{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:05:29Z","timestamp":1790726729238,"version":"4.1.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2022,6,30]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Hemoconcentration is a minimal contributor to changes in serum creatinine during treatment of decompensated heart failure.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Changes in GFR is the primary driver of serum creatinine in treatment of decompensated heart failure.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Worsening serum creatinine is common during treatment of acute decompensated heart failure (ADHF). A possible contributor to creatinine increase is diuresis-induced changes in volume of distribution (VD) of creatinine as total body water (TBW) contracts around a fixed mass of creatinine. Our objective was to better understand the filtration and nonfiltration factors driving change in creatinine during ADHF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants in the ROSE-AHF trial with baseline to 72-hour serum creatinine; net fluid output; and urinary KIM-1, NGAL, and NAG were included (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =270). Changes in VD were calculated by accounting for measured input and outputs from weight-based calculated TBW. Changes in observed creatinine (Cr\n                      <jats:sub>observed<\/jats:sub>\n                      ) were compared with predicted changes in creatinine after accounting for alterations in VD and non\u2013steady state conditions using a kinetic GFR equation (Cr\n                      <jats:sub>72HR Kinetic<\/jats:sub>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      When considering only change in VD, the median diuresis to elicit a \u22650.3 mg\/dl rise in creatinine was \u22127526 ml (IQR, \u22125932 to \u22129149). After accounting for stable creatinine filtration during diuresis, a change in VD alone was insufficient to elicit a \u22650.3 mg\/dl rise in creatinine. Larger estimated decreases in VD were paradoxically associated with improvement in Cr\n                      <jats:sub>observed<\/jats:sub>\n                      (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      =\u22120.18,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.003). Overall, \u22123% of the change in eCr\n                      <jats:sub>72HR Kinetic<\/jats:sub>\n                      was attributable to the change in VD. A \u22650.3 mg\/dl rise in eCr\n                      <jats:sub>72HR Kinetic<\/jats:sub>\n                      was not associated with worsening of KIM-1, NGAL, NAG, or postdischarge survival (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt;0.05 for all).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>During ADHF therapy, increases in serum creatinine are driven predominantly by changes in filtration, with minimal contribution from change in VD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0007582021","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T12:53:56Z","timestamp":1649768036000},"page":"1003-1010","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Hemoconcentration of Creatinine Minimally Contributes to Changes in Creatinine during the Treatment of Decompensated Heart Failure"],"prefix":"10.34067","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2510-4266","authenticated-orcid":false,"given":"Christopher","family":"Maulion","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5427-4969","authenticated-orcid":false,"given":"Sheldon","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veena S.","family":"Rao","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8800-7298","authenticated-orcid":false,"given":"Juan B.","family":"Ivey-Miranda","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut"},{"name":"Department of Heart Failure, Cardiology Hospital, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary L.","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9059-1083","authenticated-orcid":false,"given":"Devin","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0928-9168","authenticated-orcid":false,"given":"Steven G.","family":"Coca","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Negoianu","sequence":"additional","affiliation":[{"name":"Division of Renal Electrolyte and Hypertension, Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7552-3426","authenticated-orcid":false,"given":"Jennifer L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Turner","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley A.","family":"Inker","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2633-2412","authenticated-orcid":false,"given":"F. 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