Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial

John E A Blair, Peter Pang, Robert W. Schrier, Marco Metra, Brian Traver, Thomas Cook, Umberto Campia, Andrew Ambrosy, John C. Burnett, Liliana Grinfeld, Aldo P. Maggioni, Karl Swedberg, James E. Udelson, Faiez Zannad, Marvin A. Konstam, Mihai Gheorghiade

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Aim: To provide an in-depth clinical characterization and analysis of outcomes of the patients hospitalized for heart failure (HF) who subsequently develop worsening renal function (WRF) during hospitalization or soon after discharge. Methods and results: Of the 4133 patients hospitalized with worsening HF and reduced left ventricular ejection fraction (LVEF) (≤40) in the EVEREST trial, 2072 were randomized to tolvaptan, a selective vasopressin-2 receptor antagonist, and 2061 were randomized to placebo, both in addition to standard therapy. This analysis included the 2021 (98) patients in the placebo group with a complete set of renal function parameters. Renal function parameters and clinical variables were measured prospectively during hospitalization and after discharge. Worsening renal function was defined as an increase in sCr 2). Worsening renal function was observed in 13.8 in-hospital and 11.9 post-discharge. Worsening renal function during hospitalization and post-discharge was associated with greater reductions in BP, BW, and NPs. Baseline renal dysfunction as well as in-hospital and post-discharge WRF were predictive of a composite endpoint of cardiovascular (CV) mortality/HF rehospitalization. Conclusion: The prevalence of renal dysfunction is high in patients hospitalized for HF with reduced LVEF. Worsening renal function may occur not only during hospitalization, but also in the early post-discharge period. Since worsening renal function during hospitalization is associated with a significant decrease in signs and symptoms of congestion, body weight and natriuretic peptides, which are good prognostic indicators, worsening renal function during hospitalization as an endpoint in clinical trials should be re-evaluated.

Original languageEnglish (US)
Pages (from-to)2563-2572
Number of pages10
JournalEuropean Heart Journal
Volume32
Issue number20
DOIs
StatePublished - Oct 2011
Externally publishedYes

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Patient Discharge
Hospitalization
Heart Failure
Placebos
Kidney
Stroke Volume
Natriuretic Peptides
Signs and Symptoms
Body Weight
Clinical Trials

Keywords

  • Acute heart failure syndromes
  • Heart failure
  • Hospitalization
  • Renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial. / Blair, John E A; Pang, Peter; Schrier, Robert W.; Metra, Marco; Traver, Brian; Cook, Thomas; Campia, Umberto; Ambrosy, Andrew; Burnett, John C.; Grinfeld, Liliana; Maggioni, Aldo P.; Swedberg, Karl; Udelson, James E.; Zannad, Faiez; Konstam, Marvin A.; Gheorghiade, Mihai.

In: European Heart Journal, Vol. 32, No. 20, 10.2011, p. 2563-2572.

Research output: Contribution to journalArticle

Blair, JEA, Pang, P, Schrier, RW, Metra, M, Traver, B, Cook, T, Campia, U, Ambrosy, A, Burnett, JC, Grinfeld, L, Maggioni, AP, Swedberg, K, Udelson, JE, Zannad, F, Konstam, MA & Gheorghiade, M 2011, 'Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial', European Heart Journal, vol. 32, no. 20, pp. 2563-2572. https://doi.org/10.1093/eurheartj/ehr238
Blair, John E A ; Pang, Peter ; Schrier, Robert W. ; Metra, Marco ; Traver, Brian ; Cook, Thomas ; Campia, Umberto ; Ambrosy, Andrew ; Burnett, John C. ; Grinfeld, Liliana ; Maggioni, Aldo P. ; Swedberg, Karl ; Udelson, James E. ; Zannad, Faiez ; Konstam, Marvin A. ; Gheorghiade, Mihai. / Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial. In: European Heart Journal. 2011 ; Vol. 32, No. 20. pp. 2563-2572.
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abstract = "Aim: To provide an in-depth clinical characterization and analysis of outcomes of the patients hospitalized for heart failure (HF) who subsequently develop worsening renal function (WRF) during hospitalization or soon after discharge. Methods and results: Of the 4133 patients hospitalized with worsening HF and reduced left ventricular ejection fraction (LVEF) (≤40) in the EVEREST trial, 2072 were randomized to tolvaptan, a selective vasopressin-2 receptor antagonist, and 2061 were randomized to placebo, both in addition to standard therapy. This analysis included the 2021 (98) patients in the placebo group with a complete set of renal function parameters. Renal function parameters and clinical variables were measured prospectively during hospitalization and after discharge. Worsening renal function was defined as an increase in sCr 2). Worsening renal function was observed in 13.8 in-hospital and 11.9 post-discharge. Worsening renal function during hospitalization and post-discharge was associated with greater reductions in BP, BW, and NPs. Baseline renal dysfunction as well as in-hospital and post-discharge WRF were predictive of a composite endpoint of cardiovascular (CV) mortality/HF rehospitalization. Conclusion: The prevalence of renal dysfunction is high in patients hospitalized for HF with reduced LVEF. Worsening renal function may occur not only during hospitalization, but also in the early post-discharge period. Since worsening renal function during hospitalization is associated with a significant decrease in signs and symptoms of congestion, body weight and natriuretic peptides, which are good prognostic indicators, worsening renal function during hospitalization as an endpoint in clinical trials should be re-evaluated.",
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T1 - Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial

