Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology

Wilfried Mullens, Kevin Damman, Jeffrey M. Testani, Pieter Martens, Christian Mueller, Johan Lassus, W. H.Wilson Tang, Hadi Skouri, Frederik H. Verbrugge, Francesco Orso, Loreena Hill, Ural Dilek, Mitcha Lainscak, Patrick Rossignol, Marco Metra, Alexandre Mebazaa, Petar Seferovic, Frank Ruschitzka, Andrew Coats

Research output: Contribution to journalArticle

Abstract

Appropriate interpretation of changes in markers of kidney function is essential during the treatment of acute and chronic heart failure. Historically, kidney function was primarily assessed by serum creatinine and the calculation of estimated glomerular filtration rate. An increase in serum creatinine, also termed worsening renal function, commonly occurs in patients with heart failure, especially during acute heart failure episodes. Even though worsening renal function is associated with worse outcome on a population level, the interpretation of such changes within the appropriate clinical context helps to correctly assess risk and determine further treatment strategies. Additionally, it is becoming increasingly recognized that assessment of kidney function is more than just glomerular filtration rate alone. As such, a better evaluation of sodium and water handling by the renal tubules allows to determine the efficiency of loop diuretics (loop diuretic response and efficiency). Also, though neurohumoral blockers may induce modest deteriorations in glomerular filtration rate, their use is associated with improved long-term outcome. Therefore, a better understanding of the role of cardio–renal interactions in heart failure in symptom development, disease progression and prognosis is essential. Indeed, perhaps even misinterpretation of kidney function is a leading cause of not attaining decongestion in acute heart failure and insufficient dosing of guideline-directed medical therapy in general. This position paper of the Heart Failure Association Working Group on Cardio-Renal Dysfunction aims at improving insights into the interpretation of renal function assessment in the different heart failure states, with the goal of improving heart failure care.

Original languageEnglish
JournalEuropean Journal of Heart Failure
DOIs
Publication statusAccepted/In press - Jan 1 2020

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Keywords

  • Acute kidney injury
  • Biomarkers
  • Diuretic efficiency
  • Diuretic response
  • Glomerular filtration
  • Guidelines
  • Heart failure
  • Kidney function
  • Outcome
  • Renal imaging
  • Tubular function
  • Worsening of renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mullens, W., Damman, K., Testani, J. M., Martens, P., Mueller, C., Lassus, J., Tang, W. H. W., Skouri, H., Verbrugge, F. H., Orso, F., Hill, L., Dilek, U., Lainscak, M., Rossignol, P., Metra, M., Mebazaa, A., Seferovic, P., Ruschitzka, F., & Coats, A. (Accepted/In press). Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. https://doi.org/10.1002/ejhf.1697