Impact Of Renal Function Research Articles

Impact of renal function on eligibility for chemotherapy and survival in patients who have undergone radical nephro‐ureterectomy

What's known on the subject? and what does the study add?: Radical nephroureterectomy (RNU), the standard of care treatment for high-risk urothelial carcinoma of the upper tract (UTUC), results in loss of a renal unit. Loss of renal function decreases eligibility for systemic chemotherapies and results in decreased overall survival in various malignancies. The study shows that only a small proportion of patients had a preoperative renal function that would allow cisplatin-based chemotherapy. Moreover, eGFR significantly decreased after RNU, thereby lowering the rate of cisplatin eligibility to only 16 and 52% of patients based on the thresholds of 60 and 45 mL/min/1.73 m(2) , respectively. Taken together with the rest of the literature, the findings of the study support the use of cisplatin-based chemotherapy, when indicated, in the neoadjuvant rather than adjuvant setting. To report (i) the estimated glomerular filtration rate (eGFR) changes in patients undergoing radical nephro-ureterectomy (RNU) for upper tract urothelial carcinoma (UTUC); (ii) the rate of change in eGFR in patients eligible for cisplatin-based chemotherapy; and (iii) the association of preoperative, postoperative and rate of change of renal function variables with survival outcomes. We performed a retrospective analysis of 666 patients treated with RNU for UTUC at seven international institutions from 1994 to 2007. The eGFR was calculated at baseline and at 3-6 months (Modification of Diet in Renal Disease formula (MDRD) and Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EP) equations). The median (interquartile range) eGFR decreased by 18.2 (8-12)% after RNU. A total of 37% of patients had a preoperative eGFR ≥ 60 mL/min/1.73 m(2) , which decreased to 16% after RNU (P < 0.001); 72% of patients had a preoperative eGFR ≥ 45 mL/min/1.73 m(2) , which decreased to 52% after RNU (P < 0.001). The distributions were similar when analyses were restricted to patients with locally advanced disease (pT3-pT4) and/or lymph node metastasis. Patients older than the median age of 70 years were more likely to have a decrease in eGFR after RNU (P < 0.001). None of the renal function variables was associated with clinical outcomes such as disease recurrence, cancer-specific and overall mortality; however, when analyses were restricted to patients who had no adjuvant chemotherapy and did not experience disease recurrence (n = 431), a preoperative eGFR ≥ 60 mL/min/1.73 m(2) (P = 0.03) and a postoperative eGFR ≥ 45 mL/min/1.73 m(2) (P = 0.04) were associated with better overall survival in univariable analyses. In patients who had UTUC, eGFR was low and furthermore, it significantly decreased after RNU. Renal function did not affect cancer-specific outcomes after RNU.

Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification

IntroductionThe development of acute kidney injury (AKI) is associated with poor outcome. The modified RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) classification for AKI, which classifies patients with renal replacement therapy needs according to RIFLE failure class, improves the predictive value of AKI in patients undergoing cardiac surgery. Our aim was to assess risk factors for post-operative AKI and the impact of renal function on short- and long-term survival among all AKI subgroups using the modified RIFLE classification.MethodsWe prospectively studied 2,940 consecutive cardiosurgical patients between January 2004 and July 2009. AKI was defined according to the modified RIFLE system. Pre-operative, operative and post-operative variables usually measured on and during admission, which included main outcomes, were recorded together with cardiac surgery scores and ICU scores. These data were evaluated for association with AKI and staging in the different RIFLE groups by means of multivariable analyses. Survival was analyzed via Kaplan-Meier and a risk-adjusted Cox proportional hazards regression model. A complete follow-up (mean 6.9 ± 4.3 years) was performed in 2,840 patients up to April 2013.ResultsOf those patients studied, 14% (n = 409) were diagnosed with AKI. We identified one intra-operative (higher cardiopulmonary bypass time) and two post-operative (a longer need for vasoactive drugs and higher arterial lactate 24 hours after admission) predictors of AKI. The worst outcomes, including in-hospital mortality, were associated with the worst RIFLE class. Kaplan-Meier analysis showed survival of 74.9% in the RIFLE risk group, 42.9% in the RIFLE injury group and 22.3% in the RIFLE failure group (P <0.001). Classification at RIFLE injury (Hazard ratio (HR) = 2.347, 95% confidence interval (CI) 1.122 to 4.907, P = 0.023) and RIFLE failure (HR = 3.093, 95% CI 1.460 to 6.550, P = 0.003) were independent predictors for long-term patient mortality.ConclusionsAKI development after cardiac surgery is associated mainly with post-operative variables, which ultimately could lead to a worst RIFLE class. Staging at the RIFLE injury and RIFLE failure class is associated with higher short- and long-term mortality in our population.

