Risk Stratification of Acute Kidney Injury Using the Blood Urea Nitrogen/Creatinine Ratio in Patients With Acute Decompensated Heart Failure

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  • Takaya Yoichi
    Department of Cardiology, National Cerebral and Cardiovascular Center
  • Yoshihara Fumiki
    Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center
  • Yokoyama Hiroyuki
    Department of Cardiology, National Cerebral and Cardiovascular Center
  • Kanzaki Hideaki
    Department of Cardiology, National Cerebral and Cardiovascular Center
  • Kitakaze Masafumi
    Department of Cardiology, National Cerebral and Cardiovascular Center
  • Goto Yoichi
    Department of Cardiology, National Cerebral and Cardiovascular Center
  • Anzai Toshihisa
    Department of Cardiology, National Cerebral and Cardiovascular Center
  • Yasuda Satoshi
    Department of Cardiology, National Cerebral and Cardiovascular Center
  • Ogawa Hisao
    Department of Cardiology, National Cerebral and Cardiovascular Center
  • Kawano Yuhei
    Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center

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Abstract

Background:Risk stratification of acute kidney injury (AKI) is important for acute decompensated heart failure (ADHF). The aim of this study was to determine whether clinical markers, such as the blood urea nitrogen/creatinine ratio (BUN/Cr) or BUN or creatinine values alone, stratify the risk of AKI for mortality.Methods and Results:In all, 371 consecutive ADHF patients were enrolled in the study. AKI was defined as serum creatinine ≥0.3 mg/dl or a 1.5-fold increase in serum creatinine levels within 48 h. During ADHF therapy, AKI occurred in 99 patients; 55 patients died during the 12-month follow-up period. Grouping patients according to AKI and a median BUN/Cr at admission of 22.1 (non-AKI+low BUN/Cr, non-AKI+high BUN/Cr, AKI+low BUN/Cr, and AKI+high BUN/Cr groups) revealed higher mortality in the AKI+high BUN/Cr group (log-rank test, P<0.001). Cox’s proportional hazard analysis revealed an association between AKI+high BUN/Cr and mortality, whereas the association with AKI+low BUN/Cr did not reach statistical significance. When patients were grouped according to AKI and median BUN or creatinine values at admission, AKI was associated with mortality, regardless of BUN or creatinine.Conclusions:The combination of AKI and elevated BUN/Cr, but not BUN or creatinine individually, is linked with an increased risk of mortality in ADHF patients, suggesting that the BUN/Cr is useful for risk stratification of AKI. (Circ J 2015; 79: 1520–1525)

Journal

  • Circulation Journal

    Circulation Journal 79 (7), 1520-1525, 2015

    The Japanese Circulation Society

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