• Julio Núñez, Pau Llàcer, Sergio García-Blas, Clara Bonanad, Silvia Ventura, José María Núñez, Ruth Sánchez, Lorenzo Fácila, Rafael de la Espriella, Juana María Vaquer, Alberto Cordero, Mercè Roqué, Carlos Chamorro, Vicent Bodi, Ernesto Valero, Enrique Santas, María Del Carmen Moreno, Gema Miñana, Arturo Carratalá, Enrique Rodríguez, Anna Mollar, Patricia Palau, María José Bosch, Vicente Bertomeu-González, Josep Lupón, Jorge Navarro, Francisco J Chorro, Jose L Górriz, Juan Sanchis, Adriaan A Voors, and Antoni Bayés-Genís.
• Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain. Electronic address: yulnunez@gmail.com.
• Am. J. Med. 2020 Mar 1; 133 (3): 370-380.e4.

BackgroundThe 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.MethodsThis 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.ResultsThe 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/1.73m2. 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/1.73m2) 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).ConclusionA CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction.Copyright © 2019 Elsevier Inc. All rights reserved.

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