Prognostic significance of blood urea nitrogen/creatinine ratio in chronic HFpEF. (24th February 2022)

• Record Type: Journal Article
• Authors: Zhen, Zhe; Liang, Weihao; Tan, Weiping; Dong, Bin; Wu, Yuzhong; Liu, Chen; Xue, Ruicong
• Is Part Of: European journal of clinical investigation. Volume 52:Number 7(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-02-24
• Subjects: heart failure with preserved ejection fraction -- blood urea nitrogen /creatinine ratio -- morbidity -- prognosis; Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.13761
• Languages: English
• ISSNs: 0014-2972

Abstract

Abstract: Background: The prognostic significance of blood urea nitrogen (BUN)/creatinine ratio specifically in chronic heart failure with preserved ejection fraction (HFpEF) patients remained unclear. We aimed to evaluate the association of BUN/creatinine ratio (baseline level and visit‐to‐visit variation) with the risk of adverse clinical outcomes among patients with chronic HFpEF. Methods and results: This is a secondary analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. Of the enrolled 3445 participants in the TOPCAT trial, associations between BUN/creatinine and clinical outcomes were examined in a subset of 1521 (baseline measurements level) and 1453 (visit‐to‐visit variation) participants. A multivariable Cox proportional hazard model was used to assess the prognostic significance of BUN/creatinine ratio and BUN/creatinine ratio variation for the prespecified clinical outcomes. A higher BUN/creatinine ratio was associated with a higher risk of all‐cause mortality (hazard ratio [HR] = 1.52, 95%CI, 1.21‐1.91; p < .001) as well as cardiovascular disease mortality (HR = 1.83, 95%CI, 1.35‐2.49; p < .001) in the fully adjusted model. Greater visit‐to‐visit variability in BUN/creatinine ratio tended to be independently associated with a higher risk of heart failure hospitalization and primary endpoint ( p < .001 for both outcomes). Furthermore, those findings were consistent across participants stratified by the presence of chronic kidney disease at baseline. Conclusions: Higher BUN/creatinine ratio and greater BUN/creatinine ratio variability are independently associated with adverse outcomes in HFpEF participants in the TOPCAT trial.