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author | Sujino, Yasumori Nakano, Shintaro Tanno, Jun Shiraishi, Yasuyuki Goda, Ayumi Mizuno, Atsushi Nagatomo, Yuji Kohno, Takashi Muramatsu, Toshihiro Nishimura, Shigeyuki Kohsaka, Shun Yoshikawa, Tsutomu |
author_facet | Sujino, Yasumori Nakano, Shintaro Tanno, Jun Shiraishi, Yasuyuki Goda, Ayumi Mizuno, Atsushi Nagatomo, Yuji Kohno, Takashi Muramatsu, Toshihiro Nishimura, Shigeyuki Kohsaka, Shun Yoshikawa, Tsutomu |
author_sort | Sujino, Yasumori |
collection | PubMed |
description | AIMS: The blood urea nitrogen (BUN)/creatinine ratio is a strong prognostic indicator in patients with acute decompensated heart failure (ADHF). However, the clinical impact of a high BUN/creatinine ratio at discharge with respect to renal dysfunction, neurohormonal hyperactivity, and different responsiveness to decongestion therapy remains unclear. Herein, we examined (i) the predictive value of a high BUN/creatinine ratio at discharge and (ii) its haemoconcentration‐dependent effects, in patients with ADHF. METHODS AND RESULTS: The West Tokyo Heart Failure registry was a multicentre, prospective cohort registry‐based study that enrolled patients hospitalized with a diagnosis of ADHF. The endpoint was post‐discharge all‐cause death. Based on the degree of haemoconcentration, patients (n = 2090) were divided into four subcategories. In multivariate proportional hazard analyses, a higher BUN/creatinine ratio was independently associated with higher all‐cause mortality in the total population and in the extreme haemodilution (ΔHaemoglobin ≤ −0.9 g/dL) and haemoconcentration (0.8 g/dL ≤ ΔHaemoglobin) subcategories, but not in the modest haemodilution/haemoconcentration subcategories. CONCLUSIONS: A higher BUN/creatinine ratio at discharge was independently associated with higher post‐discharge all‐cause mortality in patients with ADHF. The predictive value of a high BUN/creatinine ratio at discharge was haemoconcentration dependent and may be an unfavourable predictor in patients showing excessive haemoconcentration and haemodilution, but not in those showing modest haemoconcentration/haemodilution. |
format | Online Article Text |
id | pubmed-6989280 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-69892802020-02-03 Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration Sujino, Yasumori Nakano, Shintaro Tanno, Jun Shiraishi, Yasuyuki Goda, Ayumi Mizuno, Atsushi Nagatomo, Yuji Kohno, Takashi Muramatsu, Toshihiro Nishimura, Shigeyuki Kohsaka, Shun Yoshikawa, Tsutomu ESC Heart Fail Original Research Articles AIMS: The blood urea nitrogen (BUN)/creatinine ratio is a strong prognostic indicator in patients with acute decompensated heart failure (ADHF). However, the clinical impact of a high BUN/creatinine ratio at discharge with respect to renal dysfunction, neurohormonal hyperactivity, and different responsiveness to decongestion therapy remains unclear. Herein, we examined (i) the predictive value of a high BUN/creatinine ratio at discharge and (ii) its haemoconcentration‐dependent effects, in patients with ADHF. METHODS AND RESULTS: The West Tokyo Heart Failure registry was a multicentre, prospective cohort registry‐based study that enrolled patients hospitalized with a diagnosis of ADHF. The endpoint was post‐discharge all‐cause death. Based on the degree of haemoconcentration, patients (n = 2090) were divided into four subcategories. In multivariate proportional hazard analyses, a higher BUN/creatinine ratio was independently associated with higher all‐cause mortality in the total population and in the extreme haemodilution (ΔHaemoglobin ≤ −0.9 g/dL) and haemoconcentration (0.8 g/dL ≤ ΔHaemoglobin) subcategories, but not in the modest haemodilution/haemoconcentration subcategories. CONCLUSIONS: A higher BUN/creatinine ratio at discharge was independently associated with higher post‐discharge all‐cause mortality in patients with ADHF. The predictive value of a high BUN/creatinine ratio at discharge was haemoconcentration dependent and may be an unfavourable predictor in patients showing excessive haemoconcentration and haemodilution, but not in those showing modest haemoconcentration/haemodilution. John Wiley and Sons Inc. 2019-12-09 /pmc/articles/PMC6989280/ /pubmed/31814319 http://dx.doi.org/10.1002/ehf2.12531 Text en © 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Research Articles Sujino, Yasumori Nakano, Shintaro Tanno, Jun Shiraishi, Yasuyuki Goda, Ayumi Mizuno, Atsushi Nagatomo, Yuji Kohno, Takashi Muramatsu, Toshihiro Nishimura, Shigeyuki Kohsaka, Shun Yoshikawa, Tsutomu Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration |
title | Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration |
title_full | Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration |
title_fullStr | Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration |
title_full_unstemmed | Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration |
title_short | Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration |
title_sort | clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989280/ https://www.ncbi.nlm.nih.gov/pubmed/31814319 http://dx.doi.org/10.1002/ehf2.12531 |
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