{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:40:47Z","timestamp":1786977647094,"version":"build-2736575974"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":993,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T00:00:00Z","timestamp":1677110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Maintenance of euvolaemia with diuretics is critical in heart failure (HF) patients with chronic kidney disease (CKD); however, it is challenging because no reliable marker of volume status exists. Fractional excretion of urea nitrogen (FEUN) is a useful index of volume status in patients with renal failure. We aimed to examine whether FEUN is a surrogate marker of volume status for risk stratification in HF patients with CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We examined 516 HF patients with CKD (defined as discharge estimated glomerular filtration rate &amp;lt; 60 mL\/min\/1.73 m2) whose FEUN was measured at discharge (median age, 80 years; 58% male). The patients were divided into four groups according to quartile FEUN value at discharge: low-FEUN, FEUN \u2264 32.1; medium-FEUN, 32.1 &amp;lt; FEUN \u2264 38.0; high-FEUN, 38.0 &amp;lt; FEUN \u2264 43.7; and extremely-high-FEUN, FEUN &amp;gt; 43.7. FEUN was calculated by the following formula: (urinary urea \u00d7 serum creatinine) \u00d7 100\/(serum urea \u00d7 urinary creatinine). During the 3 year follow-up, 131 HF readmissions occurred. Kaplan\u2013Meier analysis showed that the HF readmission rate was significantly lower in the medium-FEUN group than in the other three groups (log-rank test, P = 0.029). Multivariate Cox regression analysis identified the low-FEUN, high-FEUN, and extremely-high-FEUN values as independent factors associated with post-discharge HF readmission. In the analysis of 130 patients who underwent right heart catheterization during hospitalization, a significant correlation between FEUN value and right atrial pressure was observed (R = 0.243, P = 0.005). Multivariate linear regression analysis revealed that FEUN value at discharge decreased in a dose-dependent manner with loop diuretics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In HF patients with CKD, FEUN is a potential marker of volume status for risk stratification of post-discharge HF readmission. Low FEUN value (FEUN \u2264 32.1) may represent intravascular dehydration, whereas high FEUN value (FEUN &amp;gt; 38.0) may represent residual congestion; both of them were independent risk factors for HF readmission. FEUN may be useful to determine euvolaemia and guide fluid management in HF patients with CKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14327","type":"journal-article","created":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T00:50:02Z","timestamp":1677199802000},"page":"1706-1716","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Utility of Fractional Excretion of Urea Nitrogen in Heart Failure Patients with Chronic Kidney Disease"],"prefix":"10.1093","volume":"10","author":[{"given":"Yukihiro","family":"Watanabe","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School , 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7320-7641","authenticated-orcid":false,"given":"Yoshiaki","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School , 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Nishino","sequence":"additional","affiliation":[{"name":"Department of Health Care Administration, Nippon Medical School , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhei","family":"Tara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School , 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuhito","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Public Health, Nippon Medical School , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Service, Nippon Medical School Hospital , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Mozawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School , 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School , 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukichi","family":"Tokita","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School , 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Yasutake","sequence":"additional","affiliation":[{"name":"Department of General Medicine and Health Science, Nippon Medical School , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuniya","family":"Asai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School , 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-ki","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Nippon Medical School , 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"key":"2026012114104485500_ehf214327-bib-0001","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"Collaborators. GDaIIaP","year":"2018","journal-title":"Lancet"},{"key":"2026012114104485500_ehf214327-bib-0002","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1002\/ejhf.1594","article-title":"Survival of patients with chronic heart failure in the community: a systematic review and meta-analysis","volume":"21","author":"Jones","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0003","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1002\/ejhf.890","article-title":"Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry","volume":"19","author":"Chioncel","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0004","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/eurheartj\/eht386","article-title":"Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis","volume":"35","author":"Damman","year":"2014","journal-title":"Eur