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Andrew J Burger - One of the best experts on this subject based on the ideXlab platform.
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serum Blood Urea Nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates
Journal of the American College of Cardiology, 2005Co-Authors: Ajay J Kirtane, Andrew J Burger, Sabina A. Murphy, David M Leder, Sushrut S Waikar, Glenn M Chertow, Duane S Pinto, Dimitrios Karmpaliotis, Kausik K Ray, Christopher P CannonAbstract:Objectives: We hypothesized that elevated Blood Urea Nitrogen (BUN) would be associated with adverse outcomes independent of serum creatinine (sCr)-based estimates of kidney function in patients wi...
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serum Blood Urea Nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates
Journal of the American College of Cardiology, 2005Co-Authors: Ajay J Kirtane, Andrew J Burger, Christopher P Cannon, Sabina A. Murphy, David M Leder, Sushrut S Waikar, Glenn M Chertow, Duane S Pinto, Dimitrios Karmpaliotis, Eugene BraunwaldAbstract:Objectives We hypothesized that elevated Blood Urea Nitrogen (BUN) would be associated with adverse outcomes independent of serum creatinine (sCr)-based estimates of kidney function in patients with acute coronary syndromes (ACS). Background Although lower glomerular filtration rates (GFR) have prognostic significance among patients with ACS, estimates of GFR based on sCr may perform less accurately among patients with milder kidney dysfunction. In this population in particular, BUN, which can reflect increased proximal tubular reabsorption in addition to decreased GFR, may have independent prognostic value. Methods Data were drawn from 9,420 patients with unstable coronary syndromes from Orbofiban in Patients With Unstable Coronary Syndromes-Thrombolysis In Myocardial Infarction (OPUS-TIMI)-16, a trial that excluded patients with sCr >1.6 mg/dl or estimated creatinine clearance <40 ml/min. Results Patients with elevated BUN were older, had a higher prevalence of comorbidities, and had higher heart rates, lower systolic Blood pressures, and an abnormal Killip class more often on admission. In univariate analyses, as well as in stratified and multivariable analyses including sCr-based estimates of GFR as a covariate, a stepwise increase in mortality occurred with increasing BUN (multivariable hazard ratio with BUN 20 to 25 mg/dl 1.9, 95% confidence interval 1.3 to 2.6; with BUN ≥25 mg/dl 3.2 [95% confidence interval 2.2 to 4.7]) compared with BUN ≤20 mg/dl. A higher BUN was also associated with increased mortality among strata of troponin-I, B-type natriuretic peptide, and C-reactive protein concentrations. Conclusions Among patients with unstable coronary syndromes and predominantly normal or mildly reduced GFR, an elevated BUN is associated with increased mortality, independent of sCr-based estimates of GFR and other biomarkers.
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elevated Blood Urea Nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure
The American Journal of Medicine, 2004Co-Authors: Doron Aronson, Murray A Mittleman, Andrew J BurgerAbstract:Abstract Background Hospitalization for decompensated heart failure is associated with high mortality after discharge. In heart failure, renal function involves both cardiovascular and hemodynamic properties. We studied the relation between renal dysfunction and mortality in patients admitted for decompensated heart failure. Methods The prognostic importance of four measures of renal function—Blood Urea Nitrogen, serum creatinine, Blood Urea Nitrogen/creatinine ratio, and estimated creatinine clearance—was evaluated in 541 patients (mean [± SD] age, 63 ± 14 years; 377 men [70%]) with a previous diagnosis of heart failure (96% with New York Heart Association class III or IV symptoms) who were admitted for clinical decompensation. Results During a mean follow-up of 343 ± 185 days, 177 patients (33%) died. In multivariable Cox regression models, the risk of all-cause mortality increased with each quartile of Blood Urea Nitrogen, with an adjusted relative risk of 2.3 in patients in the upper compared with the lower quartiles (95% confidence interval [CI]: 1.3 to 4.1; P = 0.005). Creatinine and estimated creatinine clearance were not significant predictors of mortality after adjustment for other covariates. Blood Urea Nitrogen/creatinine ratio yielded similar prognostic information as Blood Urea Nitrogen (adjusted relative risk=2.3; 95% CI: 1.4 to 3.8; P = 0.0007 for patients in the upper compared with the lower quartiles). Conclusion Blood Urea Nitrogen is a simple clinical variable that provides useful prognostic information in patients admitted for decompensated heart failure. In this setting, elevated Blood Urea Nitrogen levels probably reflect the cumulative effects of hemodynamic and neurohormonal alterations that result in renal hypoperfusion.