AU - Blair, John E A

AU - Pang, Peter

AU - Schrier, Robert W.

AU - Metra, Marco

AU - Traver, Brian

AU - Cook, Thomas

AU - Campia, Umberto

AU - Ambrosy, Andrew

AU - Burnett, John C.

AU - Grinfeld, Liliana

AU - Maggioni, Aldo P.

AU - Swedberg, Karl

AU - Udelson, James E.

AU - Zannad, Faiez

AU - Konstam, Marvin A.

AU - Gheorghiade, Mihai

PY - 2011/10

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N2 - Aim: To provide an in-depth clinical characterization and analysis of outcomes of the patients hospitalized for heart failure (HF) who subsequently develop worsening renal function (WRF) during hospitalization or soon after discharge. Methods and results: Of the 4133 patients hospitalized with worsening HF and reduced left ventricular ejection fraction (LVEF) (≤40) in the EVEREST trial, 2072 were randomized to tolvaptan, a selective vasopressin-2 receptor antagonist, and 2061 were randomized to placebo, both in addition to standard therapy. This analysis included the 2021 (98) patients in the placebo group with a complete set of renal function parameters. Renal function parameters and clinical variables were measured prospectively during hospitalization and after discharge. Worsening renal function was defined as an increase in sCr 2). Worsening renal function was observed in 13.8 in-hospital and 11.9 post-discharge. Worsening renal function during hospitalization and post-discharge was associated with greater reductions in BP, BW, and NPs. Baseline renal dysfunction as well as in-hospital and post-discharge WRF were predictive of a composite endpoint of cardiovascular (CV) mortality/HF rehospitalization. Conclusion: The prevalence of renal dysfunction is high in patients hospitalized for HF with reduced LVEF. Worsening renal function may occur not only during hospitalization, but also in the early post-discharge period. Since worsening renal function during hospitalization is associated with a significant decrease in signs and symptoms of congestion, body weight and natriuretic peptides, which are good prognostic indicators, worsening renal function during hospitalization as an endpoint in clinical trials should be re-evaluated.

AB - Aim: To provide an in-depth clinical characterization and analysis of outcomes of the patients hospitalized for heart failure (HF) who subsequently develop worsening renal function (WRF) during hospitalization or soon after discharge. Methods and results: Of the 4133 patients hospitalized with worsening HF and reduced left ventricular ejection fraction (LVEF) (≤40) in the EVEREST trial, 2072 were randomized to tolvaptan, a selective vasopressin-2 receptor antagonist, and 2061 were randomized to placebo, both in addition to standard therapy. This analysis included the 2021 (98) patients in the placebo group with a complete set of renal function parameters. Renal function parameters and clinical variables were measured prospectively during hospitalization and after discharge. Worsening renal function was defined as an increase in sCr 2). Worsening renal function was observed in 13.8 in-hospital and 11.9 post-discharge. Worsening renal function during hospitalization and post-discharge was associated with greater reductions in BP, BW, and NPs. Baseline renal dysfunction as well as in-hospital and post-discharge WRF were predictive of a composite endpoint of cardiovascular (CV) mortality/HF rehospitalization. Conclusion: The prevalence of renal dysfunction is high in patients hospitalized for HF with reduced LVEF. Worsening renal function may occur not only during hospitalization, but also in the early post-discharge period. Since worsening renal function during hospitalization is associated with a significant decrease in signs and symptoms of congestion, body weight and natriuretic peptides, which are good prognostic indicators, worsening renal function during hospitalization as an endpoint in clinical trials should be re-evaluated.

KW - Acute heart failure syndromes

KW - Heart failure

KW - Hospitalization

KW - Renal function

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