A randomized controlled trial on carbohydrate antigen 125-guided diuretic treatment versus usual care in patients with acute heart failure and renal dysfunction.

Autores de INCLIVA

• 

  Julio Nuñez Villota

  Autor

• Sergio Garcia Blas

  Autor

• 

  Clara Bonanad Lozano

  Autor

• Ruben Facila De La Esperanza

  Autor

• 

  Rafael De La Espriella Juan

  Autor

• Juana Maria Vaquer Santamaria

  Autor

• 

  Vicent Bodí Peris

  Autor

• Ernesto Valero Picher

  Autor

• Enrique Santas Olmeda

  Autor

• Gema Miñana Escriva

  Autor

• Arturo Carratalá Calvo

  Autor

• Enrique Rodriguez Borja

  Autor

• Anna Mireia Mollar Fernandez

  Autor

• 

  Jorge Navarro Perez

  Autor

• 

  Francisco Javier Chorro Gascó

  Autor

• 

  Jose Luis Górriz Teruel

  Autor

• 

  Juan Sanchis Fores

  Autor

Participantes ajenos a INCLIVA

• Llacer, Pau
• Ventura, Silvia
• Nunez, Jose Maria
• Sanchez, Ruth
• Cordero, Alberto
• Roque, Merce
• Chamorro, Carlos
• Del Carmen Moreno, Maria
• Palau, Patricia
• Bosch, Maria Jose
• Bertomeu-Gonzalez, Vicente
• Lupon, Josep
• Voors, Adriaan A
• Bayes-Genis, Antoni
• IMPROVE-HF Investigators

Grupos y Plataformas de I+D+i

• Grupo de investigación cardiometabólica en atención primaria

  

  Leading Researcher

  Jorge Navarro Perez

• Grupo de investigación en Cardiología Clínica

  

  Leading Researcher

  Juan Sanchis Fores

• Grupo de Investigación en Electrofisiología cardiaca experimental

  

  Leading Researcher

  Antonio M. Alberola Aguilar

• Grupo de Investigación Traslacional en Cardiopatía Isquémica

  

  Leading Researcher

  Vicent Bodí Peris

Abstract

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 two groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n=79), and to clinical evaluation in the usual care group (n=81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24h were the co-primary endpoints, respectively.; RESULTS: The mean age was 78±8years, the median amino-terminal pro-brain natriuretic peptide was 7765pg/mL, and the mean eGFR was 33.7±11.3mL/min/1.73m2. Over 72h, 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>35U/mL received the highest furosemide equivalent dose (p<0.001) and had higher diuresis (p=0.013). At 72-h, 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-h (35.8 vs. 39.5, p=0.391).; CONCLUSION: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72h in patients with acute heart failure and renal dysfunction. Abreviations. Copyright © 2019. Published by Elsevier Inc.

© 2019 Elsevier Inc. All rights reserved.

Keywords

• Acute heart failure; Biomarker guided-therapy; Carbohydrate antigen 125; Clinical trial; Diuretic treatment; Renal failure