Page 129 - Biomarkers for risk stratification and guidance in heart failure

Chapter 6
ABSTRACT
Objectives
To assess the prognostic value of change in renal function as estimated by changes in eGFR in addition to change in NT-proBNP early after hospital discharge for acute heart failure.
Background
Renal dysfunction (RD) and heart failure (HF) often coincide and are independently correlated with prognosis. Likewise, change in renal function and the natriuretic peptide NT-proBNP have been associated with risk for morbidity and mortality. However, the prognostic importance of change in renal function in relation to change in NT-proBNP has not been investigated.
Methods
We evaluated the prognostic value of change in renal function as estimated by changes in eGFR in addition to change in NT-proBNP in patients recently admitted because of acute HF between hospital discharge and 1 month after hospital discharge in 271 patients included in the PRIMA study. Primary endpoint was HF readmission or mortality within one year of follow-up.
Results
In a multivariate Cox regression analysis, decrease versus increase in eGFR yielded no prognostic impact (Hazard ratio \[HR\] = 1.27, 95% CI 0.83-1.94, P=0.28). A decrease in eGFR more than 20% also wasn’t related to the combined endpoint (HR for decrease >20% versus change between 20% 1.34, 95% CI 0.80-2.24, P=0.262). This in contrast to change in NT-proBNP (HR for increase versus decrease in NT-proBNP 4.04, 95% CI 2.35-6.97, P<0.001), and NT-proBNP concentration at discharge (HR = 2.11 per log NT-proBNP, 95%-CI 1.21-3.70, P=0.009).
Conclusion
The prognostic impact of change in renal function early after hospital discharge because of acute HF is subordinate to change in NT-proBNP.
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