TY - JOUR
T1 - CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction
AU - Núñez, Julio
AU - Llàcer, Pau
AU - García-Blas, Sergio
AU - Bonanad, Clara
AU - Ventura, Silvia
AU - Núñez, José María
AU - Sánchez, Ruth
AU - Fácila, Lorenzo
AU - de la Espriella, Rafael
AU - Vaquer, Juana María
AU - Cordero, Alberto
AU - Roqué, Mercè
AU - Chamorro, Carlos
AU - Bodi, Vicent
AU - Valero, Ernesto
AU - Santas, Enrique
AU - Moreno, María del Carmen
AU - Miñana, Gema
AU - Carratalá, Arturo
AU - Rodríguez, Enrique
AU - Mollar, Anna
AU - Palau, Patricia
AU - Bosch, María José
AU - Bertomeu-González, Vicente
AU - Lupón, Josep
AU - Navarro, Jorge
AU - Chorro, Francisco J.
AU - Górriz, Jose L.
AU - Sanchis, Juan
AU - Voors, Adriaan A.
AU - Bayés-Genís, Antoni
N1 - Funding Information:
We gratefully acknowledge the assistance of Amparo Villaescusa, Paula Lizandra, Antonio Gabarr?n, Marta Peir?, Loli Iglesias, and Bernat Navarro. Funding: This work was supported by: Project PI13/01519 in collaboration with ?Plataforma de Unidades de Investigaci?n Cl?nica y Ensayos Cl?nicos? (SCReN) (PT13/0002/0031). Co-funded by ?Fondos FEDER?; unrestricted grants from ?Proyectos de Investigaci?n de Insuficiencia Cardiaca de la Secci?n de Insuficiencia Cardiaca 2015? and ?Beca Mutual M?dica 2014?; PIE15/00013, and CIBER CV 16/11/00420 and 16/11/00403. The funder has no role in the study design, data collection, analysis and modeling, interpretation of the results, and in writing the manuscript. Conflicts of Interest: JN received board speaker fees and travel expenses from Novartis, Roche Diagnostics, Abbott, Rovi, Vifor Pharma, and AstraZeneca. LF received speaker fees and travel expenses from Novartis. VB-G received speaker fees and travel expenses from Daiichi Sankyo, Boehringer Ingelheim, Bayer, Pfizer, LivaNova, Sanofi, Ferrer, Medtronic, and St Jude Medical. JS received speaker fees from Astra-Zeneca, Abbott, and Edwards Lifesciences. JLG received board membership fees, speaker fees, and consulting fees from Astra Zeneca and Vifor Fresenius Medical Care Renal Pharma. AAV received consultancy fees and/or research grants from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, Cytokinetics, GlaxoSmithKline, Novartis, Roche Diagnostics, and Servier. AB-G received board membership fees and travel expenses from Novartis, Roche Diagnostics, and Critical Diagnostics. PL, SG-B, CB, SV, JMN, RS, RE, JMV, AC, MR, CC, VB, EV, ES, MCM, GM, AC, ER, AM, PP, MJB, JL JN, FJC eport none.
Publisher Copyright:
© 2019 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3
Y1 - 2020/3
N2 - 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/1.73m2. 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 = 0.042). 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/1.73m2) 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.
AB - 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/1.73m2. 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 = 0.042). 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/1.73m2) 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.
KW - Acute heart failure
KW - Biomarker guided-therapy
KW - Carbohydrate antigen 125
KW - Clinical trial
KW - Diuretic treatment
KW - Renal failure
UR - http://www.scopus.com/inward/record.url?scp=85076346743&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2019.07.041
DO - 10.1016/j.amjmed.2019.07.041
M3 - Artículo
C2 - 31422111
AN - SCOPUS:85076346743
VL - 133
SP - 370-380.e4
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 3
ER -