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F.H. Verbrugge , J. Duchenne , M. Dupont, W. Mullens

3 rd INTERNATIONAL FLUID ACADEMY DAYS – ORAL ABSTRACT SESSION Serum urea/creatinine ratio predicts successful loop diuretic therapy in congestive heart failure. F.H. Verbrugge , J. Duchenne , M. Dupont, W. Mullens Department of Cardiology , Ziekenhuis Oost-Limburg, Belgium

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F.H. Verbrugge , J. Duchenne , M. Dupont, W. Mullens

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  1. 3rd INTERNATIONAL FLUID ACADEMY DAYS – ORAL ABSTRACT SESSIONSerum urea/creatinine ratio predicts successful loop diuretic therapy in congestive heart failure F.H. Verbrugge, J. Duchenne, M. Dupont, W. Mullens Department of Cardiology, Ziekenhuis Oost-Limburg, Belgium Faculty of Medicine & Life Sciences, Hasselt University, Belgium

  2. Background Hasselblad V et al. Eur J Heart Fail. 2007.

  3. Background UREA REABSORPTION Verbrugge FH et al. Eur J Heart Fail. In press.

  4. Background Testani JM et al. J Am Coll Cardiol. 2011.

  5. Objectives • To assess the prognostic value of the urea/creatinine ratio (UCR) in patients admitted with heart failure (HF) • To assess the impact of the UCR on efficacy of loop diuretic uptitration in HF

  6. Methods • Cohort study in single tertiary care center(Ziekenhuis Oost-Limburg, Genk, Belgium) • Consecutive patients admitted with a primary diagnosis of HF (January, 2009 – March, 2011) • Loop diuretic uptitration: increase of maintenance dose at discharge compared to admission • End-point: freedom from all-cause mortality or HF readmission

  7. ResultsSTUDY FLOWCHART • Follow-up: 22 ± 10 months • 54 patients died (17%) • 91 patients readmitted for HF (29%) • 194 patients with event-free survival (61%)

  8. ResultsBASELINE CHARACTERISTICS

  9. ResultsUREA/CREATININE RATIO Freedom from all-cause mortality or HF readmission Adjusted HR (95% CI) for 1 SD increase in UCR = 1.30 (1.05 – 1.62) P-value = 0.001

  10. ResultsLOOP DIURETIC UPTITRATION Freedom from all-cause mortality or HF readmission Loopdiureticuptitration Loopdiureticuptitration P-value = 0.041 P-value = 0.559 HR (95% CI) for uptitration = 1.61 (1.01 – 2.57) HR (95% CI) for uptitration = 1.07 (0.61 – 1.89)

  11. Conclusions • The UCR is a strong and independent predictor of all-cause mortality and readmissions in hospitalized HF patients • High UCR, as a surrogate for neurohumoral activation, characterizes a vulnerable population that demonstrates adverse outcome with loop diuretic uptitration Alternatives for decongestive therapy?

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