Jian-ping Luo - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of renoprotective effect of Chinese chive extracts on adenine-induced chronic renal failure
KeAi, 2018Co-Authors: Jian-ping Luo, Li-hua Pan, Xue-qiang ZhaAbstract:The renoprotective effects of Chinese chive water and ethanol extracts (CCWE and CCEE) on adenine-induced chronic renal failure (CRF) mice were evaluated in this study. Results showed that the renal pathological damages and the enhancement of serum creatinine and Blood Urea Nitrogen of CRF mice could be significantly alleviated by the treatment of CCWE, but not CCEE. When the concentration of CCWE reached 200 mg/kg/day, the area of renal pathological damage was decreased to the 48.1% of model group, and the levels of serum creatinine and Blood Urea Nitrogen were decreased to the 87.7% and 83.9% of model group, respectively. Meanwhile, it could be found that renal oxidative stress and inflammation of CRF mice were remarkably inhibited by CCWE. These results indicated CCWE could improve the kidney function of CRF mice via enhancing antioxidant ability and inhibiting inflammation, and was the main renoprotective fraction of Chinese chive. Keywords: Chinese chive, Renoprotection, Chronic renal failur
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renoprotective effect of chinese chive polysaccharides in adenine induced chronic renal failure
International Journal of Biological Macromolecules, 2018Co-Authors: Haoran Chena, Xue-qiang Zha, Li-hua Pan, Jian-ping LuoAbstract:In this work, we investigated the effect of Chinese chive polysaccharides (CCP) on renal function in mice with adenine-induced chronic renal failure (CRF). Results exhibited that adenine treatment caused serious renal pathological damages and elevation of serum creatinine and Blood Urea Nitrogen of mice. However, these changes could be significantly reversed by the administration of CCP in a dose-dependent manner. When CCP dosage reached 200mg/kg/day, the area of renal pathological damage was decreased by 59.2%, and the levels of serum creatinine and Blood Urea Nitrogen were decreased by 23.9% and 34.7% compared to those of model group. Moreover, it was found that renal oxidative damage, inflammation and fibrosis of adenine-induced CRF mice could also be significantly inhibited by CCP. These results suggested that CCP could improve the kidney functions of adenine-induced CRF mice and the renoprotective effect might be associated with its antioxidant, anti-inflammatory and anti-fibrosis activities.
Christopher M Oconnor - One of the best experts on this subject based on the ideXlab platform.
