Systolic Blood Pressure at Admission, Estimated Glomerular Filtration Rate, and Outcomes in Patients Hospitalized With Acute Heart Failure

Background: The prognostic significance of urinary N-acetyl-β-D-glucosamidase in acute heart failure has not been fully elucidated. Accordingly, this study investigated whether urinary N-acetyl-β-D-glucosamidase could be associated with subsequent adverse events in acute heart failure patients. Methods: We studied 708 consecutive acute heart failure patients who had accessible N-acetyl-β-D-glucosamidase data on admission from the National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure registry. We assessed the relationship between the admission N-acetyl-β-D-glucosamidase level and the combined endpoint of all-cause death and worsening heart failure. Worsening heart failure was defined as worsening symptoms and signs of heart failure requiring intensification of intravenous therapy such as diuretics, vasodilators and inotropes or initiation of mechanical support after stabilisation with initial treatment during hospitalisation, or readmission due to heart failure after discharge. Results: During a median follow-up period of 763 (interquartile range 431–1028) days, higher urinary N-acetyl-β-D-glucosamidase was significantly related to increased events of all-cause death and worsening heart failure. In addition, patients with higher urinary N-acetyl-β-D-glucosamidase and lower estimated glomerular filtration rate on admission had the worst clinical outcomes. In multivariable Cox regression, urinary N-acetyl-β-D-glucosamidase on admission was independently associated with adverse events (hazard ratio 1.19, 95% confidence interval 1.04–1.35) even after adjustment by covariates including the baseline estimated glomerular filtration rate. Conclusions: Higher urinary N-acetyl-β-D-glucosamidase level on admission was independently associated with worse clinical outcomes. Our findings indicate the potential value of assessing urinary N-acetyl-β-D-glucosamidase on admission for further risk stratification in patients with acute heart failure.

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Mineralocorticoid Receptor Antagonists for Hypertension Management in Advanced Chronic Kidney Disease

Hypertension ◽

10.1161/hypertensionaha.120.15199 ◽

2020 ◽

Vol 76 (1) ◽

pp. 144-149 ◽

Cited By ~ 4

Author(s):

George Bakris ◽

Y. Fred Yang ◽

Bertram Pitt

Keyword(s):

Blood Pressure ◽

Glomerular Filtration Rate ◽

Systolic Blood Pressure ◽

Glomerular Filtration ◽

Mineralocorticoid Receptor ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Uncontrolled Hypertension ◽

Mineralocorticoid Receptor Antagonist ◽

Increased Risk

Spironolactone, a steroidal mineralocorticoid receptor antagonist, is recommended as add-on therapy for treatment-resistant/uncontrolled hypertension. However, caution is advised in patients with advanced chronic kidney disease (CKD) due to an increased risk for hyperkalemia. KBP-5074 is a nonsteroidal mineralocorticoid receptor antagonist under investigation for the treatment of treatment-resistant and uncontrolled hypertension in patients with moderate-to-severe CKD. BLOCK-CKD is a phase 2, international, multicenter, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of KBP-5074, on top of current therapy, in patients with stage 3B/4 CKD (estimated glomerular filtration rate ≥15 and ≤44 mL/[min·1.73 m 2 ]) and resistant hypertension (trough cuff seated systolic blood pressure ≥140 mm Hg, despite treatment with maximally tolerated doses of 2 or more antihypertensive medicines with complementary mechanisms). Patients (n=240) will be randomized 1:1:1 to once-daily treatment with KBP-5074 0.25 mg, KBP-5074 0.5 mg, or placebo, stratified by estimated glomerular filtration rate (≥30 versus <30 mL/[min·1.73 m 2 ]) and systolic blood pressure (≥160 versus <160 mm Hg). Approximately 30% of enrolled patients should have an estimated glomerular filtration rate of 15 to 29 mL/(min·1.73 m 2 ). The primary efficacy analysis is the change in trough cuff seated systolic blood pressure from baseline to day 84 for the KBP-5074 doses compared with placebo. Changes in urinary albumin-creatinine ratio will be assessed along with changes in serum potassium/incidence of hyperkalemia and changes in estimated glomerular filtration rate and serum creatinine. BLOCK-CKD will determine whether the addition of KBP-5074 will effectively lower blood pressure without an increased risk of hyperkalemia in patients who are not candidates for steroidal mineralocorticoid receptor antagonists due to advanced CKD. Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT 03574363.

