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Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction.
Intern Emerg Med. 2015 Dec; 10(8):965-72.IE

Abstract

Renal dysfunction (RD) and venous congestion are related and common in heart failure (HF). Studies suggest that venous congestion may be the primary driver of RD in HF. In this study, we sought to investigate retrospectively the relationship between common measures of renal function with caval congestion and mortality among outpatients with HF and RD. We reviewed data from 103 HF outpatients (45 males, mean age 74 years, ejection fraction 41.8 ± 11.6 %) with estimated glomerular filtration rate (eGFR) of < 60 ml/min in a single centre. During an ambulatory visit, all patients underwent blood test and ultrasonography of the inferior vena cava (IVC). Caval congestion was defined as IVC with both dilatation and impaired collapsibility. The best values of renal metrics in predicting caval congestion were determined with receiver-operating characteristic analysis. The BUN/Cr ratio is moderately correlated with IVC expiratory maximum diameter (r = 0.31, p < 0.0007). In a multiple logistic regression model, BUN/Cr > 25.5 (adjusted OR 2.98, p 0.015) and eGFR ≤ 45.8 (adjusted OR 5.38, p 0.002) identify patients at risk for caval congestion; a BUN/Cr > 23.7 was the best predictor of impaired collapsibility (adjusted OR 4.41, p 0.001). a BUN/Cr > 25.5 (HR 2.19, 95 % CI 1.21-3.94, p < 0.001) and NYHA class 3 (HR 2.91, 95 % CI 1.60-5.31, p < 0.0005) were independent risk factors associated with all-cause death during a median follow-up of 31 months. In outpatients with HF and RD, a higher BUN/Cr and lower eGFR are reliable renal biomarkers for caval congestion. The BUN/Cr is associated with long-term mortality and may help to stratify HF severity.

Authors+Show Affiliations

Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy. gaspare.parrinello@unipa.it.Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, USA.Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.Cardiology Division, Stony Brook University, Stony Brook, NY, USA.Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. "Paolo Giaccone", Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26037394

Citation

Parrinello, Gaspare, et al. "Blood Urea Nitrogen to Creatinine Ratio Is Associated With Congestion and Mortality in Heart Failure Patients With Renal Dysfunction." Internal and Emergency Medicine, vol. 10, no. 8, 2015, pp. 965-72.
Parrinello G, Torres D, Testani JM, et al. Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction. Intern Emerg Med. 2015;10(8):965-72.
Parrinello, G., Torres, D., Testani, J. M., Almasio, P. L., Bellanca, M., Pizzo, G., Cuttitta, F., Pinto, A., Butler, J., & Paterna, S. (2015). Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction. Internal and Emergency Medicine, 10(8), 965-72. https://doi.org/10.1007/s11739-015-1261-1
Parrinello G, et al. Blood Urea Nitrogen to Creatinine Ratio Is Associated With Congestion and Mortality in Heart Failure Patients With Renal Dysfunction. Intern Emerg Med. 2015;10(8):965-72. PubMed PMID: 26037394.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction. AU - Parrinello,Gaspare, AU - Torres,Daniele, AU - Testani,Jeffrey M, AU - Almasio,Piero Luigi, AU - Bellanca,Michele, AU - Pizzo,Giuseppina, AU - Cuttitta,Francesco, AU - Pinto,Antonio, AU - Butler,Javed, AU - Paterna,Salvatore, Y1 - 2015/06/03/ PY - 2015/03/05/received PY - 2015/05/13/accepted PY - 2015/6/4/entrez PY - 2015/6/4/pubmed PY - 2017/1/24/medline KW - Collapse index KW - Congestion KW - Heart failure KW - Inferior vena cava KW - Outpatients KW - Renal dysfunction SP - 965 EP - 72 JF - Internal and emergency medicine JO - Intern Emerg Med VL - 10 IS - 8 N2 - Renal dysfunction (RD) and venous congestion are related and common in heart failure (HF). Studies suggest that venous congestion may be the primary driver of RD in HF. In this study, we sought to investigate retrospectively the relationship between common measures of renal function with caval congestion and mortality among outpatients with HF and RD. We reviewed data from 103 HF outpatients (45 males, mean age 74 years, ejection fraction 41.8 ± 11.6 %) with estimated glomerular filtration rate (eGFR) of < 60 ml/min in a single centre. During an ambulatory visit, all patients underwent blood test and ultrasonography of the inferior vena cava (IVC). Caval congestion was defined as IVC with both dilatation and impaired collapsibility. The best values of renal metrics in predicting caval congestion were determined with receiver-operating characteristic analysis. The BUN/Cr ratio is moderately correlated with IVC expiratory maximum diameter (r = 0.31, p < 0.0007). In a multiple logistic regression model, BUN/Cr > 25.5 (adjusted OR 2.98, p 0.015) and eGFR ≤ 45.8 (adjusted OR 5.38, p 0.002) identify patients at risk for caval congestion; a BUN/Cr > 23.7 was the best predictor of impaired collapsibility (adjusted OR 4.41, p 0.001). a BUN/Cr > 25.5 (HR 2.19, 95 % CI 1.21-3.94, p < 0.001) and NYHA class 3 (HR 2.91, 95 % CI 1.60-5.31, p < 0.0005) were independent risk factors associated with all-cause death during a median follow-up of 31 months. In outpatients with HF and RD, a higher BUN/Cr and lower eGFR are reliable renal biomarkers for caval congestion. The BUN/Cr is associated with long-term mortality and may help to stratify HF severity. SN - 1970-9366 UR - https://www.unboundmedicine.com/medline/citation/26037394/Blood_urea_nitrogen_to_creatinine_ratio_is_associated_with_congestion_and_mortality_in_heart_failure_patients_with_renal_dysfunction_ L2 - https://dx.doi.org/10.1007/s11739-015-1261-1 DB - PRIME DP - Unbound Medicine ER -