Pomalidomide (POM) with Low-Dose Dexamethasone (LoDEX) in Patients with Relapsed and Refractory Multiple Myeloma (RRMM): Impact of Renal Function on Patient Outcomes

AbstractAbstract 4072 Background:One of the most common end-organ damage in pts with MM is renal insufficiency (RI). Patients (pts) presenting with severe RI generally have a poor outcome. However, those pts who correct their renal function achieve outcomes comparable to those of pts with normal renal function (Chanan Khan, Clin Cancer Res 2012;18:2145-63). POM is extensively metabolized and renally eliminated, with <5% eliminated as the parent drug. POM is approximately 30% protein-bound. The characteristics of POM suggest that exposure to parent drug would not be substantively affected by the degree of renal function. MM-002 is a multicenter phase 1/2 study randomizing heavily-pretreated RRMM pts to receive POM alone or POM+LoDEX (Richardson PG, et al. Blood 2011;118:abs 634). In this post hoc analysis of pts who received POM+LoDEX, safety data are analyzed according to the degree of renal function to determine whether renal function alters the safety profile of POM therapy. Methods:Eligible pts with MM who had received ≥2 prior therapies were randomized to treatment with either POM+LoDEX (POM, 4 mg/day for days 1–21 of a 28-day cycle; LoDEX, 40 mg/week) or POM alone. Pts with baseline serum creatinine >3.0 mg/dL were excluded from the study. At progression, pts receiving POM alone could receive POM+LoDEX at investigator’s discretion. Pts were retrospectively categorized into three groups based on calculated baseline creatinine clearance (CrCl) by the Cockcroft-Gault formula: CrCl >60 mL/min; CrCl 45–60 mL/min; CrCl <45 mL/min. Treatment-emergent adverse events (TEAEs) were defined as any AE occurring or worsening after first treatment with study medication and within 30 days after end of treatment. All pts received aspirin, 81 to 100 mg/day, or another form of thromboprophylaxis. Results:A total of 113 pts received POM+LoDEX; the median age of these pts was 64 years (range 34–88). Median number of prior therapies was 5 (range 2–13). The majority of pts were male (62/113, 54.9%) and had an ECOG status score of 0 (32/113, 28.3%), or 1 (68/113, 60.2%). Seventy pts had CrCl >60 mL/min, 14 had CrCl 45–60 mL/min, and 26 had CrCl <45 mL/min. Only 5 pts had CrCl ≤30. The average daily dose of POM (4 mg) and the relative dose intensity (0.9) were similar across the three renal groups. Median time to first POM dose reduction by renal group was 49.5 days (d), 71.0 d, and 32.5 d respectively; treatment duration was 5.5 months (mos), 5.0 mos, and 3.4 mos, in pts with CrCl >60 mL/min, CrCl 45–60 mL/min, and CrCl <45 mL/min, respectively. Grade 3/4 TEAEs occurring in ≥10% of pts are presented in the Table. Grade 3/4 neutropenia was observed in 40% of pts with CrCl >60 mL/min, 21% of pts with CrCl 45–60 mL/min, and 54% of pts with CrCl <45 mL/min. Grade 3/4 anemia and thrombocytopenia were observed in 19%, 21%, 35% and 20%, 14%, and 15%, respectively for pts with CrCl >60 mL/min, CrCl 45–60 mL/min, and CrCl <45 mL/min. Frequently observed non-hematological grade 3/4 AEs included pneumonia and fatigue which was observed in 24%, 21%, 19% and 14%, 29%, and 8% of pts, respectively for pts with CrCl >60 mL/min, CrCl 45–60 mL/min, and CrCl <45 mL/min. Conclusions:Adverse events observed with POM, given at 4 mg/day on days 1–21 of each 28-day cycle in combination with LoDEX, were generally comparable regardless to baseline renal function, however these data are confounded by low pt numbers. A prospective study (MM-008) investigating POM in MM pts with different degrees of renal impairment is ongoing.TableCrCl >60 mL/min (n=70)CrCl 45–60 mL/min (n=14)CrCl <45 mL/min (n=26)Grade 3/4 TEAEs occurring in >10% of pts, %Neutropenia402154Anemia192135Thrombocytopenia201415Leukopenia10144Pneumonia242119Urinary tract infection6719Fatigue14298Dyspnea10723Back pain10712Septic shock0140Hyperkalemia1012Other Grade 3/4 AEs of interest, %Febrile neutropenia104Pulmonary embolism104Deep vein thrombosis104Rash100 Disclosures:Siegel:Onyx: Advisory Board, Advisory Board Other, Honoraria, Speakers Bureau; Millennium Pharma: Advisory Board, Advisory Board Other, Honoraria, Speakers Bureau; Celgene: Advisory Board Other, Honoraria, Speakers Bureau; Merck: Advisory Board, Advisory Board Other, Honoraria, Speakers Bureau. Off Label Use: Pomalidomide is an investigational drug and is not approved for the treatment of patients with any condition. Richardson:Celgene, Millennium, Johnson & Johnson: Advisory Board Other. Baz:Celgene, Millennium, Bristol Myers Squibb, Novartis: Research Funding. Chen:Celgene: Employment, Equity Ownership. Zaki:Celgene: Employment, Equity Ownership. Anderson:Acetylon, Oncopep: Scientific Founder, Scientific Founder Other; Celgene, Millennium, BMS, Onyx: Membership on an entity’s Board of Directors or advisory committees.

