Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease
Abstract Aims Maintenance of euvolaemia with diuretics is critical in heart failure (HF) patients with chronic kidney disease (CKD); however, it is challenging because no reliable marker of volume status exists. Fractional excretion of urea nitrogen (FEUN) is a useful index of volume status in patie...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-06-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14327 |
| _version_ | 1797824678013698048 |
|---|---|
| author | Yukihiro Watanabe Yoshiaki Kubota Takuya Nishino Shuhei Tara Katsuhito Kato Daisuke Hayashi Kosuke Mozawa Junya Matsuda Yukichi Tokita Masahiro Yasutake Kuniya Asai Yu‐ki Iwasaki |
| author_facet | Yukihiro Watanabe Yoshiaki Kubota Takuya Nishino Shuhei Tara Katsuhito Kato Daisuke Hayashi Kosuke Mozawa Junya Matsuda Yukichi Tokita Masahiro Yasutake Kuniya Asai Yu‐ki Iwasaki |
| author_sort | Yukihiro Watanabe |
| collection | DOAJ |
| description | Abstract Aims Maintenance of euvolaemia with diuretics is critical in heart failure (HF) patients with chronic kidney disease (CKD); however, it is challenging because no reliable marker of volume status exists. Fractional excretion of urea nitrogen (FEUN) is a useful index of volume status in patients with renal failure. We aimed to examine whether FEUN is a surrogate marker of volume status for risk stratification in HF patients with CKD. Methods and results We examined 516 HF patients with CKD (defined as discharge estimated glomerular filtration rate < 60 mL/min/1.73 m2) whose FEUN was measured at discharge (median age, 80 years; 58% male). The patients were divided into four groups according to quartile FEUN value at discharge: low‐FEUN, FEUN ≤ 32.1; medium‐FEUN, 32.1 < FEUN ≤ 38.0; high‐FEUN, 38.0 < FEUN ≤ 43.7; and extremely‐high‐FEUN, FEUN > 43.7. FEUN was calculated by the following formula: (urinary urea × serum creatinine) × 100/(serum urea × urinary creatinine). During the 3 year follow‐up, 131 HF readmissions occurred. Kaplan–Meier analysis showed that the HF readmission rate was significantly lower in the medium‐FEUN group than in the other three groups (log‐rank test, P = 0.029). Multivariate Cox regression analysis identified the low‐FEUN, high‐FEUN, and extremely‐high‐FEUN values as independent factors associated with post‐discharge HF readmission. In the analysis of 130 patients who underwent right heart catheterization during hospitalization, a significant correlation between FEUN value and right atrial pressure was observed (R = 0.243, P = 0.005). Multivariate linear regression analysis revealed that FEUN value at discharge decreased in a dose‐dependent manner with loop diuretics. Conclusions In HF patients with CKD, FEUN is a potential marker of volume status for risk stratification of post‐discharge HF readmission. Low FEUN value (FEUN ≤ 32.1) may represent intravascular dehydration, whereas high FEUN value (FEUN > 38.0) may represent residual congestion; both of them were independent risk factors for HF readmission. FEUN may be useful to determine euvolaemia and guide fluid management in HF patients with CKD. |
| first_indexed | 2024-03-13T10:42:37Z |
| format | Article |
| id | doaj.art-f1a2ba2eb3a84d369352d039f3d5eb89 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-13T10:42:37Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-f1a2ba2eb3a84d369352d039f3d5eb892023-05-18T03:08:57ZengWileyESC Heart Failure2055-58222023-06-011031706171610.1002/ehf2.14327Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney diseaseYukihiro Watanabe0Yoshiaki Kubota1Takuya Nishino2Shuhei Tara3Katsuhito Kato4Daisuke Hayashi5Kosuke Mozawa6Junya Matsuda7Yukichi Tokita8Masahiro Yasutake9Kuniya Asai10Yu‐ki Iwasaki11Department of Cardiovascular Medicine Nippon Medical School 1‐1‐5 Sendagi, Bunkyo‐ku Tokyo 113‐8603 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5 Sendagi, Bunkyo‐ku Tokyo 113‐8603 JapanDepartment of Health Care Administration Nippon Medical School Tokyo JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5 Sendagi, Bunkyo‐ku Tokyo 113‐8603 JapanDepartment of Hygiene and Public Health Nippon Medical School Tokyo JapanDepartment of Pharmaceutical Service Nippon Medical School Hospital Tokyo JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5 Sendagi, Bunkyo‐ku Tokyo 113‐8603 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5 Sendagi, Bunkyo‐ku Tokyo 113‐8603 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5 