• Mateusz Sokolski, Robert Zymliński, Jan Biegus, Paweł Siwołowski, Sylwia Nawrocka-Millward, John Todd, Malli Rama Yerramilli, Joel Estis, Ewa Anita Jankowska, Waldemar Banasiak, and Piotr Ponikowski.
• Wroclaw Medical University, Department of Heart Diseases, Wroclaw, Poland.
• Eur. J. Heart Fail. 2017 Jun 1; 19 (6): 760-767.

AimsRecent studies indicate the need to redefine worsening renal function (WRF) in acute heart failure (AHF), linking a rise in creatinine with clinical status to identify patients who develop 'true WRF'. We evaluated the usefulness of serial assessment of urinary levels of neutrophil gelatinase-associated lipocalin (uNGAL), kidney injury molecule-1 (uKIM-1), and cystatin C (uCysC) for prediction of 'true WRF'.Methods And ResultsIn 132 patients with AHF, uNGAL, uKIM-1, and uCysC were measured using a highly sensitive immunoassay based on a single-molecule counting technology (Singulex, Alameda, CA, USA) at baseline, day 2, and day 3. Patients who developed WRF (a ≥0.3 mg/dL increase in serum creatinine or a >25% decrease in the estimated glomerular filtration rate from the baseline value) were differentiated into those 'true WRF' (presence of deterioration/no improvement in clinical status during hospitalization) vs. 'pseudo-WRF' (uneventful clinical course). 'True WRF' occurred in 13 (10%), 'pseudo-WRF' in 15 (11%), whereas the remaining 104 (79%) patients did not develop WRF. Patients with 'true WRF' were more often females, had higher levels of NT-proBNP, creatinine, and urea on admission, higher urine albumin to creatinine ratio at day 2, higher uNGAL at baseline, day 2, and day 3, and higher KIM-1 at day 2 (vs. pseudo-WRF vs. without WRF, all P < 0.05). Patients with pseudo-WRF did not differ from those without WRF. In the multivariable model, elevated uNGAL at all time points and uKIM-1 at day 2 remained independent predictors of 'true WRF'.ConclusionElevated levels of uNGAL and uKIM-1 may predict development of 'true WRF' in AHF.© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

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