Impact of renal function on clopidogrel-induced antiplatelet effects in coronary artery disease patients without diabetes mellitus

Diabetes mellitus (DM) is the most important predictor of chronic kidney disease (CKD), and pharmacodynamic (PD) studies have shown that DM patients with impaired renal function are characterized by reduced clopidogrel response. However, post-hoc PD studies conducted in unselected cohorts, composed of both DM and non-DM patients, have reached controversial findings on the effects of CKD on clopidogrel response, likely attributed to patient heterogeneity. The impact of renal function on clopidogrel response in non-DM patients remains unexplored and represented the aim of this prospective investigation. We conducted a prospective PD investigation in non-DM patients with and without CKD defined as an estimated glomerular filtration rate (eGFR) below or above 60mL/min, respectively. All patients had known coronary artery disease and were on maintenance aspirin therapy. PD assessments were assessed at baseline and 2 and 24h after a 600mg loading dose of clopidogrel. PD assays included light transmission aggregometry (LTA) using 5 and 20μmol ADP with and without PGE1 and flow cytometric assessment of the phosphorylation status of the vasodilator-stimulated phosphoprotein (VASP) to determine the platelet reactivity index. A total of 60 patients were studied (n=30 eGFR ≥60mL/min; n=30 eGFR <60mL/min). At baseline there were no differences between groups. Following clopidogrel loading dose administration, levels of on-treatment platelet reactivity were similar between groups at 2 and 24h as measured with LTA and VASP. Accordingly, there were no differences in rates of high on-treatment platelet reactivity between groups. In non-DM patients with CAD, the presence of impaired renal function is not associated with differences in clopidogrel-induced antiplatelet effects compared with patients with preserved renal function.

