Biomarker Identifies Kidney Injury In Heart Failure Patients

Dr. Wilson Tang MD Professor of Medicine Cleveland Clinic Lerner College of Medicine Case Western Reserve University Director of the Center for Clinical Genomics Cleveland Interview with:
Dr. Wilson Tang MD
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Director of the Center for Clinical Genomics
Cleveland Clinic 

Medical Research: What is the background for this study? What are the main findings?

Dr. Tang: Renal impairment has long been associated with worse outcomes in acute heart failure. Administration of diuretic therapy often obscures accurate assessment of renal function by urine output.  Despite extensive literature suggesting the poor outcomes in those with a rise in creatinine following treatment, recent data has suggested that in the presence of effective diuresis, this phenomenon likely represents hemoconcentration and azotemia rather than acute kidney injury.  We observed that using a novel and sensitive biomarker that identified acute kidney injury, specific to tubular injury, we can identify those at higher risk of adverse outcomes in patents admitted for acute heart failure.   However, after adjusting for standard risk factors, the prognostic value was clearly attenuated.

Medical Research: What should clinicians and patients take away from your report?

Dr. Tang: More specific and sensitive biomarkers have been sought out to better identify more detrimental kidney injury patterns in the setting of large volume diuresis in acute heart failure.  However, our findings imply that circulating KIM-1 may not stratify patients with acute heart failure above and beyond standard clinical variables.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Tang: Renal impairment during acute heart failure treatment remains a poorly characterized, challenging clinical scenario despite the availability of novel renal biomarkers.   Currently, acute kidney injury is based upon changes in biomarkers rather than concrete clinical findings or consequences.  As novel biomarkers continue to emerge, their role in clinical practice may or may not be incremental to standard variables. Further, what these biomarkers actually imply may also vary depending on the clinical scenario, and thus their utility should be directed testing in the acute heart failure setting.

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Dr. Wilson Tang MD (2015). Biomarker Identifies Kidney Injury In Heart Failure Patients 

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