However, improving renal function at day 3 was an independent predictor of worse outcomes and persistent jugular venous distension at day 3 was less frequent in patients with WRF at day 3 [24]. be made public without patients consent according to the Japanese law Act around the Protection of Personal Information. This decision was made by Kameda Medical Center, Clinical Research Committee and Chief of Cardiology Division, Dr. Akira Mizukami. All data requests should be sent to REALITY-AHF study committee (moc.liamg@fha.ytilaer). Abstract IWP-4 Aims The prognostic impact of worsening renal function (WRF) in patients with acute heart failure (AHF) remains under debate. Successful decongestion might offset the unfavorable impact of WRF, but little is known about indicators of successful decongestion in the very acute phase of AHF. We hypothesized that decongestion as evaluated by the percent reduction in brain natriuretic peptide (BNP) could identify relevant prognostic implications of WRF in the very acute phase of AHF. Methods and results Data on 907 consecutive hospitalized patients with AHF in the REALITY-AHF study (age: 7812 years; 55.1% male) were analyzed. Creatinine and BNP were measured at baseline and 48 hours from admission. WRF was defined as an increase in creatinine 0.3 mg at 48 hours from admission. The primary endpoint was 1-12 months all-cause mortality. Patients were divided into four groups according to the presence/absence of WRF and a BNP reduction higher/lower than the median: no-WRF/higher-BNP-reduction (n = 390), no-WRF/lower-BNP-reduction (n = 397), WRF/higher-BNP-reduction (n = 63), and WRF/lower-BNP-reduction groups (n = 57). Kaplan-Meier curve analysis showed that this WRF/lower-BNP-reduction group experienced a worse prognosis than the other groups. In a Cox regression analysis, only the WRF/lower-BNP-reduction group experienced higher mortality compared to the no-WRF/higher-BNP-reduction group (hazard ratio: 3.34, p 0.001). Conclusion In the very acute phase of AHF, BNP reduction may aid in identifying relevant prognostic significance of WRF. Introduction Accumulating evidences demonstrate the importance of treatment during the very acute phase in acute heart failure (AHF). Decongestion with intravenous loop diuretics is the mainstay treatment for AHF, as congestion is one of the main reasons for heart failure admission [1C4]. However, the use of loop diuretics causes worsening renal function (WRF), which has been reported to be associated with a poor prognosis in patients with AHF [5]. This association, however, does not always hold, as several recent studies have shown that this prognostic impact of WRF varies according to the clinical context in which it occurs [6C8]. More specifically, WRF occurring during successful decongestive treatment is not associated with a poor prognosis, whereas WRF occurring during an unfavorable clinical course is associated with a poor prognosis [6C8]. Distinguishing these two phenotypes of WRF is usually clinically relevant, as the subsequent treatment could differ. Therefore, it is critically important to understand the extent to which ongoing decongestive treatment is effective. A rational (bio)marker that provides such information is usually yet to be developed; however, the brain natriuretic peptide (BNP) level has been widely used as a marker of congestion, mainly because of its strong association with prognosis in patients with heart failure [9,10]. Especially in the very acute phase of AHF treatment, dynamic changes in the intravascular volume due to aggressive diuresis might provoke changes in both BNP and creatinine levels. However, very few studies have investigated the prognostic conversation between the switch in BNP level and WRF during treatment in very acute phase AHF. We, therefore, hypothesized that combining information regarding changes in BNP and creatinine levels during the acute phase may enable the risk stratification of patients with AHF and WRF. Methods Study participants The present study utilized data from your REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure), a prospective multicenter registry focused on presentation and treatment during the very early phase of AHF hospitalization. Details regarding the study design have been published elsewhere [4,11C16]. Briefly, consecutive patients with AHF aged 20 years who were hospitalized via the emergency department (ED) at 20 hospitals in Japan were enrolled. The diagnosis of AHF was determined by an attending physician at each site, using the Framingham criteria [17]. All patients measured BNP or NT-proBNP at admission and those with BNP 100 ng/L or NT-proBNP 300 ng/L were excluded because of uncertainty in the diagnosis