3rd INTERNATIONAL FLUID ACADEMY DAYS – ORAL ABSTRACT SESSION

Serum urea/creatinine ratio predicts successful loop diuretic therapy in congestive heart failure

F.H. Verbrugge, J. Duchenne, M. Dupont, W. Mullens

Department of Cardiology, Ziekenhuis Oost-Limburg, Belgium

Faculty of Medicine & Life Sciences, Hasselt University, Belgium

Background

2Hasselblad V et al. Eur J Heart Fail. 2007.

Background

3Verbrugge FH et al. Eur J Heart Fail. In press.

UREAREABSORPTION

Background

4Testani JM et al. J Am Coll Cardiol. 2011.

Objectives

1. To assess the prognostic value of the urea/creatinine

ratio (UCR) in patients admitted with heart failure (HF)

2. To assess the impact of the UCR on efficacy of loop

diuretic uptitration in HF

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Methods

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Cohort study in single tertiary care center

(Ziekenhuis Oost-Limburg, Genk, Belgium)

Consecutive patients admitted with a primary diagnosis of HF

(January, 2009 – March, 2011)

Loop diuretic uptitration: increase of maintenance dose at

discharge compared to admission

End-point: freedom from all-cause mortality or HF readmission

ResultsSTUDY FLOWCHART

Primary diagnosis of HF

January, 2009 – March, 2011N = 318

Loop diuretic dose decrease

N = 40

Loop diuretic dose unchanged

N = 177

Loop diuretic dose uptitrated

N = 101

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• Follow-up: 22 ± 10 months

• 54 patients died (17%)

• 91 patients readmitted for HF (29%)

• 194 patients with event-free survival (61%)

ResultsBASELINE CHARACTERISTICS

Baseline characteristics (N = 318)Age (year) 70 ± 11

Male / female gender 71% / 29%

New York Heart Association functional class (I / II / III / IV) 5% / 33% / 53% / 9%

Left ventricular ejection fraction ≥40% 34%

Chronic obstructive pulmonary disease 26%

Diabetes 29%

Body mass index (kg/m²) 28 ± 5

Heart rate (bpm) 74 (63 – 91)

Systolic/diastolic blood pressure (mmHg) 131 ± 24 / 74 ± 14

Estimated glomerular filtration rate (mL/min/1.73m²) 65 ± 27

Plasma NT-proBNP (pg/mL) 2,775 (1,242 – 12,074)

Renin-angiotensin system blocker treatment 51%

β-blocker treatment 62%

Mineralocorticoid receptor antagonist treatment 33%

ResultsUREA/CREATININE RATIO

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Adjusted HR (95% CI) for 1 SD increase in UCR = 1.30 (1.05 – 1.62)

Freedom from all-cause mortality or HF readmission

P-value = 0.001

ResultsLOOP DIURETIC UPTITRATION

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Freedom from all-cause mortality or HF readmission

Loop diureticuptitration

Loop diureticuptitration

HR (95% CI) for uptitration = 1.07 (0.61 – 1.89)HR (95% CI) for uptitration = 1.61 (1.01 – 2.57)

P-value = 0.041 P-value = 0.559

Conclusions

The UCR is a strong and independent

predictor of all-cause mortality and

readmissions in hospitalized HF patients

High UCR, as a surrogate for neurohumoral

activation, characterizes a vulnerable

population that demonstrates adverse

outcome with loop diuretic uptitration

Alternatives for decongestive therapy?11