Risk stratification of acute kidney injury using the blood urea nitrogen/creatinine ratio in patients with acute decompensated heart failure

Yoichi Takaya, Fumiki Yoshihara, Hiroyuki Yokoyama, Hideaki Kanzaki, Masafumi Kitakaze, Yoichi Goto, Toshihisa Anzai, Satoshi Yasuda, Hisao Ogawa, Yuhei Kawano

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Risk stratification of acute kidney injury (AKI) is important for acute decompensated heart failure (ADHF). The aim of this study was to determine whether clinical markers, such as the blood urea nitrogen/creatinine ratio (BUN/Cr) or BUN or creatinine values alone, stratify the risk of AKI for mortality. Methods and Results: In all, 371 consecutive ADHF patients were enrolled in the study. AKI was defined as serum creatinine ≥0.3 mg/dl or a 1.5-fold increase in serum creatinine levels within 48 h. During ADHF therapy, AKI occurred in 99 patients; 55 patients died during the 12-month follow-up period. Grouping patients according to AKI and a median BUN/Cr at admission of 22.1 (non-AKI+low BUN/Cr, non-AKI+high BUN/Cr, AKI+low BUN/Cr, and AKI+high BUN/Cr groups) revealed higher mortality in the AKI+high BUN/Cr group (log-rank test, P<0.001). Cox’s proportional hazard analysis revealed an association between AKI+high BUN/Cr and mortality, whereas the association with AKI+low BUN/Cr did not reach statistical significance. When patients were grouped according to AKI and median BUN or creatinine values at admission, AKI was associated with mortality, regardless of BUN or creatinine. Conclusions: The combination of AKI and elevated BUN/Cr, but not BUN or creatinine individually, is linked with an increased risk of mortality in ADHF patients, suggesting that the BUN/Cr is useful for risk stratification of AKI.

Original languageEnglish
Pages (from-to)1520-1525
Number of pages6
JournalCirculation Journal
Volume79
Issue number7
DOIs
Publication statusPublished - Jun 9 2015
Externally publishedYes

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Blood Urea Nitrogen
Acute Kidney Injury
Creatinine
Heart Failure
Mortality
Kidney
Wounds and Injuries
Serum

Keywords

  • Acute decompensated heart failure
  • Acute kidney injury
  • Blood urea nitrogen/creatinine ratio
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Risk stratification of acute kidney injury using the blood urea nitrogen/creatinine ratio in patients with acute decompensated heart failure. / Takaya, Yoichi; Yoshihara, Fumiki; Yokoyama, Hiroyuki; Kanzaki, Hideaki; Kitakaze, Masafumi; Goto, Yoichi; Anzai, Toshihisa; Yasuda, Satoshi; Ogawa, Hisao; Kawano, Yuhei.

In: Circulation Journal, Vol. 79, No. 7, 09.06.2015, p. 1520-1525.

Research output: Contribution to journalArticle

Takaya, Y, Yoshihara, F, Yokoyama, H, Kanzaki, H, Kitakaze, M, Goto, Y, Anzai, T, Yasuda, S, Ogawa, H & Kawano, Y 2015, 'Risk stratification of acute kidney injury using the blood urea nitrogen/creatinine ratio in patients with acute decompensated heart failure', Circulation Journal, vol. 79, no. 7, pp. 1520-1525. https://doi.org/10.1253/circj.CJ-14-1360
Takaya, Yoichi ; Yoshihara, Fumiki ; Yokoyama, Hiroyuki ; Kanzaki, Hideaki ; Kitakaze, Masafumi ; Goto, Yoichi ; Anzai, Toshihisa ; Yasuda, Satoshi ; Ogawa, Hisao ; Kawano, Yuhei. / Risk stratification of acute kidney injury using the blood urea nitrogen/creatinine ratio in patients with acute decompensated heart failure. In: Circulation Journal. 2015 ; Vol. 79, No. 7. pp. 1520-1525.
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AU - Yoshihara, Fumiki

AU - Yokoyama, Hiroyuki

AU - Kanzaki, Hideaki

AU - Kitakaze, Masafumi

AU - Goto, Yoichi

AU - Anzai, Toshihisa

AU - Yasuda, Satoshi

AU - Ogawa, Hisao

AU - Kawano, Yuhei

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N2 - Background: Risk stratification of acute kidney injury (AKI) is important for acute decompensated heart failure (ADHF). The aim of this study was to determine whether clinical markers, such as the blood urea nitrogen/creatinine ratio (BUN/Cr) or BUN or creatinine values alone, stratify the risk of AKI for mortality. Methods and Results: In all, 371 consecutive ADHF patients were enrolled in the study. AKI was defined as serum creatinine ≥0.3 mg/dl or a 1.5-fold increase in serum creatinine levels within 48 h. During ADHF therapy, AKI occurred in 99 patients; 55 patients died during the 12-month follow-up period. Grouping patients according to AKI and a median BUN/Cr at admission of 22.1 (non-AKI+low BUN/Cr, non-AKI+high BUN/Cr, AKI+low BUN/Cr, and AKI+high BUN/Cr groups) revealed higher mortality in the AKI+high BUN/Cr group (log-rank test, P<0.001). Cox’s proportional hazard analysis revealed an association between AKI+high BUN/Cr and mortality, whereas the association with AKI+low BUN/Cr did not reach statistical significance. When patients were grouped according to AKI and median BUN or creatinine values at admission, AKI was associated with mortality, regardless of BUN or creatinine. Conclusions: The combination of AKI and elevated BUN/Cr, but not BUN or creatinine individually, is linked with an increased risk of mortality in ADHF patients, suggesting that the BUN/Cr is useful for risk stratification of AKI.

AB - Background: Risk stratification of acute kidney injury (AKI) is important for acute decompensated heart failure (ADHF). The aim of this study was to determine whether clinical markers, such as the blood urea nitrogen/creatinine ratio (BUN/Cr) or BUN or creatinine values alone, stratify the risk of AKI for mortality. Methods and Results: In all, 371 consecutive ADHF patients were enrolled in the study. AKI was defined as serum creatinine ≥0.3 mg/dl or a 1.5-fold increase in serum creatinine levels within 48 h. During ADHF therapy, AKI occurred in 99 patients; 55 patients died during the 12-month follow-up period. Grouping patients according to AKI and a median BUN/Cr at admission of 22.1 (non-AKI+low BUN/Cr, non-AKI+high BUN/Cr, AKI+low BUN/Cr, and AKI+high BUN/Cr groups) revealed higher mortality in the AKI+high BUN/Cr group (log-rank test, P<0.001). Cox’s proportional hazard analysis revealed an association between AKI+high BUN/Cr and mortality, whereas the association with AKI+low BUN/Cr did not reach statistical significance. When patients were grouped according to AKI and median BUN or creatinine values at admission, AKI was associated with mortality, regardless of BUN or creatinine. Conclusions: The combination of AKI and elevated BUN/Cr, but not BUN or creatinine individually, is linked with an increased risk of mortality in ADHF patients, suggesting that the BUN/Cr is useful for risk stratification of AKI.

KW - Acute decompensated heart failure

KW - Acute kidney injury

KW - Blood urea nitrogen/creatinine ratio

KW - Prognosis

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