Heart J"},{"key":"2026012114104485500_ehf214327-bib-0005","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jacc.2021.05.002","article-title":"Kidney function and outcomes in patients hospitalized with heart failure","volume":"78","author":"Patel","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026012114104485500_ehf214327-bib-0006","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1161\/CIRCHEARTFAILURE.112.969246","article-title":"Markers of decongestion, dyspnea relief, and clinical outcomes among patients hospitalized with acute heart failure","volume":"6","author":"Kociol","year":"2013","journal-title":"Circ Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0007","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1161\/CIRCHEARTFAILURE.111.963413","article-title":"Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function","volume":"5","author":"Metra","year":"2012","journal-title":"Circ Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0008","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1038\/nrneph.2016.113","article-title":"Heart failure and kidney dysfunction: epidemiology, mechanisms and management","volume":"12","author":"Schefold","year":"2016","journal-title":"Nat Rev Nephrol"},{"key":"2026012114104485500_ehf214327-bib-0009","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/j.ejheart.2007.07.011","article-title":"Relation between dose of loop diuretics and outcomes in a heart failure population: results of the ESCAPE trial","volume":"9","author":"Hasselblad","year":"2007","journal-title":"Eur J Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0010","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s10741-020-09995-z","article-title":"Association of loop diuretics use and dose with outcomes in outpatients with heart failure: a systematic review and meta-analysis of observational studies involving 96,959 patients","volume":"27","author":"Kapelios","year":"2022","journal-title":"Heart Fail Rev"},{"key":"2026012114104485500_ehf214327-bib-0011","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/ejhf.1369","article-title":"The use of diuretics in heart failure with congestion\u2014a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"21","author":"Mullens","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0012","doi-asserted-by":"crossref","first-page":"121","DOI":"10.3949\/ccjm.79a.11030","article-title":"Finding the cause of acute kidney injury: which index of fractional excretion is better?","volume":"79","author":"Gotfried","year":"2012","journal-title":"Cleve Clin J Med"},{"key":"2026012114104485500_ehf214327-bib-0013","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1046\/j.1523-1755.2002.00683.x","article-title":"Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure","volume":"62","author":"Carvounis","year":"2002","journal-title":"Kidney Int"},{"key":"2026012114104485500_ehf214327-bib-0014","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.020480","article-title":"Prognostic value of fractional excretion of urea nitrogen at discharge in acute decompensated heart failure","volume":"10","author":"Nogi","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2026012114104485500_ehf214327-bib-0015","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1586\/erc.09.74","article-title":"TORAFIC study protocol: torasemide prolonged release versus furosemide in patients with chronic heart failure","volume":"7","author":"D\u00edez","year":"2009","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"2026012114104485500_ehf214327-bib-0016","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/BF02089953","article-title":"Clinical and pharmacological investigations of the new saluretic azosemid","volume":"14","author":"Kr\u00fcck","year":"1978","journal-title":"Eur J Clin Pharmacol"},{"key":"2026012114104485500_ehf214327-bib-0017","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/4907024","article-title":"Urinary biochemistry in the diagnosis of acute kidney injury","volume":"2018","author":"Lima","year":"2018","journal-title":"Dis Markers"},{"key":"2026012114104485500_ehf214327-bib-0018","doi-asserted-by":"crossref","first-page":"R234","DOI":"10.1186\/cc13057","article-title":"Urinary output and fractional excretion of sodium and urea as indicators of transient versus intrinsic acute kidney injury during early sepsis","volume":"17","author":"Vanmassenhove","year":"2013","journal-title":"Crit Care"},{"key":"2026012114104485500_ehf214327-bib-0019","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1002\/hep.29772","article-title":"Fractional excretion of urea: a simple tool for the differential diagnosis of acute kidney injury in cirrhosis","volume":"68","author":"Patidar","year":"2018","journal-title":"Hepatology"},{"key":"2026012114104485500_ehf214327-bib-0020","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1002\/ejhf.667","article-title":"Impact of haemoconcentration during acute heart failure therapy on mortality and its relationship with worsening renal