2023
The blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. The role of furosemide urine excretion on diuretic and natriuretic response in acute heart failure
Biegus J, Zymliński R, Testani J, Fudim M, Cox Z, Guzik M, Iwanek G, Hurkacz M, Raj D, Marciniak D, Ponikowska B, Ponikowski P. The blunted loop diuretic response in acute heart failure is driven by reduced tubular responsiveness rather than insufficient tubular delivery. The role of furosemide urine excretion on diuretic and natriuretic response in acute heart failure. European Journal Of Heart Failure 2023, 25: 1323-1333. PMID: 37042083, DOI: 10.1002/ejhf.2852.Peer-Reviewed Original ResearchConceptsAcute heart failureDiuretic responseHeart failureChronic usersTubular deliveryUrine volumeAcute heart failure patientsGlomerular filtration rateHeart failure patientsHigher urine volumeDiuretic exposureFurosemide deliveryFurosemide usersGood diuresisFurosemide doseFailure patientsNatriuretic responseFurosemide useTubular responseFiltration rateObservational studyUrine excretionNaïve groupHealthy individualsBody weight
2020
Renal profiling based on estimated glomerular filtration rate and spot urine sodium identifies high‐risk acute heart failure patients
Biegus J, Zymliński R, Testani J, Marciniak D, Zdanowicz A, Jankowska EA, Banasiak W, Ponikowski P. Renal profiling based on estimated glomerular filtration rate and spot urine sodium identifies high‐risk acute heart failure patients. European Journal Of Heart Failure 2020, 23: 729-739. PMID: 33190378, DOI: 10.1002/ejhf.2053.Peer-Reviewed Original ResearchConceptsAcute heart failureGlomerular filtration rateHeart failureFiltration rateDay 1Acute heart failure patientsHospital heart failureSpot urine sodiumHeart failure patientsUrinary sodium concentrationAHF patientsInotrope useTherapeutic profilingUrine sodiumFailure patientsIndependent prognosticatorRenal functionDay 2PatientsEGFRConcomitant assessmentWater handlingSodium concentrationPrognosticatorExcreters
2019
Renal Effects of Intensive Volume Removal in Heart Failure Patients With Preexisting Worsening Renal Function
Rao VS, Ahmad T, Brisco-Bacik MA, Bonventre JV, Wilson FP, Siew ED, Felker GM, Anstrom KK, Mahoney DD, Bart BA, Tang WHW, Velazquez EJ, Testani JM. Renal Effects of Intensive Volume Removal in Heart Failure Patients With Preexisting Worsening Renal Function. Circulation Heart Failure 2019, 12: e005552. PMID: 31163974, PMCID: PMC6585463, DOI: 10.1161/circheartfailure.118.005552.Peer-Reviewed Original ResearchConceptsRenal tubular injury biomarkersTubular injury biomarkersHeart failure patientsAcute decompensated heart failure patientsDecompensated heart failure patientsTubular injury markersInjury biomarkersFailure patientsRenal functionInjury markersAcute decompensated heart failureVolume removalCARRESS-HF trialRenal function recoveryDecompensated heart failureRenal tubular injuryRenal effectsSerum creatinineTubular injuryBiomarker substudyHeart failurePharmacological therapyClinical outcomesFunction recoveryHigh incidence
2017
An exploratory analysis of the competing effects of aggressive decongestion and high-dose loop diuretic therapy in the DOSE trial
Hanberg JS, Tang WH, Wilson FP, Coca SG, Ahmad T, Brisco MA, Testani JM. An exploratory analysis of the competing effects of aggressive decongestion and high-dose loop diuretic therapy in the DOSE trial. International Journal Of Cardiology 2017, 241: 277-282. PMID: 28392080, PMCID: PMC5471358, DOI: 10.1016/j.ijcard.2017.03.114.Peer-Reviewed Original ResearchConceptsHigh-dose loop diureticsDiuretic doseAggressive decongestionDose trialFluid outputLoop diureticsHigh-dose loop diuretic therapyDose-related adverse effectsAdverse effectsLoop diuretic doseLoop diuretic therapyHeart failure patientsNet fluid balanceNet fluid outputRate of deathEmergency department (ED) visitationPotential beneficial effectsHypothesis-generating observationsEffective decongestionDiuretic therapyFailure patientsAdverse outcomesDecongestive effectImproved outcomesFluid balance
2016
Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients With Heart Failure
