{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T16:46:41Z","timestamp":1793292401432,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T00:00:00Z","timestamp":1638403200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>For patients with acute heart failure (AHF), substantial diuresis after administration of loop diuretics is generally associated with better clinical outcomes but may cause creatinine to rise, suggesting renal function decline. We investigated the interaction between diuretic response and worsening renal function (WRF) on clinical outcomes in patients with AHF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      In two AHF cohorts (PROTECT,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u20091698 and RELAX\u2010AHF\u20102,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u20095586 in current analysis), the prognostic impact of WRF (creatinine \u22650.3\u00a0mg\/dl increase baseline\u2014day 4; sensitivity analyses incorporated baseline renal function) by diuretic response (kg weight loss\/40\u2009mg furosemide equivalent baseline\u2014day 4) was investigated with regard to (cardiovascular) death or cardiovascular\/renal hospitalization using subpopulation treatment effect pattern plots (STEPP) and survival analyses. WRF occurred in 286 (16.8%) and 1031 (18.5%) patients in PROTECT and RELAX\u2010AHF\u20102, respectively. Patients with WRF had higher left ventricular ejection fraction and lower estimated glomerular filtration rate at baseline (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.05), and received higher doses of loop diuretics and had a worse diuretic response (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.001). In patients with a poor diuretic response (\u22640.35\u2009kg weight loss\/40\u2009mg furosemide equivalent as identified by STEPP), WRF was associated with higher risk of (cardiovascular) death or cardiovascular\/renal hospitalization (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u20090.001 both cohorts), but this was not the case for patients with a good diuretic response (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u20090.900 both cohorts).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In two large cohorts of patients with AHF, WRF in the first 4\u2009days was not associated with worse outcomes when patients had a good diuretic response. The occurrence of WRF in patients with AHF should therefore be considered in the context of diuretic response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2384","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T04:03:43Z","timestamp":1637121823000},"page":"365-374","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":86,"title":["Worsening renal function in acute heart failure in the context of diuretic response"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9217-956X","authenticated-orcid":false,"given":"Johanna E.","family":"Emmens","sequence":"first","affiliation":[{"name":"Department of Cardiology University of Groningen, University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jozine M.","family":"ter Maaten","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Groningen, University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuya","family":"Matsue","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine Juntendo University Graduate School of Medicine  Tokyo Japan"},{"name":"Cardiovascular Respiratory Sleep Medicine Juntendo University Graduate School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylwia M.","family":"Figarska","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Groningen, University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iziah E.","family":"Sama","sequence":"additional","affiliation":[{"name":"Department of Cardiology University of Groningen, University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gad","family":"Cotter","sequence":"additional","affiliation":[{"name":"Momentum Research and Inserm U942 MASCOT  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.F.","family":"Cleland","sequence":"additional","affiliation":[{"name":"Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Well\u2010Being, University of Glasgow, Glasgow Royal Infirmary  Glasgow UK"},{"name":"National Heart &amp; Lung Institute, Imperial College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A.","family":"Davison","sequence":"additional","affiliation":[{"name":"Momentum Research and Inserm U942 MASCOT  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Michael","family":"Felker","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine Duke University  Durham NC USA"},{"name":"Duke Clinical Research Institute  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M.","family":"Givertz","sequence":"additional","affiliation":[{"name":"Cardiovascular Division Brigham and Women's Hospital  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Greenberg","sequence":"additional","affiliation":[{"name":"University of California San Diego Health, Sulpizio Cardiovascular Institute  La Jolla CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Indiana University School of Medicine  Indianapolis IN 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