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CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction.

Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain. Electronic address: yulnunez@gmail.com. Internal Medicine Department, Hospital de Manises, Manises, Valencia, Spain. Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain. Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain. Internal Medicine Department, Hospital de La Plana, Villa-Real, Castellón, Spain. Critical Care Unit, Hospital Universitario del Vinalopó, Elche, Alicante, Spain. Internal Medicine Department, Hospital Virgen de Los Lirios, Alcoy, Spain. Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain. Biochemistry Department, Hospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVA, Valencia, Spain. Cardiology Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain. Cardiology Department, Hospital Clínic de Barcelona, Barcelona, Spain. Cardiology Department, Hospital General Universitario de Castellón. Universitat Jaume I, Castellón, Spain. CIBER Cardiovascular, Madrid, Spain; Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain. Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain. Nephrology Department, Hospital Clínico Universitario, INCLIVA. Universitat de València, Valencia, Spain. Cardiology Department, University Medical Center Groningen, Netherlands.

The American journal of medicine. 2020;(3):370-380.e4
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Abstract

BACKGROUND The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. METHODS This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. RESULTS The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). CONCLUSION A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.

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