334 Predictive Value of Cardiac Computed Tomography and the Impact of Renal Function on All Cause Mortality in Confirm: Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry

334 Predictive Value of Cardiac Computed Tomography and the Impact of Renal Function on All Cause Mortality in Confirm: Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry

324 Why Should Renal Function Impact Chronic Management Of Stroke Prevention In Atrial Fibrillation?

324 Why Should Renal Function Impact Chronic Management Of Stroke Prevention In Atrial Fibrillation?

Impact of renal function on outcomes after elective endovascular abdominal aortic aneurysm repair

Impact of renal function on outcomes after elective endovascular abdominal aortic aneurysm repair

Impact of Renal Function on Prognostic Utility of the Seattle Heart Failure Model

Impact of Renal Function on Prognostic Utility of the Seattle Heart Failure Model

The impact of renal function on therapeutic options for advanced non-small cell lung cancer (NSCLC).

e18076 Background: Certain commonly used chemotherapeutic agents for advanced NSCLC require minimum threshold renal function for administration. To determine how such requirements affect treatment options, we evaluated renal function patterns in a real-world cohort of patients. Methods: Retrospective analysis of consecutive patients treated for stage IV NSCLC from 2000 to 2007 at the UT Southwestern Medical Center. Clinical data obtained from tumor registries and medical records. Creatinine clearance (CrCl) was determined using the Cockcroft-Gault formula. Mixed model analysis was used to evaluate associations between patient clinical factors and longitudinal renal function. Results: 296 patients (3,930 Cr measurements) were included in the analysis. Mean age was 63 years, 43% were women, and 47% were white. Patients had a median of 5 (IQR 4-18) Cr measurements. The median overall CrCl was 92 (IQR 68-124) mL/min; the median pre-treatment CrCl was 96 (IQR 74-123) mL/min; and the median nadir CrCl was 78 (IQR 56-100) mL/min, occurring a median of 35 (IQR 1-235) d after diagnosis. Renal function was significantly associated with age (P&lt;0.001), race (P=0.009), and gender (P=0.001). 22% of patients had a recorded CrCl &lt; 60 mL/min (a commonly used threshold for cisplatin administration), with median onset of 89 d after diagnosis and median time to recover to ≥ 60 mL of 20 (IQR 3-85) d. The incidence and median duration of CrCl &lt; 60 mL/min varied by age (&lt;65 y: 8%, 17 d; ≥65 y: 30%, 43 d), gender (male: 9%, 15 d; female: 28%, 36 d), and race (white: 30%, 42 d; non-white: 13%, 21 d). 10% of patients had a recorded CrCl &lt; 45 mL/min (threshold for pemetrexed), with median onset 228 d after diagnosis and median time to recover to ≥ 45 mL/min of 33 (IQR 3-73) d. The incidence and median duration of CrCl &lt; 45 mL/min also varied by age (&lt;65 y: 6%, 6 d; ≥65 y: 8%, 72 d), gender (male: 4%, 5 d; females: 9%, 68 d), and race (white: 4%, 68 d; non-white 8%, 8 d). Conclusions: In a real-world cohort of patients treated for stage IV NSCLC, renal function falls below commonly used thresholds for cisplatin and pemetrexed in fewer than a quarter of patients. When such declines in renal function do occur, their duration may preclude administration of these drugs for prolonged periods.

The Impact of Renal Function on Outcomes of Bariatric Surgery

In this issue of JASN , Turgeon et al. [1][1] offer new insights into the relationship between complications from bariatric surgery and kidney function measured by GFR. They report a positive correlation between stage of kidney disease and complication rate. Given significantly higher complication

Impact of renal function on cardiovascular events in patients undergoing radical nephrectomy for renal cancer

To examine the actual impact of renal dysfunction on cardiovascular events in Japanese patients undergoing radical nephrectomy for renal cancer. This retrospective study included 178 Japanese patients who underwent radical nephrectomy between 1980 and 2010. Kaplan-Meier survival curves with a log-rank test and the Cox proportional hazards model were used to investigate the impact of the estimated glomerular filtration rate at 1 month after the radical nephrectomy on cardiovascular-event-free, cancer-specific and overall survivals. During a median follow up of 68 months, 23 patients experienced cardiovascular events and 32 died. Postoperative renal dysfunction (estimated glomerular filtration rate <45 mL/min/1.73 m(2) 1 month after radical nephrectomy) was a significant risk factor for postoperative cardiovascular events in addition to age and history of cardiovascular disease. After adjustment for preoperative characteristics, postoperative renal dysfunction increased the risk of cardiovascular events by 3.48-fold (95% confidence interval 1.28-8.66). For overall and cancer-specific survivals, postoperative renal dysfunction did not represent an independent risk factor. Renal dysfunction has a significant impact on cardiovascular events in patients undergoing radical nephrectomy for renal cancer.