function","volume":"19","author":"Breidthardt","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0021","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1038\/s41569-020-0379-7","article-title":"Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment","volume":"17","author":"Boorsma","year":"2020","journal-title":"Nat Rev Cardiol"},{"key":"2026012114104485500_ehf214327-bib-0022","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.semnephrol.2009.03.008","article-title":"The physiology of urinary concentration: an update","volume":"29","author":"Sands","year":"2009","journal-title":"Semin Nephrol"},{"key":"2026012114104485500_ehf214327-bib-0023","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/00041552-200409000-00008","article-title":"Renal urea transporters","volume":"13","author":"Sands","year":"2004","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"2026012114104485500_ehf214327-bib-0024","first-page":"F823","article-title":"Vasopressin effects on urea and H2O transport in inner medullary collecting duct subsegments","volume":"253","author":"Sands","year":"1987","journal-title":"Am J Physiol"},{"key":"2026012114104485500_ehf214327-bib-0025","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.jcmg.2008.06.005","article-title":"Comparison of hand-carried ultrasound assessment of the inferior vena cava and N-terminal pro-brain natriuretic peptide for predicting readmission after hospitalization for acute decompensated heart failure","volume":"1","author":"Goonewardena","year":"2008","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026012114104485500_ehf214327-bib-0026","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1093\/eurjhf\/hfq132","article-title":"Dyspnoea and worsening heart failure in patients with acute heart failure: results from the Pre-RELAX-AHF study","volume":"12","author":"Metra","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0027","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1093\/eurheartj\/ehs444","article-title":"Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial","volume":"34","author":"Ambrosy","year":"2013","journal-title":"Eur Heart J"},{"key":"2026012114104485500_ehf214327-bib-0028","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s00392-022-02036-9","article-title":"Lack of correlation between different congestion markers in acute decompensated heart failure","volume":"112","author":"Haag","year":"2022","journal-title":"Clin Res Cardiol"},{"key":"2026012114104485500_ehf214327-bib-0029","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.bcp.2007.09.026","article-title":"Comparative effects of torasemide and furosemide in rats with heart failure","volume":"75","author":"Veeraveedu","year":"2008","journal-title":"Biochem Pharmacol"},{"key":"2026012114104485500_ehf214327-bib-0030","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1161\/CIRCHEARTFAILURE.113.000828","article-title":"Decongestive therapy and renal function in acute heart failure: time for a new approach?","volume":"7","author":"Goldsmith","year":"2014","journal-title":"Circ Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0031","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jacc.2015.10.073","article-title":"A test in context: critical evaluation of natriuretic peptide testing in heart failure","volume":"67","author":"Francis","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2026012114104485500_ehf214327-bib-0032","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1002\/ehf2.12531","article-title":"Clinical implications of the blood urea nitrogen\/creatinine ratio in heart failure and their association with haemoconcentration","volume":"6","author":"Sujino","year":"2019","journal-title":"ESC Heart Fail"},{"key":"2026012114104485500_ehf214327-bib-0033","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1136\/bmj.2.6092.929","article-title":"Plasma creatinine and urea:creatinine ratio in patients with raised plasma urea","volume":"2","author":"Morgan","year":"1977","journal-title":"Br Med J"},{"key":"2026012114104485500_ehf214327-bib-0034","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1093\/eurheartj\/ehv010","article-title":"The kidney in heart failure: an update","volume":"36","author":"Damman","year":"2015","journal-title":"Eur Heart J"},{"key":"2026012114104485500_ehf214327-bib-0035","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1002\/ejhf.1697","article-title":"Evaluation of kidney function throughout the heart failure trajectory\u2014a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"22","author":"Mullens","year":"2020","journal-title":"Eur J Heart Fail"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ehf2.14327","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ehf2.14327","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/10\/3\/1706\/65017834\/eschf_10_3_1706.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/10\/3\/1706\/65017834\/eschf_10_3_1706.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T19:11:58Z","timestamp":1769022718000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/10\/3\/1706\/8304716"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,23]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2,23]]},"published-print":{"date-parts":[[2023,6,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.14327","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,6]]},"published":{"date-parts":[[2023,2,23]]},"assertion":[{"value":"2022-08-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}