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JACC Heart Fail. 2013 Oct;1(5):417-24. doi: 10.1016/j.jchf.2013.05.007. Epub 2013 Sep 11.

Tubular damage and worsening renal function in chronic heart failure.

Author information

  • 1Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: k.damman@umcg.nl.
  • 2Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
  • 3Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.
  • 4Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
  • 5INSERM, Centre d'Investigations Cliniques, and Universit√© de Lorraine, INSERM U961, Nancy, France.
  • 6UO Cardiologia Territoriale, Ospedale di Terni, Terni, Italy.
  • 7Servizio di Cardiologia, Ospedale di Venosa, Venosa, Italy.
  • 8Azienda Ospedaliera Santa Maria degli Angeli, UO Cardiologia, Pordenone, Italy.
  • 9GVM Care and Research, Ettore Sansavini Health Science Foundation-Maria Cecilia Hospital, Cotignola, Italy.
  • 10ANMCO Research Center, Florence, Italy.

Abstract

OBJECTIVES:

This study sought to investigate the relationship between tubular damage and worsening renal function (WRF) in chronic heart failure (HF) BACKGROUND: WRF is associated with poor outcome in chronic HF. It is unclear whether urinary tubular markers may identify patients at risk for WRF.

METHODS:

In 2,011 patients with chronic HF, we evaluated the ability of urinary tubular markers (N-acetyl-beta-d-glucosaminidase (NAG), kidney injury molecule (KIM)-1, and neutrophil gelatinase-associated lipocalin (NGAL) to predict WRF. Finally, we assessed the prognostic importance of WRF.

RESULTS:

A total of 290 patients (14.4%) experienced WRF during follow-up, and WRF was a strong and independent predictor of all-cause mortality and HF hospitalizations (hazard ratio [HR]: 2.87; 95% CI: 2.40 to 3.43; p < 0.001). Patients with WRF had lower baseline glomerular filtration rate and higher KIM-1, NAG, and NGAL levels. In a multivariable-adjusted model, KIM-1 was the strongest independent predictor of WRF (HR: 1.23; 95% CI: 1.09 to 1.39 per log increase; p = 0.001).

CONCLUSIONS:

WRF was associated with strongly impaired outcome in patients with chronic HF. Increased level of urinary KIM-1 was the strongest independent predictor of WRF and could therefore be used to identify patients at risk for WRF and poor clinical outcome. (GISSI-HF-Effects of n-3 PUFA and Rosuvastatin on Mortality-Morbidity of Patients With Symptomatic CHF; NCT00336336).

Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

heart failure; renal insufficiency; tubular damage; worsening renal function

PMID:
24621973
[PubMed - indexed for MEDLINE]
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