CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

被引：75

作者：

Nunez, Julio ^{[1
,2
]}

Llacer, Pau ^{[3
]}

Garcia-Blas, Sergio ^{[1
,2
]}

Bonanad, Clara ^{[1
]}

Ventura, Silvia ^{[4
]}

Maria Nunez, Jose ^{[5
]}

Sanchez, Ruth ^{[6
]}

Facila, Lorenzo ^{[7
]}

de la Espriella, Rafael ^{[1
]}

Maria Vaquer, Juana ^{[8
]}

Cordero, Alberto ^{[9
]}

Roque, Merce ^{[10
]}

Chamorro, Carlos ^{[6
]}

Bodi, Vicent ^{[1
,2
]}

Valero, Ernesto ^{[1
,2
]}

Santas, Enrique ^{[1
]}

del Carmen Moreno, Maria ^{[3
]}

Minana, Gema ^{[1
,2
]}

Carratala, Arturo ^{[8
]}

Rodriguez, Enrique ^{[8
]}

Mollar, Anna ^{[1
]}

Palau, Patricia ^{[11
]}

Jose Bosch, Maria ^{[4
]}

Bertomeu-Gonzalez, Vicente ^{[9
]}

Lupon, Josep ^{[2
,12
,13
,14
]}

Navarro, Jorge ^{[15
]}

Chorro, Francisco J. ^{[1
,2
]}

Gorriz, Jose L. ^{[16
]}

Sanchis, Juan ^{[1
,2
]}

Voors, Adriaan A. ^{[17
]}

Bayes-Genis, Antoni ^{[2
,12
,13
,14
]}

机构：

[1] Univ Valencia, Hosp Clin Univ Valencia, Cardiol Dept, INCLIVA, Valencia, Spain

[2] CIBER Cardiovasc, Madrid, Spain

[3] Hosp Manises, Internal Med Dept, Valencia, Spain

[4] Hosp La Plana, Internal Med Dept, Villa Real, Castellon, Spain

[5] Hosp Univ Vinalopo, Crit Care Unit, Alicante, Spain

[6] Hosp Virgen Los Lirios, Internal Med Dept, Alcoy, Spain

[7] Hosp Gen Univ Valencia, Cardiol Dept, Valencia, Spain

[8] Univ Valencia, Hosp Clin Univ Valencia, Biochem Dept, INCLIVA, Valencia, Spain

[9] Hosp Univ San Juan Alicante, Cardiol Dept, Alicante, Spain

[10] Hosp Clin Barcelona, Cardiol Dept, Barcelona, Spain

[11] Univ Jaume 1, Cardiol Dept, Hosp Gen Univ Castellon, Castellon de La Plana, Spain

[12] Hosp Badalona Germans Trias & Pujol, Cardiol Dept, Badalona, Spain

[13] Hosp Badalona Germans Trias & Pujol, Heart Failure Unit, Badalona, Spain

[14] Autonomous Univ Barcelona, Dept Med, Barcelona, Spain

[15] Univ Valencia, Hosp Clin Univ, INCLIVA, Valencia, Spain

[16] Univ Valencia, Hosp Clin Univ, Nephrol Dept, INCLIVA, Valencia, Spain

[17] Univ Med Ctr Groningen, Cardiol Dept, Groningen, Netherlands

来源：

AMERICAN JOURNAL OF MEDICINE | 2020年 / 133卷 / 03期

关键词：

Acute heart failure; Biomarker guided-therapy; Carbohydrate antigen 125; Clinical trial; Diuretic treatment; Renal failure; ANTIGEN CARBOHYDRATE 125; CARDIORENAL SYNDROME; NATRIURETIC PEPTIDE; EUROPEAN-SOCIETY; SERUM CREATININE; CONGESTION; STRATEGIES; PREDICTION; MORTALITY; TRIAL;

D O I：

10.1016/j.amjmed.2019.07.041

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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/1.73m(2). 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 .0 42) . 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/1.73m(2)) 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. (C) 2019 Elsevier Inc. All rights reserved.

引用

页码：370 / +

页数：15

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