CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction
Por:
Nunez, J, Llacer, P, Garcia-Blas, S, Bonanad, C, Ventura, S, Nunez, JM, Sanchez, R, Facila, L, de la Espriella, R, Vaquer, JM, Cordero, A, Roque, M, Chamorro, C, Bodi, V, Valero, E, Santas, E, Moreno, MD, Minana, G, Carratala, A, Rodriguez, E, Mollar, A, Palau, P, Bosch, MJ, Bertomeu-Gonzalez, V, Lupon, J, Navarro, J, Chorro, FJ, Gorriz, JL, Sanchis, J, Voors, AA and Bayes-Genis, A
Publicada:
1 mar 2020
Ahead of Print:
15 ago 2019
Resumen:
BACKGROUND: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation.
METHODS: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively.
RESULTS: The mean age was 78 +/- 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 +/- 11.3 mL/min/1.73m(2). Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0 .011) , which translated into higher urine volume (P = 0 .0 42) . Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m(2)) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391).
CONCLUSION: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction. (C) 2019 Elsevier Inc. All rights reserved.
Filiaciones:
Nunez, J:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
CIBER Cardiovasc, Madrid, Spain
Hosp Univ Vinalopo, Crit Care Unit, Alicante, Spain
Llacer, P:
Hosp Manises, Internal Med Dept, Valencia, Spain
Garcia-Blas, S:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
CIBER Cardiovasc, Madrid, Spain
Bonanad, C:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
Ventura, S:
Hosp La Plana, Internal Med Dept, Villa Real, Castellon, Spain
Nunez, JM:
Hosp Univ Vinalopo, Crit Care Unit, Alicante, Spain
Sanchez, R:
Hosp Virgen Los Lirios, Internal Med Dept, Alcoy, Spain
Facila, L:
Hosp Gen Univ Valencia, Cardiol Dept, Valencia, Spain
de la Espriella, R:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
Vaquer, JM:
Univ Valencia, Hosp Clin Univ Valencia, Biochem Dept, INCLIVA, Valencia, Spain
Cordero, A:
Hosp Univ San Juan Alicante, Cardiol Dept, Alicante, Spain
Roque, M:
Hosp Clin Barcelona, Cardiol Dept, Barcelona, Spain
Chamorro, C:
Hosp Virgen Los Lirios, Internal Med Dept, Alcoy, Spain
Bodi, V:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
CIBER Cardiovasc, Madrid, Spain
Valero, E:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
CIBER Cardiovasc, Madrid, Spain
Santas, E:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
Moreno, MD:
Hosp Manises, Internal Med Dept, Valencia, Spain
Minana, G:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
CIBER Cardiovasc, Madrid, Spain
Carratala, A:
Univ Valencia, Hosp Clin Univ Valencia, Biochem Dept, INCLIVA, Valencia, Spain
Rodriguez, E:
Univ Valencia, Hosp Clin Univ Valencia, Biochem Dept, INCLIVA, Valencia, Spain
Mollar, A:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
Palau, P:
Univ Jaume 1, Cardiol Dept, Hosp Gen Univ Castellon, Castellon de La Plana, Spain
Bosch, MJ:
Hosp La Plana, Internal Med Dept, Villa Real, Castellon, Spain
Bertomeu-Gonzalez, V:
Hosp Univ San Juan Alicante, Cardiol Dept, Alicante, Spain
:
CIBER Cardiovasc, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Badalona, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona, Spain
Navarro, J:
Univ Valencia, Hosp Clin Univ, INCLIVA, Valencia, Spain
Chorro, FJ:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
CIBER Cardiovasc, Madrid, Spain
Gorriz, JL:
Univ Valencia, Hosp Clin Univ, Nephrol Dept, INCLIVA, Valencia, Spain
Sanchis, J:
Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain
CIBER Cardiovasc, Madrid, Spain
Voors, AA:
Univ Med Ctr Groningen, Cardiol Dept, Groningen, Netherlands
:
CIBER Cardiovasc, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Badalona, Spain
Autonomous Univ Barcelona, Dept Med, Barcelona, Spain
Green Published
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