Trial reportJACC. Heart failure2020
Acute Kidney Function Declines in the Context of Decongestion in Acute Decompensated Heart Failure.
Trial report in JACC. Heart failure, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Kidney Disease and Heart Failure: Recent Advances and Current Challenges: Conclusions From a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.JACC. Heart failure · 2026Guideline
- Cardiovascular and renal effects of SGLT2 inhibitor initiation in acute heart failure: a meta-analysis of randomized controlled trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2023Pooled it
- Absence of Kidney Tubular Injury in Patients With Acute Heart Failure With Acute Kidney Injury.Circulation. Heart failure · 2024Trial
- Acute Declines in Estimated Glomerular Filtration Rate in Patients Treated With Benazepril and Hydrochlorothiazide Versus Amlodipine and Risk of Cardiovascular Outcomes.Journal of the American Heart Association · 2024Trial
- Rates of Reversal of Volume Overload in Hospitalized Acute Heart Failure: Association With Long-term Kidney Function.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2022Trial
- Impact of dapagliflozin treatment on renal function and diuretics use in acute heart failure: a pilot study.Open heart · 2022Trial
- Impact of routine urine sodium evaluation on diuretic practices in patients with acute heart failure.ESC heart failure · 2026Article
- The creatinine conundrum in heart failure: rethinking AKI definitions.Intensive care medicine · 2026Article
- Acute Kidney Injury in Acute Heart Failure Revisited: Marker of Cardiorenal Disease Severity Rather Than Isolated Renal Injury.Life (Basel, Switzerland) · 2026Review
- Managing Heart Failure Therapy in Chronic Kidney Disease: Converging Evidence and Ongoing Controversies.Cardiorenal medicine · 2026Article
- Decline in glomerular filtration rate as an endpoint in heart failure clinical trials: challenges and solutions.European heart journal · 2025Review
- Worsening Renal Function in Acute Heart Failure: Not Always Harmful.Current heart failure reports · 2025Review
- Renal Dysfunction Across the Spectrum of Cardiogenic Shock: Mechanisms, Clinical Implications, and Therapeutic Strategies.Current heart failure reports · 2025Review
- Novel Hemodynamic Markers and Kidney Function in Patients with Acute Decompensated Heart Failure.Kidney360 · 2025Article
- Acute kidney injury recovery status predicts mortality and cardiorenal outcomes in patients admitted with acute decompensated heart failure.Open heart · 2025Observational
- Biomarkers for Congestion in Heart Failure: State-of-the-art and Future Directions.Cardiac failure review · 2025Review
- The role of urine sodium in acutely decompensated heart failure.International journal of cardiology. Heart & vasculature · 2024Article
- Malnutrition stratified by marasmus and kwashiorkor in adult patients with heart failure.Scientific reports · 2024Article
- Histopathology of congestive nephropathy: a case description and literature review.ESC heart failure · 2024Review
- Fractional excretion of urea nitrogen can identify true worsening renal function in patients with heart failure.ESC heart failure · 2024Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesThis study aimed to examine whether incorporation of a comprehensive set of measures of decongestion modifies the association of acute declines in kidney function with outcomes.
backgroundIn-hospital acute declines in kidney function occur in approximately 20% to 30% of patients admitted with acute decompensated heart failure (ADHF) and may be associated with adverse outcomes.
methodsUsing data from EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan), we used multivariable Cox regression models to evaluate the association between in-hospital changes in estimated glomerular filtration rate (eGFR) with death and a composite outcome of cardiovascular death and hospitalization for heart failure. We evaluated eGFR declines within the context of changes in markers of volume overload including b-type natriuretic peptide (BNP), N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and weight, as well as changes in measures of hemoconcentration including hematocrit, albumin, and total protein.
resultsAmong 3,715 patients over a median follow-up of 9.9 months, every 30% decline in eGFR was associated with higher risk of both death (hazard ratio [HR]: 1.19; 95% confidence interval [CI]: 1.07 to 1.31) and the composite outcome (HR: 1.09; 95% CI: 1.01 to 1.18) in adjusted models. The acute decline in eGFR was no longer associated with higher risk of either outcome as long as there was evidence of decongestion, either by declines in BNP, NT-proBNP, or weight or by increases in hematocrit, albumin or total protein. Interaction testing between decline in eGFR and changes in hematocrit, albumin, and total protein was statistically significant (p interaction of <0.01 for death and p interaction of ≤0.01 for composite for all 3 biomarkers). Interaction between change in eGFR and changes in BNP (p interaction = 0.07 for death; p interaction = 0.08 for composite), NT-proBNP (p interaction = 0.15 for death; p interaction = 0.18 for composite) and weight (p interaction = 0.13 for death; p interaction = 0.19 for composite) did not meet statistical significance.
conclusionsOverall, acute declines in eGFR are associated with adverse outcomes, with evidence of modification by changes in markers of decongestion, suggesting that they are no longer associated with adverse outcomes if these markers are concomitantly improving.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.