Clinical implications of the blood urea nitrogen/creatinine ratio in heart failure and their association with haemoconcentration. (9th December 2019)

• Record Type: Journal Article
• Authors: Sujino, Yasumori; Nakano, Shintaro; Tanno, Jun; Shiraishi, Yasuyuki; Goda, Ayumi; Mizuno, Atsushi; Nagatomo, Yuji; Kohno, Takashi; Muramatsu, Toshihiro; Nishimura, Shigeyuki; Kohsaka, Shun; Yoshikawa, Tsutomu
• Is Part Of: ESC heart failure. Volume 6:Number 6(2019)
• Page Start: 1274
• Page End: 1282
• Publication Date: 2019-12-09
• Subjects: Acute decompensated heart failure -- Blood urea nitrogen/creatinine ratio -- Haemoconcentration -- Haemodilution; Heart failure -- Periodicals; 616.129005
• DOI: 10.1002/ehf2.12531
• Languages: English
• ISSNs: 2055-5822

Abstract

Abstract: Aims: The blood urea nitrogen (BUN)/creatinine ratio is a strong prognostic indicator in patients with acute decompensated heart failure (ADHF). However, the clinical impact of a high BUN/creatinine ratio at discharge with respect to renal dysfunction, neurohormonal hyperactivity, and different responsiveness to decongestion therapy remains unclear. Herein, we examined (i) the predictive value of a high BUN/creatinine ratio at discharge and (ii) its haemoconcentration‐dependent effects, in patients with ADHF. Methods and results: The West Tokyo Heart Failure registry was a multicentre, prospective cohort registry‐based study that enrolled patients hospitalized with a diagnosis of ADHF. The endpoint was post‐discharge all‐cause death. Based on the degree of haemoconcentration, patients ( n = 2090) were divided into four subcategories. In multivariate proportional hazard analyses, a higher BUN/creatinine ratio was independently associated with higher all‐cause mortality in the total population and in the extreme haemodilution (ΔHaemoglobin ≤ −0.9 g/dL) and haemoconcentration (0.8 g/dL ≤ ΔHaemoglobin) subcategories, but not in the modest haemodilution/haemoconcentration subcategories. Conclusions: A higher BUN/creatinine ratio at discharge was independently associated with higher post‐discharge all‐cause mortality in patients with ADHF. The predictive value of a high BUN/creatinine ratio at discharge was haemoconcentration dependent and may be an unfavourable predictor in patients showing excessive haemoconcentration and haemodilution, but not in those showing modest haemoconcentration/haemodilution.