Hemoconcentration of Creatinine Minimally Contributes to Changes in Creatinine during the Treatment of Decompensated Heart Failure
KIDNEY360(2022)
摘要
Background Worsening serum creatinine is common during treatment of acute decompensated heart failure(ADHF). A possible contributor to creatinine increase is diuresis-induced changes in volume of distribution (VD)of creatinine as total body water (TBW) contracts around afixed mass of creatinine. Our objective was to better understand the filtration and non-filtration factors driving change in creatinine during ADHF. Methods Participants in the ROSE-AHF trial with baseline to 72-hour serum creatinine; net fluid output; and urinary KIM-1, NGAL, and NAG were included (n5270). Changes in VD were calculated by accounting form easured input and outputs from weight-based calculated TBW. Changes in observed creatinine (Crob served)were compared with predicted changes in creatinine after accounting for alterations in VD and non-steady state conditions using a kinetic GFR equation (Cr72HR Kinetic). Results When considering only change in VD, the median diuresis to elicit a$0.3 mg/dl rise in creatinine was27526 ml (IQR,25932 to29149). After accounting for stable creatinine filtration during diuresis, a change in VD alone was insufficient to elicit a >= 0.3 mg/dl rise in creatinine. Larger estimated decreases in VD were paradoxically associated with improvement in Crob served (r=20.18,P=0.003). Overall,23% of the change ineCr72HR Kinetic was attributable to the change in VD. A >= 0.3 mg/dl rise in eCr72HR Kinetic was not associated with worsening of KIM-1, NGAL, NAG, or post discharge survival (P.0.05 for all). Conclusions During ADHF therapy, increases in serum creatinine are driven predominantly by changes infiltration, with minimal contribution from change in VD.
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关键词
acute kidney injury and ICU nephrology, creatinine, heart failure, hematologic diseases
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