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Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction

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Abstract

Renal dysfunction (RD) and venous congestion are related and common in heart failure (HF). Studies suggest that venous congestion may be the primary driver of RD in HF. In this study, we sought to investigate retrospectively the relationship between common measures of renal function with caval congestion and mortality among outpatients with HF and RD. We reviewed data from 103 HF outpatients (45 males, mean age 74 years, ejection fraction 41.8 ± 11.6 %) with estimated glomerular filtration rate (eGFR) of <60 ml/min in a single centre. During an ambulatory visit, all patients underwent blood test and ultrasonography of the inferior vena cava (IVC). Caval congestion was defined as IVC with both dilatation and impaired collapsibility. The best values of renal metrics in predicting caval congestion were determined with receiver-operating characteristic analysis. The BUN/Cr ratio is moderately correlated with IVC expiratory maximum diameter (r = 0.31, p < 0.0007). In a multiple logistic regression model, BUN/Cr >25.5 (adjusted OR 2.98, p 0.015) and eGFR ≤45.8 (adjusted OR 5.38, p 0.002) identify patients at risk for caval congestion; a BUN/Cr >23.7 was the best predictor of impaired collapsibility (adjusted OR 4.41, p 0.001). a BUN/Cr >25.5 (HR 2.19, 95 % CI 1.21–3.94, p < 0.001) and NYHA class 3 (HR 2.91, 95 % CI 1.60–5.31, p < 0.0005) were independent risk factors associated with all-cause death during a median follow-up of 31 months. In outpatients with HF and RD, a higher BUN/Cr and lower eGFR are reliable renal biomarkers for caval congestion. The BUN/Cr is associated with long-term mortality and may help to stratify HF severity.

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Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

Statement of human and animal rights

All procedures performed in human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Dipartimento Biomedico di Medicina Interna e Specialistica, A.O.U.P. “Paolo Giaccone”, Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy

    Gaspare Parrinello, Daniele Torres, Piero Luigi Almasio, Michele Bellanca, Giuseppina Pizzo, Francesco Cuttitta, Antonio Pinto & Salvatore Paterna

  2. Department of Internal Medicine and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT, USA

    Jeffrey M. Testani

  3. Cardiology Division, Stony Brook University, Stony Brook, NY, USA

    Javed Butler

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  1. Gaspare Parrinello
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  2. Daniele Torres
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  9. Javed Butler
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Correspondence to Gaspare Parrinello.

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Parrinello, G., Torres, D., Testani, J.M. et al. Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction. Intern Emerg Med 10, 965–972 (2015). https://doi.org/10.1007/s11739-015-1261-1

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