2024
Early, Individualized Recommendations for Hospitalized Patients With Acute Kidney Injury
Aklilu A, Menez S, Baker M, Brown D, Dircksen K, Dunkley K, Gaviria S, Farrokh S, Faulkner S, Jones C, Kadhim B, Le D, Li F, Makhijani A, Martin M, Moledina D, Coronel-Moreno C, O’Connor K, Shelton K, Shvets K, Srialluri N, Tan J, Testani J, Corona-Villalobos C, Yamamoto Y, Parikh C, Wilson F, Sundararajan A, Wang A, Schretlen C, Singel D, Moss E, Aune F, Iantosca G, Zou G, Chernova I, Bitzel J, Hernandez J, Lindsley J, Dane K, Orias M, Mehta P, Zassman-Isner S, Wen Y, Freeman N. Early, Individualized Recommendations for Hospitalized Patients With Acute Kidney Injury. JAMA 2024, 332 PMID: 39454050, DOI: 10.1001/jama.2024.22718.Peer-Reviewed Original ResearchElectronic health recordsUsual careHealth recordsAction teamsClinicians of patientsHospitalized patientsFinal follow-upIntervention groupHealth systemStudy pharmacistsStudy physiciansMain OutcomesAssociated with adverse outcomesAcute kidney injuryRandomized clinical trialsPrimary outcomeIndividualized recommendationsNew HavenAdverse outcomesAKI detectionCareRhode IslandComposite outcomeFollow-upIntervention
2023
Randomized controlled trial of urinE chemiStry guided aCute heArt faiLure treATmEnt (ESCALATE): Rationale and design
Cox Z, Siddiqi H, Stevenson L, Bales B, Han J, Hart K, Imhoff B, Ivey-Miranda J, Jenkins C, Lindenfeld J, Shotwell M, Miller K, Ooi H, Rao V, Schlendorf K, Self W, Siew E, Storrow A, Walsh R, Wrenn J, Testani J, Collins S. Randomized controlled trial of urinE chemiStry guided aCute heArt faiLure treATmEnt (ESCALATE): Rationale and design. American Heart Journal 2023, 265: 121-131. PMID: 37544492, PMCID: PMC10592235, DOI: 10.1016/j.ahj.2023.07.014.Peer-Reviewed Original ResearchAcute decompensated heart failureUrine chemistryDiuretic strategyIntravenous diuresisUsual careAcute heartHeart failureClinical trialsGlobal clinical statusKey exclusion criteriaUsual care strategyAcute heart failureDecompensated heart failureRandomized clinical trialsKey inclusion criteriaMultiple clinical trialsPaucity of evidenceDiuretic dosingDiuretic therapyPrimary outcomePatient's symptomsClinical statusTreatment trialsValvular stenosisClinical stateA randomized clinical trial assessing the effect of automated medication-targeted alerts on acute kidney injury outcomes
Wilson F, Yamamoto Y, Martin M, Coronel-Moreno C, Li F, Cheng C, Aklilu A, Ghazi L, Greenberg J, Latham S, Melchinger H, Mansour S, Moledina D, Parikh C, Partridge C, Testani J, Ugwuowo U. A randomized clinical trial assessing the effect of automated medication-targeted alerts on acute kidney injury outcomes. Nature Communications 2023, 14: 2826. PMID: 37198160, PMCID: PMC10192367, DOI: 10.1038/s41467-023-38532-3.Peer-Reviewed Original ResearchConceptsAcute kidney injuryUsual care groupKidney injuryCare groupAcute Kidney Injury OutcomesAlert groupNon-steroidal anti-inflammatory drugsComposite of progressionHours of randomizationMedications of interestAldosterone system inhibitorsClasses of medicationsProton pump inhibitorsRandomized clinical trialsAnti-inflammatory drugsClinical decision support systemNephrotoxic medicationsHospitalized adultsDiscontinuation ratesCertain medicationsPrimary outcomeSubstantial morbiditySystem inhibitorsPump inhibitorsParallel groupEffect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure
Mentz R, Anstrom K, Eisenstein E, Sapp S, Greene S, Morgan S, Testani J, Harrington A, Sachdev V, Ketema F, Kim D, Desvigne-Nickens P, Pitt B, Velazquez E, Adams K, Bhatt K, DeWald T, Axsom K, Murthy S, Rich J, Testani J, Smith B, Vader J, McCulloch M, Skopicki H, Psotka M, Heroux A, Lala-Trindade A, Stevens G, Tang W, Lev Y, William P, Eberly A, Gottleib S, Haught W, Grafton G, Larned J, Tejwani L, Mody F, Krim S, Robinson M, Fang J, Adler A, Bell A, Banerjee D, Ruiz Duque E, Mizyed A, Rommel J, Arhinful J, Goyal P, Hall M, Hummel S, Shetty S, Haas D, Vilaro J, Alexy T, Herre J, Clark J, Ambrosy A, Gaglianello N, Ramasubbu K, Meadows J, Tabtabai S, Sherwood M, Hasni S, D'Urso M, Muneer B, Dunlap S, Davis W, Friedman D, Guglin M, Ferguson A, Abbate A, Smart F. Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure. JAMA 2023, 329: 214-223. PMID: 36648467, PMCID: PMC9857435, DOI: 10.1001/jama.2022.23924.Peer-Reviewed Original ResearchConceptsCause mortalityHeart failureTorsemide groupFurosemide groupTotal hospitalizationsCause hospitalizationEffects of torsemideDiuretic strategyPrespecified subgroupsSecondary outcomesEjection fractionMedian agePrimary outcomeHospitalizationMAIN OUTCOMEPatientsFurosemideMortalityMonthsTorsemidePrimary hypothesisSignificant differencesFinal dateOutcomesTrials
2021
Risk stratification of patients listed for heart transplantation while supported with extracorporeal membrane oxygenation
Ivey-Miranda JB, Maulion C, Farrero-Torres M, Griffin M, Posada-Martinez EL, Testani JM, Bellumkonda L. Risk stratification of patients listed for heart transplantation while supported with extracorporeal membrane oxygenation. Journal Of Thoracic And Cardiovascular Surgery 2021, 165: 711-720. PMID: 34167814, DOI: 10.1016/j.jtcvs.2021.05.032.Peer-Reviewed Original ResearchConceptsHeart transplantMajor risk factorRisk factorsPosttransplantation mortalityHT recipientsMembrane oxygenationGood long-term prognosisSevere cardiogenic shockOrgan Sharing databaseLong-term prognosisExtracorporeal membrane oxygenationMinor risk factorsVentricular assist deviceCardiogenic shockHeart transplantationRecipient ageIndependent predictorsPrimary outcomeSharing databaseMechanical ventilationRisk stratificationUnited NetworkAdult candidatesECMOAbsence of recoveryElectronic health record alerts for acute kidney injury: multicenter, randomized clinical trial
Wilson FP, Martin M, Yamamoto Y, Partridge C, Moreira E, Arora T, Biswas A, Feldman H, Garg AX, Greenberg JH, Hinchcliff M, Latham S, Li F, Lin H, Mansour SG, Moledina DG, Palevsky PM, Parikh CR, Simonov M, Testani J, Ugwuowo U. Electronic health record alerts for acute kidney injury: multicenter, randomized clinical trial. The BMJ 2021, 372: m4786. PMID: 33461986, PMCID: PMC8034420, DOI: 10.1136/bmj.m4786.Peer-Reviewed Original ResearchConceptsAcute kidney injuryElectronic health record alertsKidney injuryPrimary outcomeMedical recordsYale New Haven Health SystemCare practicesGlobal Outcomes creatinine criteriaLarge tertiary care centerComposite of progressionDays of randomizationReceipt of dialysisPrespecified secondary outcomesTertiary care centerPatients' medical recordsSmall community hospitalNon-teaching hospitalsElectronic health recordsCreatinine criteriaUsual careSecondary outcomesAdult inpatientsKidney diseaseClinical centersWorse outcomes
2020
A Time-Updated, Parsimonious Model to Predict AKI in Hospitalized Children
Sandokji I, Yamamoto Y, Biswas A, Arora T, Ugwuowo U, Simonov M, Saran I, Martin M, Testani JM, Mansour S, Moledina DG, Greenberg JH, Wilson FP. A Time-Updated, Parsimonious Model to Predict AKI in Hospitalized Children. Journal Of The American Society Of Nephrology 2020, 31: 1348-1357. PMID: 32381598, PMCID: PMC7269342, DOI: 10.1681/asn.2019070745.Peer-Reviewed Original ResearchConceptsExternal validation cohortValidation cohortElectronic health recordsSevere AKIClinical risk stratification toolDevelopment of AKIHealth recordsRisk stratification toolInternal validation cohortLength of stayCharacteristic curveElectronic medical recordsNeonatal AKIInpatient mortalitySecondary outcomesHospital admissionPrimary outcomeHospitalized childrenCreatinine valuesMedical recordsStudy populationAKICohortChildrenPredictive variables