Sendagi, Bunkyo‐ku Tokyo 113‐8603 JapanDepartment of General Medicine and Health Science Nippon Medical School Tokyo JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5 Sendagi, Bunkyo‐ku Tokyo 113‐8603 JapanDepartment of Cardiovascular Medicine Nippon Medical School 1‐1‐5 Sendagi, Bunkyo‐ku Tokyo 113‐8603 JapanAbstract Aims Maintenance of euvolaemia with diuretics is critical in heart failure (HF) patients with chronic kidney disease (CKD); however, it is challenging because no reliable marker of volume status exists. Fractional excretion of urea nitrogen (FEUN) is a useful index of volume status in patients with renal failure. We aimed to examine whether FEUN is a surrogate marker of volume status for risk stratification in HF patients with CKD. Methods and results We examined 516 HF patients with CKD (defined as discharge estimated glomerular filtration rate < 60 mL/min/1.73 m2) whose FEUN was measured at discharge (median age, 80 years; 58% male). The patients were divided into four groups according to quartile FEUN value at discharge: low‐FEUN, FEUN ≤ 32.1; medium‐FEUN, 32.1 < FEUN ≤ 38.0; high‐FEUN, 38.0 < FEUN ≤ 43.7; and extremely‐high‐FEUN, FEUN > 43.7. FEUN was calculated by the following formula: (urinary urea × serum creatinine) × 100/(serum urea × urinary creatinine). During the 3 year follow‐up, 131 HF readmissions occurred. Kaplan–Meier analysis showed that the HF readmission rate was significantly lower in the medium‐FEUN group than in the other three groups (log‐rank test, P = 0.029). Multivariate Cox regression analysis identified the low‐FEUN, high‐FEUN, and extremely‐high‐FEUN values as independent factors associated with post‐discharge HF readmission. In the analysis of 130 patients who underwent right heart catheterization during hospitalization, a significant correlation between FEUN value and right atrial pressure was observed (R = 0.243, P = 0.005). Multivariate linear regression analysis revealed that FEUN value at discharge decreased in a dose‐dependent manner with loop diuretics. Conclusions In HF patients with CKD, FEUN is a potential marker of volume status for risk stratification of post‐discharge HF readmission. Low FEUN value (FEUN ≤ 32.1) may represent intravascular dehydration, whereas high FEUN value (FEUN > 38.0) may represent residual congestion; both of them were independent risk factors for HF readmission. FEUN may be useful to determine euvolaemia and guide fluid management in HF patients with CKD.https://doi.org/10.1002/ehf2.14327Volume statusFractional excretionUreaRenal dysfunctionAcute heart failure |
| spellingShingle | Yukihiro Watanabe Yoshiaki Kubota Takuya Nishino Shuhei Tara Katsuhito Kato Daisuke Hayashi Kosuke Mozawa Junya Matsuda Yukichi Tokita Masahiro Yasutake Kuniya Asai Yu‐ki Iwasaki Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease ESC Heart Failure Volume status Fractional excretion Urea Renal dysfunction Acute heart failure |
| title | Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease |
| title_full | Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease |
| title_fullStr | Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease |
| title_full_unstemmed | Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease |
| title_short | Utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease |
| title_sort | utility of fractional excretion of urea nitrogen in heart failure patients with chronic kidney disease |
| topic | Volume status Fractional excretion Urea Renal dysfunction Acute heart failure |
| url | https://doi.org/10.1002/ehf2.14327 |
| work_keys_str_mv | AT yukihirowatanabe utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT yoshiakikubota utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT takuyanishino utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT shuheitara utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT katsuhitokato utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT daisukehayashi utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT kosukemozawa utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT junyamatsuda utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT yukichitokita utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT masahiroyasutake utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT kuniyaasai utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease AT yukiiwasaki utilityoffractionalexcretionofureanitrogeninheartfailurepatientswithchronickidneydisease |