Renal Biomarkers and Outcomes in Outpatients With Heart Failure Open Access

Abstract

Renal Biomarkers and Outcomes in Outpatients With Heart Failure

By Bryan Overcarsh

Introduction: Cystatin C and beta-2 microglobulin (B2M) may be superior renal markers compared to creatinine (Cr), blood urea nitrogen (BUN), and calculated glomerular filtration rate (GFR) in patients with acute decompensated heart failure but data in stable heart failure patients is limited.

Methods: We evaluated the association of baseline tertiles of Cr, BUN, BUN/Cr ratio, GFR (by MDRD formula), Cys-C, and B2M with clinical events and health care resource utilization (HCRU) rates in 159 outpatients (age 57.3±11.7; 103 (65%) men; 92 (58%) white; black; EF 29.5±15.2) enrolled in a prospective cohort study.

Results: Over 42±12 months (total: 560 person-years), there were 33 (20.7%) clinical events (27 deaths, 4 transplants, 2 ventricular assist device implantations), 445 all-cause admissions (170 [38.2%] for HF), and 207 emergency department (ED) visits. Among renal markers, Cr had the strongest association with clinical events, with a highest vs. lowest tertile hazard ratio of 7.30 (95% CI 1.58-33.70; P 0.01) in models adjusted for demographics (age, race, gender), LVEF, NYHA class, systolic blood pressure, serum sodium, etiology (coronary artery disease, other), and medical therapy (beta blockade, ACE inhibitor, Angiotensin receptor blocker). Cr also had the strongest association with HCRU rates. In adjusted models, the highest vs. lowest Cr tertile rate ratio was 3.02 (95% CI 1.75- 5,24; P<0.001) for all-cause admissions; 5.2 (95% CI 1.71-15.89; P<0.005) for HF admissions; and 2.89 (95% CI 1.37-6.09; P=0.005) for ED visits.

Conclusion: In outpatients with heart failure, serum Cr may be prognostically superior to other traditional and novel markers of renal function.

Table of Contents

Table of Contents

Chapter 1...1

Literature Review

Chapter 2...7

Manuscript

Chapter 3...19

Future Directions

References...21

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	cardiorenal syndrome mortality Heart Failure
Committee Chair / Thesis Advisor	Kalogeropoulos, Andreas, Emory University
Committee Members	McClellan, William, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Does not apply (no collaborating organization)

Last modified

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Renal Biomarkers and Outcomes in Outpatients With Heart Failure ()	2018-08-28 14:03:52 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions