A combined-biomarker approach to clinical phenotyping renal dysfunction in heart failure

Jeffrey M. Testani*, Kevin Damman, Meredith A. Brisco, Susan Chen, Olga Laur, Alexander J. Kula, W. H.Wilson Tang, Chirag Parikh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Methods and Results A total of 908 patients with a discharge diagnosis of HF were included. Median values were used to define elevated BNP (>1296 pg/mL) and BUN/creat (>17). In the group without RD, survival was similar regardless of BNP and BUN/creat (n = 430, adjusted P =.52). Similarly, in patients with both a low BNP and BUN/creat, RD was not associated with mortality (n = 250, adjusted hazard ratio [HR] = 1.0, 95% confidence interval [CI] 0.6-1.6, P =.99). However, in patients with both an elevated BNP and BUN/creat those with RD had a cardiorenal profile characterized by venous congestion, diuretic resistance, hypotension, hyponatremia, longer length of stay, greater inotrope use, and substantially worse survival compared with patients without RD (n = 249, adjusted HR = 1.8, 95% CI 1.2-2.7, P =.008, P interaction =.005).

Conclusions In the setting of decompensated HF, the combined use of BNP and BUN/creat stratifies patients with RD into groups with significantly different clinical phenotypes and prognosis.

Background Differentiating heart failure (HF) induced renal dysfunction (RD) from intrinsic kidney disease is challenging. It has been demonstrated that biomarkers such as B-type natriuretic peptide (BNP) or the blood urea nitrogen to creatinine ratio (BUN/creat) can identify high- vs low-risk RD. Our objective was to determine if combining these biomarkers could further improve risk stratification and clinical phenotyping of patients with RD and HF.

Original languageEnglish (US)
Pages (from-to)912-919
Number of pages8
JournalJournal of Cardiac Failure
Issue number12
StatePublished - Dec 1 2014
Externally publishedYes


  • BNP
  • Cardiorenal syndrome
  • blood urea nitrogen to creatinine ratio
  • decompensated heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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