2020
Real-Time Prediction of Acute Kidney Injury in Hospitalized Adults: Implementation and Proof of Concept
Ugwuowo U, Yamamoto Y, Arora T, Saran I, Partridge C, Biswas A, Martin M, Moledina DG, Greenberg JH, Simonov M, Mansour SG, Vela R, Testani JM, Rao V, Rentfro K, Obeid W, Parikh CR, Wilson FP. Real-Time Prediction of Acute Kidney Injury in Hospitalized Adults: Implementation and Proof of Concept. American Journal Of Kidney Diseases 2020, 76: 806-814.e1. PMID: 32505812, PMCID: PMC8667815, DOI: 10.1053/j.ajkd.2020.05.003.Peer-Reviewed Original ResearchConceptsAKI alertsHospitalized adultsKidney injuryUrban tertiary care hospitalAcute kidney injurySerum creatinine levelsObservational cohort studyTertiary care hospitalSerum creatinine concentrationBeats/minElectronic health recordsAKI diagnosisCohort studyCreatinine levelsInpatient mortalitySystolic bloodFractional excretionCenter studyBlood biomarkersUnivariable associationsUrine microscopyCreatinine concentrationClinical careElevated riskUrea nitrogen
2016
Hypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure
Ter Maaten JM, Damman K, Hanberg JS, Givertz MM, Metra M, O'Connor CM, Teerlink JR, Ponikowski P, Cotter G, Davison B, Cleland JG, Bloomfield DM, Hillege HL, van Veldhuisen DJ, Voors AA, Testani JM. Hypochloremia, Diuretic Resistance, and Outcome in Patients With Acute Heart Failure. Circulation Heart Failure 2016, 9: e003109. PMID: 27507112, DOI: 10.1161/circheartfailure.116.003109.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAgedAged, 80 and overBiomarkersChloridesDisease ProgressionDiureticsDown-RegulationDrug ResistanceFemaleHeart FailureHospitalizationHumansKaplan-Meier EstimateLinear ModelsMaleMiddle AgedMultivariate AnalysisProportional Hazards ModelsRisk FactorsTime FactorsTreatment OutcomeXanthinesConceptsAcute heart failureMEq/L.Heart failureDay 14Serum chloridePoor diuretic responseHours of admissionLower serum chlorideBlood urea nitrogenSerum chloride levelsAHF therapiesDiuretic resistancePROTECT trialNeurohormonal activationMultivariable adjustmentRenal functionHospital admissionMultivariable analysisDiuretic responseDiuretic responsivenessDiuretic targetChloride levelsUrea nitrogenHypochloremiaChloride homeostasisReduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure
Hanberg JS, Sury K, Wilson FP, Brisco MA, Ahmad T, Maaten J, Broughton JS, Assefa M, Tang WH, Parikh CR, Testani JM. Reduced Cardiac Index Is Not the Dominant Driver of Renal Dysfunction in Heart Failure. Journal Of The American College Of Cardiology 2016, 67: 2199-2208. PMID: 27173030, PMCID: PMC4867078, DOI: 10.1016/j.jacc.2016.02.058.Peer-Reviewed Original ResearchConceptsPulmonary artery catheterizationBlood urea nitrogenCardiac indexRenal functionHeart failureRenal dysfunctionGood renal functionReduced cardiac indexHigher cardiac indexGlomerular filtration rateSignificant inverse correlationMultiple subgroupsMulticenter populationWorse eGFRHF patientsCreatinine ratioArtery catheterizationPatient subgroupsFiltration rateSerial assessmentLinear mixed modelingESCAPE trialPatientsUrea nitrogenDysfunctionThe risk of death associated with proteinuria in heart failure is restricted to patients with an elevated blood urea nitrogen to creatinine ratio