according to the guidelines [18]. Detailed inclusion/exclusion criteria and other study information were published in the publicly available University Hospital Information Network (UMIN-CTR, unique identifier: UMIN000014105).Creatinine and BNP levels were evaluated at baseline and 48 hours of admission, and the change in these two parameters was calculated. on the Protection of Personal Information. This decision was made by Kameda Medical Center, Clinical Research Committee and Chief of Cardiology Division, Dr. Akira Mizukami. All data requests should be sent to REALITY-AHF study committee (moc.liamg@fha.ytilaer). Abstract Aims The prognostic impact of worsening renal function (WRF) in patients with acute heart failure (AHF) remains under debate. Successful decongestion might offset the negative impact of WRF, but little is known about indicators of successful decongestion in the very acute phase of AHF. We hypothesized that decongestion as evaluated by the percent IWP-4 reduction in brain natriuretic peptide (BNP) could identify relevant prognostic implications of WRF in the very acute phase CLTB of AHF. Methods and results Data on 907 consecutive hospitalized patients with AHF in the REALITY-AHF study (age: 7812 years; 55.1% male) were analyzed. Creatinine and BNP were measured at baseline and 48 hours from admission. WRF was defined as an increase in creatinine 0.3 mg at 48 hours from admission. The primary endpoint was 1-year all-cause mortality. Patients were divided into four groups according to the presence/absence of WRF and a BNP reduction higher/lower than the median: no-WRF/higher-BNP-reduction (n = 390), no-WRF/lower-BNP-reduction (n = 397), WRF/higher-BNP-reduction (n = 63), and WRF/lower-BNP-reduction groups (n = 57). Kaplan-Meier curve analysis showed that the WRF/lower-BNP-reduction group had a worse prognosis than the other groups. In a Cox regression analysis, only the WRF/lower-BNP-reduction group had higher mortality compared to the no-WRF/higher-BNP-reduction group (hazard ratio: 3.34, p 0.001). Conclusion In the very acute phase of AHF, BNP reduction may aid in identifying relevant prognostic significance of WRF. Introduction Accumulating evidences demonstrate the importance of treatment during the very acute phase in acute heart failure (AHF). Decongestion with intravenous loop diuretics is the mainstay treatment for AHF, as congestion is one of the main reasons for heart failure admission [1C4]. However, the use of loop diuretics causes worsening renal function (WRF), which has been reported to be associated with a poor prognosis in patients with AHF [5]. This association, however, does not always hold, as several recent studies have shown that the prognostic impact of WRF varies according to the clinical context in which it occurs [6C8]. More specifically, WRF occurring during successful decongestive treatment is not associated with a poor prognosis, whereas WRF occurring during an unfavorable clinical course is associated with a poor prognosis [6C8]. Distinguishing these two phenotypes of WRF is clinically relevant, as the subsequent treatment could differ. Therefore, it is critically important to understand the extent to which ongoing decongestive treatment is effective. A rational (bio)marker that provides such information is yet to be developed; however, the brain natriuretic peptide (BNP) level has been widely used as a marker of congestion, mainly because of its strong association with prognosis in patients with heart failure [9,10]. Especially in the very acute phase of AHF treatment, dynamic changes in the intravascular volume due to aggressive diuresis might provoke changes in both BNP and creatinine levels. However, very few studies have investigated the prognostic interaction between the change in BNP level and WRF during treatment in very acute phase AHF. We, therefore, hypothesized that combining information regarding changes in BNP and creatinine levels during the acute phase may enable the risk stratification of patients with AHF and WRF. Methods Study participants The present study utilized data from the REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure), a prospective multicenter registry focused on presentation and treatment during the very early phase of AHF hospitalization. Details regarding the study design have been published elsewhere [4,11C16]. Briefly, consecutive patients with AHF aged 20 years who were hospitalized via the emergency department (ED) at 20 hospitals in Japan were enrolled. The diagnosis of AHF was determined by an attending physician at each site, using the Framingham criteria [17]. All patients measured IWP-4 BNP or NT-proBNP at admission and those with BNP 100 ng/L or NT-proBNP.