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Blood Urea Nitrogen to creatinine ratio in the general population and in patients with acute heart failure
Heart, 2017Co-Authors: Yuya Matsue, Christopher M Oconnor, Peter Van Der Meer, Kevin Damman, Marco Metra, Piotr Ponikowski, John R Teerlink, Gad Cotter, Beth A Davison, John G F ClelandAbstract:Objective The Blood Urea Nitrogen-to-creatinine (BUN/creatinine) ratio has been proposed as a useful parameter in acute heart failure (AHF), but data on the normal range and the added value of the ratio compared with its separate components in patients with AHF are lacking. The aim of this study is to define the normal range of BUN/creatinine ratio and to investigate its clinical significance in patients with AHF. Methods In 4484 subjects from the general population without cardiovascular comorbidities, we calculated age-specific and sex-specific normal values of the BUN/creatinine ratio, deriving a higher and lower than normal range of BUN/creatinine ratio (exceeding the 95% prediction intervals). Association of abnormal range to prognosis was tested in 2033 patients with AHF for the outcome of all-cause death through 180 days, death or cardiovascular or renal rehospitalisation through 60 days and heart failure (HF) rehospitalisation within 60 days. Results In a cohort of patients with AHF, 482 (24.6%) and 28 (1.4%) patients with HF were classified into higher and lower than normal range groups, respectively. In Cox regression analysis, higher than normal range of BUN/creatinine ratio group was an independent predictor for all-cause death (HR: 1.86, 95% CI 1.29 to 2.66) and death or cardiovascular or renal rehospitalisation (HR: 1.37, 95% CI 1.03 to 1.82), but not for HF rehospitalisation (HR: 1.23, 95% CI 0.81 to 1.86) after adjustment for other prognostic factors including both creatinine and BUN. Conclusions In patients with AHF, BUN/creatinine higher than age-specific and sex-specific normal range is associated with worse prognosis independently from both creatinine and BUN. Clinical Trials gov identifier NCT00328692 and NCT00354458
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nesiritide renal function and associated outcomes during hospitalization for acute decompensated heart failure
Circulation, 2014Co-Authors: Vincent M Van Deursen, Christopher M Oconnor, Justin A. Ezekowitz, Robert M. Califf, Stephen S Gottlieb, Amanda Stebbins, Vic Hasselblad, Randall C Starling, Adrian F Hernandez, W Wilson H TangAbstract:Background—Contradictory results have been reported on the effects of nesiritide on renal function in patients with acute decompensated heart failure. We studied the effects of nesiritide on renal function during hospitalization for acute decompensated heart failure and associated outcomes. Methods and Results—A total of 7141 patients were randomized to receive either nesiritide or placebo and creatinine was recorded in 5702 patients at baseline, after infusion, discharge, peak/nadir levels until day 30. Worsening renal function was defined as an increase of serum creatinine >0.3 mg/dL and a change of ≥25%. Median (25th–75th percentile) baseline creatinine was 1.2 (1.0–1.6) mg/dL and median baseline Blood Urea Nitrogen was 25 (18–39) mmol/L. Changes in both serum creatinine and Blood Urea Nitrogen were similar in nesiritide-treated and placebo-treated patients (P=0.20 and P=0.41) from baseline to discharge. In a multivariable model, independent predictors of change from randomization to hospital discharge...
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prognostic value of Blood Urea Nitrogen in patients hospitalized with worsening heart failure insights from the acute and chronic therapeutic impact of a vasopressin antagonist in chronic heart failure activ in chf study
Journal of Cardiac Failure, 2007Co-Authors: Gerasimos Filippatos, Wendy Gattis Stough, John Ouyang, David D Shin, Kirkwood F. Adams, Joseph S. Rossi, Donald M Lloydjones, Christopher M Oconnor, Cesare OrlandiAbstract:Abstract Background Hospitalization for acute decompensated heart failure (ADHF) is associated with a high postdischarge mortality and readmission rate. The association between baseline Blood Urea Nitrogen (BUN) and clinical outcomes in patients admitted for ADHF was evaluated in a post-hoc analysis of the ACTIV in CHF trial. Methods and Results Patients were categorized into quartiles according to baseline BUN. Cox proportional hazards regression was used to test the association between BUN, mortality, and death or readmission within 60 days. Patients in the highest quartile (>40 mg/dL) had the highest 60-day mortality (14.3%, 9.3%, 4.0%, 0%, respectively; P P Conclusions Higher baseline BUN is a powerful predictor of increased postdischarge mortality in patients hospitalized for heart failure, even in the absence of severe renal failure. Even mild to moderate elevations in baseline BUN were predictive. BUN remains an easily accessible risk stratification tool that physicians should closely monitor in the hospital setting.
Peter A Banks - One of the best experts on this subject based on the ideXlab platform.