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Physical Activity In Renal Disease (PAIRED) and the effect on hypertension: study protocol for a randomized controlled trial

10.21203/rs.2.51/v1 ◽

2018 ◽

Author(s):

Jeyasundar Radhakrishnan ◽

MD/ Michelle Graham ◽

MD Stephanie Thompson ◽

MMath/PStat Natasha Wiebe ◽

MD Gabor Gyenes ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Systolic Blood Pressure ◽

Glomerular Filtration ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Moderate Intensity ◽

Home Based

Abstract Background: The prevalence of hypertension among people with chronic kidney disease is high with over 60% of people not attaining recommended targets despite multiple medications. Given the health and economic implications of hypertension, additional strategies are needed. Exercise is an effective strategy for reducing blood pressure in the general population; however, it is not known whether exercise would have a comparable benefit in people with moderate to advanced chronic kidney disease and hypertension. Methods: This is a parallel arm trial of adults with hypertension (systolic blood pressure greater than 130 mmHg) and an estimated glomerular filtration rate of 15-45 ml/min 1.73 m2. A total of 160 participants will be randomized, with stratification for estimated glomerular filtration rate, to a 24-week aerobic-based exercise intervention or enhanced usual care. The primary outcome is the difference in 24-hour ambulatory systolic blood pressure after eight weeks of exercise training. Secondary outcomes at eight and 24 weeks include: other measurements of blood pressure, aortic stiffness (pulse wave velocity), change in the Defined Daily Dose of anti-hypertensives, medication adherence, markers of cardiovascular risk, physical fitness (cardiopulmonary exercise testing), seven day accelerometry, quality of life, and adverse events. The effect of exercise on renal function will be evaluated in an exploratory analysis. The intervention is a thrice-weekly moderate intensity aerobic exercise supplemented with isometric resistance exercise delivered in two phases. Phase 1: supervised, facility-based weekly and home-based sessions (eight weeks). Phase 2: home-based sessions (16 weeks). Discussion: To our knowledge, this study is the first trial designed to provide a precise estimate of the effect of exercise on blood-pressure in people with moderate to severe CKD and hypertension. The findings from this study will address a significant knowledge gap in hypertension management in CKD and inform the design of a larger study on the effect of exercise on CKD progression.

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Estimated glomerular filtration rate is an independent predictor for mortality of patients with acute heart failure

Journal of Cardiology ◽

10.1016/j.jjcc.2009.12.005 ◽

2010 ◽

Vol 55 (3) ◽

pp. 317-321 ◽

Cited By ~ 14

Author(s):

Atsutoshi Takagi ◽

Yoshitaka Iwama ◽

Atsushi Yamada ◽

Koichiro Aihara ◽

Hiroyuki Daida

Keyword(s):

Heart Failure ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Acute Heart Failure ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Independent Predictor

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Physical Activity In Renal Disease (PAIRED) and the effect on hypertension: study protocol for a randomized controlled trial

10.21203/rs.2.51/v2 ◽

2019 ◽

Author(s):

MD Stephanie Thompson ◽

MMath/PStat Natasha Wiebe ◽

MD Gabor Gyenes ◽

MSc Rachelle Davies ◽

Jeyasundar Radhakrishnan ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Systolic Blood Pressure ◽

Glomerular Filtration ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Moderate Intensity ◽

Home Based

Abstract Background: The prevalence of hypertension among people with chronic kidney disease is high with over 60% of people not attaining recommended targets despite multiple medications. Given the health and economic implications of hypertension, additional strategies are needed. Exercise is an effective strategy for reducing blood pressure in the general population; however, it is not known whether exercise would have a comparable benefit in people with moderate to advanced chronic kidney disease and hypertension. Methods: This is a parallel arm trial of adults with hypertension (systolic blood pressure greater than 130 mmHg) and an estimated glomerular filtration rate of 15-45 ml/min 1.73 m2. A total of 160 participants will be randomized, with stratification for estimated glomerular filtration rate, to a 24-week aerobic-based exercise intervention or enhanced usual care. The primary outcome is the difference in 24-hour ambulatory systolic blood pressure after eight weeks of exercise training. Secondary outcomes at eight and 24 weeks include: other measurements of blood pressure, aortic stiffness (pulse wave velocity), change in the Defined Daily Dose of anti-hypertensives, medication adherence, markers of cardiovascular risk, physical fitness (cardiopulmonary exercise testing), seven day accelerometry, quality of life, and adverse events. The effect of exercise on renal function will be evaluated in an exploratory analysis. The intervention is a thrice-weekly moderate intensity aerobic exercise supplemented with isometric resistance exercise delivered in two phases. Phase 1: supervised, facility-based weekly and home-based sessions (eight weeks). Phase 2: home-based sessions (16 weeks). Discussion: To our knowledge, this study is the first trial designed to provide a precise estimate of the effect of exercise on blood-pressure in people with moderate to severe CKD and hypertension. The findings from this study will address a significant knowledge gap in hypertension management in CKD and inform the design of a larger study on the effect of exercise on CKD progression. Trial registration: Registered at ClinicalTrials.gov NCT03551119. Registered on 11 June 2018.

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