The Impact of Renal Function on Outcomes of Bariatric Surgery

The effect of CKD on the risks of bariatric surgery is not well understood. Using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File, we analyzed 27,736 patients who underwent bariatric surgery from 2006 through 2008. Before surgery, 34 (0.12%) patients were undergoing long-term dialysis. Among those not undergoing dialysis, 20,806 patients (75.0%) had a normal estimated GFR or stage 1 CKD, 5011 (18.07%) had stage 2 CKD, 1734 (6.25%) had stage 3 CKD, 94 (0.34%) had stage 4 CKD, and 91 (0.33%) had stage 5 CKD. In an unadjusted analysis, CKD stage was directly associated with complication rate, ranging from 4.6% for those with stage 1 CKD or normal estimated GFR to 9.9% for those with stage 5 CKD (test for trend, P<0.001). Multivariable logistic regression demonstrated that CKD stage predicts higher complication rates (odds ratio for each higher CKD stage, 1.30) after adjustment for diabetes and hypertension. Although patients with higher CKD stage had higher complication rates, the absolute incidence of complications remained <10%. In conclusion, these data demonstrate higher risks of bariatric surgery among patients with worse renal function, but whether the potential benefits outweigh the risks in this population requires further study.

90 Impact of renal function immediately after radical nephrectomy on cardiovascular events in patients with kidney cancer

90 Impact of renal function immediately after radical nephrectomy on cardiovascular events in patients with kidney cancer

The N-terminal pro-brain-type natriuretic peptide based short-term prognosis in patients with acute pulmonary embolism according to renal function

N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is currently used for risk stratification in acute pulmonary embolism (PE). We aimed to clarify the impact of renal function on the validity of the NT-proBNP based prognosis, assuming that the biomarker is accumulated in renal insufficiency. The NT-proBNP based prediction of PE related in-hospital death was investigated according to renal function in 329 patients with acute PE. The normalized NT-proBNP ratios (NT-proBNP level divided by the age-adjusted normal upper range) were inversely correlated (r=-0.414, P<0.001) to the estimated glomerular filtration rates (eGFR). A cut-off point of≥2.5 for the normalized NT-proBNP ratio was found to be best for the prediction of mortality (AUC 0.716, 95% CI 0.626-0.805, P<0.001) and was a significant predictor for death in univariate and multivariate analysis. A normalized NT-proBNP ratio≥2.5 was a significant predictor for PE-mortality only in patients with an eGFR≥60ml/min/1.73m². Renal insufficiency significantly predicted mortality in univariate but not in multivariate analysis. High-risk PE and cerebrovascular diseases were significantly more frequent in renal dysfunction and significantly predicted death in univariate and multivariate analysis. The validity of the NT-proBNP based short-term prognosis might be limited in renal dysfunction not only by accumulation, but also because renal insufficiency itself and concurrent conditions are contributing to PE related mortality.

Impact of Renal Function Before Mechanical Circulatory Support on Posttransplant Renal Outcomes