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admission hematocrit and rise in Blood Urea Nitrogen at 24 h outperform other laboratory markers in predicting persistent organ failure and pancreatic necrosis in acute pancreatitis a post hoc analysis of three large prospective databases
The American Journal of Gastroenterology, 2015Co-Authors: Efstratios Koutroumpakis, Olaf J Bakker, Anwar Dudekula, Vikesh K Singh, Marc G Besselink, Dhiraj Yadav, Hjalmar C Van Santvoort, David C Whitcomb, Hein G Gooszen, Peter A BanksAbstract:Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases
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Blood Urea Nitrogen in the early assessment of acute pancreatitis an international validation study
JAMA Internal Medicine, 2011Co-Authors: Olaf J Bakker, Vikesh K Singh, Marc G Besselink, Hjalmar C Van Santvoort, David C Whitcomb, Hein G Gooszen, Georgios I Papachristou, Kathryn Repas, Venkata Muddana, Peter A BanksAbstract:Background Objective assessment of acute pancreatitis (AP) is critical to help guide resuscitation efforts. Herein we (1) validate serial Blood Urea Nitrogen (BUN) measurement for early prediction of mortality and (2) develop an objective BUN-based approach to early assessment in AP. Methods We performed a secondary analysis of 3 prospective AP cohort studies: Brigham and Women's Hospital (BWH), June 2005 through May 2009; the Dutch Pancreatitis Study Group (DPSG), March 2004 through March 2007; and the University of Pittsburgh Medical Center (UPMC), June 2003 through September 2007. Meta-analysis and stratified multivariate logistic regression adjusted for age, sex, and creatinine levels were calculated to determine risk of mortality associated with elevated BUN level at admission and rise in BUN level at 24 hours. The accuracy of the BUN measurements was determined by area under the receiver operating characteristic curve (AUC) analysis compared with serum creatinine measurement and APACHE II score. A BUN-based assessment algorithm was derived on BWH data and validated on the DPSG and UPMC cohorts. Results A total of 1043 AP cases were included in analysis. In pooled analysis, a BUN level of 20 mg/dL or higher was associated with an odds ratio (OR) of 4.6 (95% confidence interval [CI], 2.5-8.3) for mortality. Any rise in BUN level at 24 hours was associated with an OR of 4.3 (95% CI, 2.3-7.9) for death. Accuracy of serial BUN measurement (AUC, 0.82-0.91) was comparable to that of the APACHE II score (AUC, 0.72-0.92) in each of the cohorts. A BUN-based assessment algorithm identified patients at increased risk for mortality during the initial 24 hours of hospitalization. Conclusions We have confirmed the accuracy of BUN measurement for early prediction of mortality in AP and developed an algorithm that may assist physicians in their early resuscitation efforts.
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early changes in Blood Urea Nitrogen predict mortality in acute pancreatitis
Gastroenterology, 2009Co-Authors: Richard S Johannes, Xiaowu Sun, Darwin L Conwell, Peter A BanksAbstract:BACKGROUND & AIMS: Routine laboratory tests that reflect intravascular volume status can play an important role in the early assessment of acute pancreatitis (AP). The objective of this study was to evaluate accuracy of serial Blood Urea Nitrogen (BUN) versus serial hemoglobin (Hgb) measurement for prediction of in-hospital mortality in AP. METHODS: We performed an observational cohort study on data from 69 US hospitals from January 2003 to December 2006. Repeated measures analysis was used to examine the relationship between early trends in BUN and Hgb with respect to mortality. Multivariate logistic regression was used to evaluate the impact of admission BUN, change in BUN, admission Hgb, and change in Hgb on mortality. Time-specific receiver operating characteristic curves and multivariable logistic regression compared accuracy of BUN, Hgb, and additional routine laboratory tests. RESULTS: BUN levels were persistently higher among nonsurvivors than survivors during the first 48 hours of hospitalization (F‐test; P .0001). No such relationship existed for Hgb (F‐test; P .33). For every 5-mg/dl increase in BUN during the first 24 hours, the age- and gender-adjusted odds ratio for mortality increased by 2.2 (95% confidence limits, 1.8, 2.7). Of the 6 routine laboratory tests examined, BUN yielded the highest area under the concentration‐time curve (AUC) for predicting mortality at admission (AUC 0.79), 24 hours (AUC 0.89), and 48 hours (AUC 0.90). Combining admission BUN and change in BUN at 24 hours produced an AUC of 0.91 for mortality. CONCLUSION: In a large, hospital-based cohort study, we identified serial BUN measurement as the most valuable single routine laboratory test for predicting mortality in AP.