Testani JM, Hanberg JS, Cheng S, Rao V, Onyebeke C, Laur O, Kula A, Chen M, Wilson FP, Darlington A, Bellumkonda L, Jacoby D, Tang WH, Parikh CR. Rapid and Highly Accurate Prediction of Poor Loop Diuretic Natriuretic Response in Patients With Heart Failure. Circulation Heart Failure 2016, 9: e002370. PMID: 26721915, PMCID: PMC4741370, DOI: 10.1161/circheartfailure.115.002370.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAdministration, IntravenousAgedBiomarkersBumetanideDrug MonitoringDrug ResistanceFemaleHeart FailureHumansMaleMiddle AgedModels, BiologicalNatriuresisPredictive Value of TestsProspective StudiesReproducibility of ResultsSodiumSodium Potassium Chloride Symporter InhibitorsTime FactorsTreatment OutcomeUrinalysisConceptsAcute decompensated heart failureDecompensated heart failureNatriuretic responseSpot urine samplesSodium outputHeart failureDiuretic administrationAcute decompensated heart failure patientsDecompensated heart failure patientsLoop diuretic administrationPrimary therapeutic objectiveUrine samplesHeart failure patientsPositive sodium balanceNet fluid outputDiuretic dosingIntravenous bumetanideMedian doseFailure patientsDiuretic responseSodium balanceUrine collectionFluid balanceTherapeutic objectivesFluid output
2015
Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction
Parrinello G, Torres D, Testani JM, Almasio PL, Bellanca M, Pizzo G, Cuttitta F, Pinto A, Butler J, Paterna S. Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction. Internal And Emergency Medicine 2015, 10: 965-972. PMID: 26037394, DOI: 10.1007/s11739-015-1261-1.Peer-Reviewed Original ResearchConceptsBUN/CrInferior vena cavaRenal dysfunctionHeart failureVenous congestionBUN/Cr ratioMultiple logistic regression modelNYHA class 3Independent risk factorLong-term mortalityHeart failure patientsGlomerular filtration rateBlood urea nitrogenReceiver-operating characteristic analysisLogistic regression modelsCause deathHF outpatientsHF severityLower eGFRRenal functionAmbulatory visitsFailure patientsCreatinine ratioSingle centerRenal biomarkers
2013
Biochemical Evidence of Mild Hepatic Dysfunction Identifies Decompensated Heart Failure Patients With Reversible Renal Dysfunction
Brisco MA, McCauley BD, Chen J, Parikh CR, Testani JM. Biochemical Evidence of Mild Hepatic Dysfunction Identifies Decompensated Heart Failure Patients With Reversible Renal Dysfunction. Journal Of Cardiac Failure 2013, 19: 739-745. PMID: 24263117, PMCID: PMC3884639, DOI: 10.1016/j.cardfail.2013.10.005.Peer-Reviewed Original ResearchConceptsReversible renal dysfunctionRenal dysfunctionLiver dysfunctionElevated international normalized ratioDecompensated heart failure patientsBaseline renal dysfunctionCharacteristic laboratory abnormalitiesDecompensated HF patientsLiver dysfunction resultsSigns of HFGlomerular filtration rateHeart failure patientsMild liver dysfunctionInternational normalized ratioIntrinsic kidney diseaseBiochemical evidenceHF patientsFailure patientsLaboratory abnormalitiesRenal functionPathophysiologic factorsDischarge diagnosisKidney diseaseMultifactorial pathophysiologyNormalized ratioBlood Urea Nitrogen/Creatinine Ratio Identifies a High-Risk but Potentially Reversible Form of Renal Dysfunction in Patients With Decompensated Heart Failure
Brisco MA, Coca SG, Chen J, Owens AT, McCauley BD, Kimmel SE, Testani JM. Blood Urea Nitrogen/Creatinine Ratio Identifies a High-Risk but Potentially Reversible Form of Renal Dysfunction in Patients With Decompensated Heart Failure. Circulation Heart Failure 2013, 6: 233-239. PMID: 23325460, PMCID: PMC4067251, DOI: 10.1161/circheartfailure.112.968230.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersBlood Urea NitrogenCardio-Renal SyndromeChi-Square DistributionCreatinineFemaleGlomerular Filtration RateHeart FailureHumansKaplan-Meier EstimateKidneyLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPatient AdmissionPrognosisProportional Hazards ModelsRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsUp-RegulationConceptsReversible renal dysfunctionBUN/CrBlood urea nitrogen/creatinine ratioUrea nitrogen/creatinine ratioHeart failureRenal functionRenal dysfunctionCreatinine ratioElevated BUN/CrPatients meeting eligibility criteriaDecompensated heart failure patientsDecompensated heart failureHigh-risk patientsHeart failure patientsGlomerular filtration rateRisk of deathMeeting eligibility criteriaConsecutive hospitalizationsBaseline characteristicsFailure patientsDischarge diagnosisFiltration rateEligibility criteriaPatientsReversible form