A randomized controlled trial on carbohydrate antigen 125-guided diuretic treatment versus usual care in patients with acute heart failure and renal dysfunction.
Am J Med. 2019 Aug 15;:
Authors: Núñez J, Llàcer P, García-Blas S, Bonanad C, Ventura S, Núñez JM, Sánchez R, Fácila L, de la Espriella R, Vaquer JM, Cordero A, Roqué M, Chamorro C, Bodi V, Valero E, Santas E, Del Carmen Moreno M, Miñana G, Carratalá A, Rodríguez E, Mollar A, Palau P, Bosch MJ, Bertomeu-González V, Lupón J, Navarro J, Chorro FJ, Górriz JL, Sanchis J, Voors AA, Bayés-Genís A, IMPROVE-HF Investigators
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.
PMID: 31422111 [PubMed - as supplied by publisher]