Tubular damage and worsening renal function in chronic heart failure

Kevin Damman, Serge Masson, Hans L. Hillege, Adriaan A. Voors, Dirk J. van Veldhuisen, Patrick Rossignol, Gianni Proietti, Savino Barbuzzi, Gian Luigi Nicolosi, Luigi Tavazzi, Aldo P. Maggioni, Roberto Latini

Research output: Contribution to journalArticlepeer-review


Objectives: This study sought to investigate the relationship between tubular damage and worsening renal function (WRF) inchronic heart failure (HF). Background: WRF is associated with poor outcome in chronic HF. It is unclear whether urinary tubular markers may identify patients at risk for WRF. Methods: In 2,011 patients with chronic HF, we evaluated the ability of urinary tubular markers ( N-acetyl-beta- d-glucosaminidase (NAG), kidney injury molecule (KIM)-1, and neutrophil gelatinase-associated lipocalin (NGAL) to predict WRF. Finally, we assessed the prognostic importance of WRF. Results: A total of 290 patients (14.4%) experienced WRF during follow-up, and WRF was a strong and independent predictor of all-cause mortality and HF hospitalizations (hazard ratio [HR]: 2.87; 95% CI: 2.40 to 3.43; p<0.001). Patients with WRF had lower baseline glomerular filtration rate and higher KIM-1, NAG, and NGAL levels. In a multivariable-adjusted model, KIM-1 was the strongest independent predictor of WRF (HR: 1.23; 95% CI: 1.09 to 1.39 per log increase; p= 0.001). Conclusions: WRF was associated with strongly impaired outcome in patients with chronic HF. Increased level of urinary KIM-1 was the strongest independent predictor of WRF and could therefore be used to identify patients at risk for WRF and poor clinical outcome. (GISSI-HF-Effects of n-3 PUFA and Rosuvastatin on Mortality-Morbidity of Patients With Symptomatic CHF; NCT00336336).

Original languageEnglish
Pages (from-to)417-424
Number of pages8
JournalJACC: Heart Failure
Issue number5
Publication statusPublished - Oct 2013


  • EGFR
  • Heart failure
  • HF
  • KIM
  • NAG
  • NGAL
  • Renal insufficiency
  • Tubular damage
  • Worsening renal function
  • WRF

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)


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