Brisco MA, Zile MR, Maaten J, Hanberg JS, Wilson FP, Parikh C, Testani JM. The risk of death associated with proteinuria in heart failure is restricted to patients with an elevated blood urea nitrogen to creatinine ratio. International Journal Of Cardiology 2016, 215: 521-526. PMID: 27153048, PMCID: PMC4986924, DOI: 10.1016/j.ijcard.2016.04.100.Peer-Reviewed Original ResearchConceptsElevated blood urea nitrogenBUN/CrRenal dysfunctionBlood urea nitrogenCreatinine ratioUrea nitrogenLeft Ventricular Dysfunction (SOLVD) trialVentricular Dysfunction trialsGlomerular filtration rateRisk of deathBaseline characteristicsWorsened survivalAdverse eventsHeart failureTop tertileFiltration rateBottom tertileProteinuriaSurvival disadvantagePatientsMortalityTertileDysfunctionSurvivalSurvival models
2014
A Combined-Biomarker Approach to Clinical Phenotyping Renal Dysfunction in Heart Failure
Testani JM, Damman K, Brisco MA, Chen S, Laur O, Kula AJ, Tang WH, Parikh C. A Combined-Biomarker Approach to Clinical Phenotyping Renal Dysfunction in Heart Failure. Journal Of Cardiac Failure 2014, 20: 912-919. PMID: 25152498, PMCID: PMC4292792, DOI: 10.1016/j.cardfail.2014.08.008.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedBiomarkersBlood Urea NitrogenCardio-Renal SyndromeCohort StudiesConfidence IntervalsCreatinineFemaleGlomerular Filtration RateHeart FailureHospitals, UniversityHumansMaleMiddle AgedPhenotypePrognosisRenal InsufficiencyRetrospective StudiesSensitivity and SpecificityStatistics, NonparametricSurvival RateConceptsB-type natriuretic peptideElevated B-type natriuretic peptideRenal dysfunctionHeart failureLower B-type natriuretic peptideUse of BNPCombined biomarker approachDecompensated heart failureIntrinsic kidney diseaseBlood urea nitrogenDifferent clinical phenotypesBUN/Diuretic resistanceInotrope useWorse survivalCreatinine ratioRisk stratificationDischarge diagnosisNatriuretic peptideVenous congestionKidney diseaseStratify patientsClinical phenotypingPatientsUrea nitrogen
2011
Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials
Testani JM, Coca SG, Shannon RP, Kimmel SE, Cappola TP. Influence of renal dysfunction phenotype on mortality in the setting of cardiac dysfunction: analysis of three randomized controlled trials. European Journal Of Heart Failure 2011, 13: 1224-1230. PMID: 21926073, PMCID: PMC3200208, DOI: 10.1093/eurjhf/hfr123.Peer-Reviewed Original ResearchConceptsGlomerular filtration rateBUN/creatinineRenal insufficiencyNeurohormonal activationRisk of mortalityHeart failurePulmonary Artery Catheterization Effectiveness trialLeft Ventricular Dysfunction (SOLVD) trialBaseline renal insufficiencyBeta-Blocker EvaluationVentricular Dysfunction trialsHeart failure populationCongestive heart failureBlood urea nitrogenCreatinine ratioPrimary outcomeCardiac dysfunctionFailure populationFiltration rateEffectiveness trialPoor survivalStudy populationUrea nitrogenPatientsMortalityInteraction Between Loop Diuretic-Associated Mortality and Blood Urea Nitrogen Concentration in Chronic Heart Failure
Testani JM, Cappola TP, Brensinger CM, Shannon RP, Kimmel SE. Interaction Between Loop Diuretic-Associated Mortality and Blood Urea Nitrogen Concentration in Chronic Heart Failure. Journal Of The American College Of Cardiology 2011, 58: 375-382. PMID: 21757114, PMCID: PMC3980479, DOI: 10.1016/j.jacc.2011.01.052.Peer-Reviewed Original ResearchConceptsHigh-dose loop diureticsBlood urea nitrogenLoop diureticsBUN levelsNeurohormonal activationBaseline characteristicsHeart failureNormal BUN levelChronic heart failureRisk of deathBlood urea nitrogen concentrationElevated BUN levelsCongestive symptomsOverall cohortWorsened survivalImproved survivalPrimary outcomeAdverse outcomesUrea nitrogen concentrationDiureticsUrea nitrogenBUN concentrationPatientsMortalitySurvival