PLoS ONE (Jan 2014)

Evidence of uncoupling between renal dysfunction and injury in cardiorenal syndrome: insights from the BIONICS study.

  • Matthieu Legrand,
  • Benedetta De Berardinis,
  • Hanna K Gaggin,
  • Laura Magrini,
  • Arianna Belcher,
  • Benedetta Zancla,
  • Alexandra Femia,
  • Mandy Simon,
  • Shweta Motiwala,
  • Rasika Sambhare,
  • Salvatore Di Somma,
  • Alexandre Mebazaa,
  • Vishal S Vaidya,
  • James L Januzzi,
  • Global Research on Acute Conditions Team (GREAT)

DOI
https://doi.org/10.1371/journal.pone.0112313
Journal volume & issue
Vol. 9, no. 11
p. e112313

Abstract

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ObjectiveThe objective of the study was to assess urinary biomarkers of renal injury for their individual or collective ability to predict Worsening renal function (WRF) in patients with acutely decompensated heart failure (ADHF).MethodsIn a prospective, blinded international study, 87 emergency department (ED) patients with ADHF were evaluated with biomarkers of cardiac stretch (B type natriuretic peptide [BNP] and its amino terminal equivalent [NT-proBNP], ST2), biomarkers of renal function (creatinine, estimated glomerular filtration rate [eGFR]) and biomarkers of renal injury (plasma neutrophil gelatinase associated lipocalin [pNGAL], urine kidney injury molecule-1 [KIM-1], urine N-acetyl-beta-D-glucosaminidase [NAG], urine Cystatin C, urine fibrinogen). The primary endpoint was WRF.Results26% developed WRF; baseline characteristics of subjects who developed WRF were generally comparable to those who did not. Biomarkers of renal function and urine biomarkers of renal injury were not correlated, while urine biomarkers of renal injury correlated between each other. Biomarker concentrations were similar between patients with and without WRF except for baseline BNP. Although plasma NGAL was associated with the combined endpoint, none of the biomarker showed predictive accuracy for WRF.ConclusionsIn ED patients with ADHF, urine biomarkers of renal injury did not predict WRF. Our data suggest that a weak association exists between renal dysfunction and renal injury in this setting (Clinicaltrials.gov NCT#0150153).