Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
Internal Medicine Department, Hospital de Manises, Manises, Valencia, Spain.
Am J Med. 2020 Mar;133(3):370-380.e4. doi: 10.1016/j.amjmed.2019.07.041. Epub 2019 Aug 15.
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.
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.
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/1.73m. 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/1.73m) 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).
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.
急性心力衰竭伴肾功能障碍患者的最佳利尿治疗策略仍不明确。血浆糖类抗原 125（CA125）是体液超负荷的替代指标，也是指导利尿治疗的潜在有价值工具。本研究旨在确定 CA125 指导的利尿策略是否优于常规治疗，以改善急性心力衰竭伴肾功能障碍患者的短期肾功能。
这是一项多中心、开放标签研究，将 160 例急性心力衰竭伴肾功能障碍患者按 1:1 比例随机分为 2 组。CA125 指导组（n=79）根据 CA125 水平确定袢利尿剂剂量，常规治疗组（n=81）根据临床评估确定剂量。72 小时和 24 小时时估算肾小球滤过率（eGFR）的变化分别为主要共同终点。
患者平均年龄为 78±8 岁，中位氨基末端脑钠肽前体为 7765pg/ml，平均 eGFR 为 33.7±11.3ml/min/1.73m。72 小时时，CA125 指导组的呋塞米等效剂量高于常规治疗组（P=0.011），尿量也更高（P=0.042）。此外，CA125 指导组中 CA125＞35U/ml 的患者接受了最高的呋塞米等效剂量（P＜0.001），并出现了更高的利尿作用（P=0.013）。72 小时时，CA125 指导组 eGFR（ml/min/1.73m）显著改善（37.5 比 34.8，P=0.036），24 小时时无显著变化（35.8 比 39.5，P=0.391）。
在急性心力衰竭伴肾功能障碍患者中，CA125 指导的利尿策略可显著改善 72 小时时的 eGFR 和其他肾功能参数。
