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New Publication Highlights Transient Increases in Creatinine or Tubular Injury Markers in Heart Failure Patients Should Not Dissuade Use of Ultrafiltration
The study, titled, “Renal Effects of Intensive Volume Removal in Heart Failure Patients With Preexisting Worsening Renal Function” further analyzed data on renal tubular injury biomarkers from a subset of 105 participants in the CARRESS-HF trial. The study supports that increases in serum creatinine should not be the major factor to dissuade decongestion by ultrafiltration or diuretics in patients where a therapeutic advantage may exist. Even if creatinine worsened and tubular biomarkers increased, renal function usually recovered by 60 days. In fact, participants with an increase in urinary biomarkers (who had 12-fold-increase odds of worsening renal function defined by a 20% change in serum creatinine) had the greatest improvement in kidney function at 60 days. Thus, changes in serum creatinine or kidney injury biomarkers should be discouraged as a surrogate endpoint in heart failure trials. Study authors concluded that modest or transient increases in creatinine levels, or increases in renal tubule injury biomarkers were outweighed by the benefits of decongestion, which aligns with the review conducted by Drs. Costanzo and Kazory published in the
“In the past, we have received some criticism regarding the increase in creatinine levels with ultrafiltration, such as with the Aquadex FlexFlow® system, and our response has been that the ultimate benefits outweighed potential risks. This analysis is yet another study that supports this assertion, with the added information that increases in serum creatinine levels were associated with superior decongestion and recovery of renal function at 60-days even in the presence of renal tubule injury biomarkers,” commented
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Source: CHF Solutions, Inc.