2019
Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure The 3T Trial
Cox ZL, Hung R, Lenihan DJ, Testani JM. Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure The 3T Trial. JACC Heart Failure 2019, 8: 157-168. PMID: 31838029, PMCID: PMC7058489, DOI: 10.1016/j.jchf.2019.09.012.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAgedChlorothiazideDiureticsDose-Response Relationship, DrugDouble-Blind MethodDrug Therapy, CombinationFemaleFollow-Up StudiesFurosemideHeart FailureHumansInfusions, IntravenousMaleMetolazoneMiddle AgedProspective StudiesRetrospective StudiesTolvaptanTreatment OutcomeConceptsAcute heart failureLoop diuretic resistanceDiuretic resistanceHigh-dose loop diuretic therapyLoop diuretic therapyDouble-blinded trialInfusion of furosemideCombination diureticsDiuretic strategyDiuretic therapyOral metolazoneTolvaptan therapyDiuretic efficacyHeart failurePrimary outcomePatientsLimited evidenceWeight lossTherapyChlorothiazideMetolazoneTolvaptanDiureticsInfusionCohort
2015
Perioperative heart-type fatty acid binding protein is associated with acute kidney injury after cardiac surgery
Schaub JA, Garg AX, Coca SG, Testani JM, Shlipak MG, Eikelboom J, Kavsak P, McArthur E, Shortt C, Whitlock R, Parikh CR. Perioperative heart-type fatty acid binding protein is associated with acute kidney injury after cardiac surgery. Kidney International 2015, 88: 576-583. PMID: 25830762, PMCID: PMC4556547, DOI: 10.1038/ki.2015.104.Peer-Reviewed Original ResearchMeSH KeywordsAcute Kidney InjuryAgedAged, 80 and overBiomarkersCardiac Surgical ProceduresChi-Square DistributionFatty Acid Binding Protein 3Fatty Acid-Binding ProteinsFemaleHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisNorth AmericaOdds RatioPerioperative PeriodProportional Hazards ModelsProspective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexUp-RegulationConceptsAcute kidney injurySevere acute kidney injuryCardiac surgeryKidney injuryKidney injury molecule-1Neutrophil gelatinase-associated lipocalinHeart-type fatty acid binding proteinAKI risk factorsInjury molecule-1Long-term mortalityBrain natriuretic peptideGelatinase-associated lipocalinH-FABP levelsMulti-center cohortTRIBE-AKI cohortFatty acid binding proteinLiver fatty acidHeart fatty acidCommon complicationSecondary outcomesSerum creatininePrimary outcomeInterleukin-18Risk stratificationCardiac injuryAutomated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial
Wilson FP, Shashaty M, Testani J, Aqeel I, Borovskiy Y, Ellenberg SS, Feldman HI, Fernandez H, Gitelman Y, Lin J, Negoianu D, Parikh CR, Reese PP, Urbani R, Fuchs B. Automated, electronic alerts for acute kidney injury: a single-blind, parallel-group, randomised controlled trial. The Lancet 2015, 385: 1966-1974. PMID: 25726515, PMCID: PMC4475457, DOI: 10.1016/s0140-6736(15)60266-5.Peer-Reviewed Original ResearchConceptsAcute kidney injuryUsual care groupKidney injuryCare groupAlert groupClinical outcomesElectronic alertsEligible participantsKidney Disease Improving Global OutcomesEnd-stage renal diseaseAcute kidney injury alertsEffective treatment optionIntensive care unitElectronic alert systemComputer-generated sequenceRandomisation strataSurgical admissionsUsual carePrimary outcomeRenal diseaseCare unitTreatment optionsCreatinine valuesCreatinine concentrationSuch injuries
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