Renal dysfunction is common before mechanical circulatory support (MCS). Mechanical circulatory support frequently improves renal function, but the impact of pre-MCS renal dysfunction on renal function after cardiac transplantation (CTX) is unknown. Patients with MCS from January 1995 until April 2008 at a single center were included if their MCS duration was at least 60 days and they underwent successful CTX. Patients were followed for 1 year after CTX. A total of 116 patients were included in the study. Mechanical circulatory support was biventricular assist device in 28% and left ventricular assist device in 72% (continuous flow left ventricular assist device, 14%). Mean duration of MCS was 124 days. Patients were grouped according to tertiles of pre-MCS creatinine clearance (CrCl): group 1, CrCl less than 45 mL/min; group 2, CrCl between 45 and 65 mL/min inclusive; and group 3, CrCl more than 65 mL/min. Group 3 had the best renal outcomes both after MCS and 1 year after CTX. Regardless of group, patients who had a CrCl of at least 60 mL/min before CTX had similar 1-year posttransplant CrCl (55 versus 53 versus 56 mL/min for groups 1 through 3, respectively; not significantly different). However, the ability to achieve this level of renal function after MCS was less likely in those with the worst renal function before the initiation of MCS (53% versus 74% versus 90% for groups 1 through 3, respectively; p=0.001). The use of MCS leads to improvements in renal function in patients after MCS. However, the renal outcomes after CTX seem to be more dependent on the level of renal function achieved during MCS than on the level of renal function before MCS.

Allogeneic Hematopoietic Stem Cell Transplantation for Patients With Light Renal Failure

Although renal function may affect the outcome of allogeneic hematopoietic stem cell transplantation (HSCT), mildly reduced renal function which is defined as serum creatinine level between 1.2 to 2.0 mg/dl did not correlate with non-relapse mortality (NRM) in the analysis of hematopoietic cell transplantation comorbidity index (HCT-CI). Creatinine clearance rate (Ccr) is a useful and exact way to asses renal function. Impact of renal function which is evaluated using Ccr before HSCT on the outcome has not been investigated yet.

Renal Function and Cardiovascular Events During Antihypertensive Treatment in Elderly Patients

Evaluation of: Hayashi K, Saruta T, Goto Y, Ishii M; JATOS Study Group: Impact of renal function on cardiovascular events in elderly hypertensive patients treated with efonidipine. Hypertens. Res. 33(11), 1211–1220 (2010). Antihypertensive therapy with efonidipine-based regimens increased estimated glomerular filtration rate (eGFR) throughout the trial period in elderly patients with hypertension in both strict- and mild-treatment groups. The incidence of cardiovascular events was higher in patients with proteinuria than in those without proteinuria at baseline, while disappearance of proteinuria during antihypertensive therapy was closely associated with a reduced incidence of cardiovascular events. Furthermore, cardiovascular event rate was increased in patients with greater declines in eGFR during the study period of 2 years, although baseline eGFR did not correlate with the incidence of cardiovascular events. These findings have implications for therapeutic strategies in treating hypertension with regard to renal protection and cardiovascular events in elderly hypertensive patients.

Impact of Renal Function in Patients with Multi-Vessel Coronary Disease (MVD) on Long Term Mortality Following Coronary Artery Bypass Grafting (CABG) Compared with Percutaneous Coronary Intervention (PCI)

Background: Renal failure is an important predictor of mortality in patients with MVD who undergo coronary revascularisation. We sought to determine if the degree of renal impairment affects long-term mortality based on choice of revascularisation strategy. Method: We analysed 7841 patients with MVD undergoing either CABG (n = 6,739) or PCI (n = 1,102) between 2004 and 2008, enrolled in two large multi-centre Australian registries. Patients were assigned to three groups using stratified propensity matching based on their estimated glomerular filtration rate (eGFR) at baseline; ≥60 (CABG = 4674 vs. PCI = 839), 30–59 (CABG = 1799 vs. PCI = 226) and <30 ml/min/1.73 m2 (CABG = 266 vs. PCI = 37) respectively. Shock, myocardial infarction (MI) <24 h, previous CABG, valve surgery or PCI were exclusions. We compared Cox-proportional hazards-adjusted National Death Index-linked long-term mortality (mean 3.2 years). Results: In patients with eGFR30-59 and ≥60 ml/min/1.73 cm2, there were more women, octogenarians and recent MI in the PCI group and a higher prevalence of cerebrovascular disease, peripheral vascular disease, prior heart failure and MI in the CABG group. Observed long-term mortality rates (CABG vs. PCI) were 4.8% vs. 4.3% p = 0.50, 11.3% vs. 17.3% p = 0.009, 19.9% vs. 40.5% p = 0.005 in the three strata, respectively. Following adjustment, patients with eGFR ≥ 60 ml/min/1.73 cm2 had no significant difference in long-term mortality. However, with eGFR30-59 ml/min/1.73 cm2, PCI was an independent predictor of long-term mortality (HR1.55, 95%CI 1.07–2.25, p = 0.02). For eGFR < 30 ml/min/1.73 cm2, there was a trend towards higher mortality with PCI (HR1.80, 95%CI 0.95–3.41, p = 0.07). Conclusion: In this stratified, propensity-matched study there was a long-term mortality hazard associated with PCI for patients with eGFR30-59 ml/min/1.73 m2. The effect may be higher for eGFR < 30 ml/min/1.73 m2.