Stephen E Kimmel - One of the best experts on this subject based on the ideXlab platform.
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Blood Urea Nitrogen creatinine ratio identifies a high risk but potentially reversible form of renal dysfunction in patients with decompensated heart failure
Circulation-heart Failure, 2013Co-Authors: Meredith A Brisco, Stephen E Kimmel, Steven G Coca, Jennifer Chen, Anjali T Owens, Brian D Mccauley, Jeffrey M TestaniAbstract:Background—Identifying reversible renal dysfunction (RD) in the setting of heart failure is challenging. The goal of this study was to evaluate whether elevated admission Blood Urea Nitrogen/creatinine ratio (BUN/Cr) could identify decompensated heart failure patients likely to experience improvement in renal function (IRF) with treatment. Methods and Results—Consecutive hospitalizations with a discharge diagnosis of heart failure were reviewed. IRF was defined as ≥20% increase and worsening renal function as ≥20% decrease in estimated glomerular filtration rate. IRF occurred in 31% of the 896 patients meeting eligibility criteria. Higher admission BUN/Cr was associated with in-hospital IRF (odds ratio, 1.5 per 10 increase; 95% confidence interval [CI], 1.3–1.8; P<0.001), an association persisting after adjustment for baseline characteristics (odds ratio, 1.4; 95% CI, 1.1–1.8; P=0.004). However, higher admission BUN/Cr was also associated with post-discharge worsening renal function (odds ratio, 1.4; 95% ...
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interaction between loop diuretic associated mortality and Blood Urea Nitrogen concentration in chronic heart failure
Journal of the American College of Cardiology, 2011Co-Authors: Thomas P Cappola, Colleen M Brensinger, Richard P Shannon, Stephen E KimmelAbstract:Objectives The purpose of this study was to investigate whether a surrogate for renal neurohormonal activation, Blood Urea Nitrogen (BUN), could identify patients destined to experience adverse outcomes associated with the use of high-dose loop diuretics (HDLD). Background Loop diuretics are commonly used to control congestive symptoms in heart failure; however, these agents cause neurohormonal activation and have been associated with worsened survival. Methods Subjects in the BEST (Beta-Blocker Evaluation of Survival Trial) receiving loop diuretics at baseline were analyzed (N = 2,456). The primary outcome was the interaction between BUN- and HDLD-associated mortality. Results In the overall cohort, HDLD use (≥160 mg/day) was associated with increased mortality (hazard ratio [HR]: 1.56; 95% confidence interval [CI]: 1.35 to 1.80). However, after extensively controlling for baseline characteristics, this association did not persist (HR: 1.06; 95% CI: 0.89 to 1.25). In subjects with BUN levels above the median (21.0 mg/dl), both the unadjusted (HR: 1.59; 95% CI: 1.34 to 1.88) and adjusted (HR: 1.29; 95% CI: 1.07 to 1.60) risk of death was higher in the HDLD group. In patients with BUN levels below the median, there was no associated risk with HDLD (HR: 0.99; 95% CI: 0.75 to 1.34) and after controlling for baseline characteristics, the HDLD group had significantly improved survival (HR: 0.71; 95% CI: 0.49 to 0.96) (p interaction = 0.018). Conclusions The risk associated with HDLD use is strongly dependent on BUN concentrations with reduced survival in patients with an elevated BUN level and improved survival in patients with a normal BUN level. These data suggest a role for neurohormonal activation in loop diuretic–associated mortality.