Midregional Pro–Atrial Natriuretic Peptide for the Diagnosis of Cardiac-Related Dyspnea according to Renal Function in the Emergency Department: A Comparison with B-Type Natriuretic Peptide (BNP) and N-Terminal ProBNP

Although renal dysfunction influences the threshold values of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in diagnosis of cardiac-related dyspnea (CRD), its effects on midregional pro-atrial natriuretic peptide (MR-proANP) threshold values are unknown. We evaluated the impact of renal function on MR-proANP concentrations and compared our results to those of BNP and NT-proBNP. MR-proANP, BNP, and NT-proBNP concentrations were measured in blood samples collected routinely from dyspneic patients admitted to the emergency department. Patients were subdivided into tertiles based on their estimated glomerular filtration rate [eGFR, in mL · min(-1) · (1.73 m(2))(-1)]: tertiles 1 (<44.3), 2 (44.3-58.5), and 3 (≥58.6). Of 378 patients studied, 69% (n = 260) had impaired renal function [<60 mL · min(-1) · (1.73 m(2))(-1)] and 30% (n = 114) had CRD. MR-proANP, BNP, and NT-proBNP concentrations were significantly increased in patients with impaired renal function. In each tertile, all peptides remained significantly increased in CRD patients by comparison with non-CRD patients. By ROC analysis, MR-proANP, BNP, and NT-proBNP threshold values for the diagnosis of CRD increased as eGFR decreased from tertile 3 to tertile 1. Areas under the ROC curve for all peptides were significantly lower in tertile 1. Using adapted thresholds, MR-proANP, BNP, and NT-proBNP remained independently predictive of CRD, even in tertile 1 patients. Renal function influences optimum cutoff points of MR-proANP for the diagnosis of CRD. With use of an optimum threshold value adapted to the eGFR category, MR-proANP remains as effective as BNP and NT-proBNP in independently predicting a diagnosis of CRD in the emergency department.

Cardio-renal interaction: impact of renal function and anemia on the outcome of chronic heart failure

The purpose of this study is to investigate the effects of renal function and anemia on the outcome of chronic heart failure (CHF). We targeted 711 consecutive patients who were hospitalized at the Division of Cardiology of Fujita Health University Hospital during a 5-year period. The subjects were divided into four groups according to their estimated glomerular filtration rate (e-GFR) calculated using the Modification of Diet in Renal Disease (MDRD) formula. Intergroup comparisons were conducted for underlying heart diseases, clinical findings at the time of hospitalization, treatment, and outcome. Moreover, the patients were divided into two groups according to their serum hemoglobin concentration at the time of hospitalization, using 12.0 g/dl as the dividing point, to study the effects of anemia on the outcome. In the group with decreased renal function, the average age was higher, and ischemic heart disease and associated conditions such as hypertension and diabetes mellitus were observed in most of the patients. In addition, the rate of anemia development and the plasma B-type natriuretic peptide concentration were also high. The greater the deterioration in renal function, the poorer the outcome became (P < 0.0001). Chronic heart failure complicated by anemia showed an especially poor outcome (P < 0.0001). As this study showed that renal function and anemia significantly affected the outcome of CHF, it is clear that the preservation of renal function and the management of anemia are important in addition to the conventional treatments for CHF.