1. Assessment of Proximal Tubular Function by Tubular Maximum Phosphate Reabsorption Capacity in Heart Failure
- Author
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Johanna E. Emmens, Martin H. de Borst, Eva M. Boorsma, Kevin Damman, Gerjan Navis, Dirk J. van Veldhuisen, Kenneth Dickstein, Stefan D. Anker, Chim C. Lang, Gerasimos Filippatos, Marco Metra, Nilesh J. Samani, Piotr Ponikowski, Leong L. Ng, Adriaan A. Voors, Jozine M. ter Maaten, Groningen Institute for Organ Transplantation (GIOT), Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), and Value, Affordability and Sustainability (VALUE)
- Subjects
EXPRESSION ,Male ,PROGNOSIS ,Epidemiology ,PATHOPHYSIOLOGY ,ACUTE KIDNEY INJURY ,DIAGNOSIS ,Kidney ,outcomes ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,Phosphates ,Kidney Tubules, Proximal ,DIURETIC RESISTANCE ,proximal tubule ,renal dysfunction ,80 and over ,Humans ,Aged ,Heart Failure ,EXCRETION ,Transplantation ,urogenital system ,heart failure ,Aged, 80 and over ,Female ,Middle Aged ,Renal Reabsorption ,Proximal ,female genital diseases and pregnancy complications ,DYSFUNCTION ,ISCHEMIA ,COTRANSPORTER ,Kidney Tubules ,Nephrology ,Original Article - Abstract
BACKGROUND AND OBJECTIVES: The estimated glomerular filtration rate (eGFR) is a crucial parameter in heart failure. Much less is known about the importance of tubular function. We addressed the effect of tubular maximum phosphate reabsorption capacity (TmP/GFR), a parameter of proximal tubular function, in patients with heart failure.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We established TmP/GFR (Bijvoet formula) in 2085 patients with heart failure and studied its association with deterioration of kidney function (>25% eGFR decrease from baseline) and plasma neutrophil gelatinase-associated lipocalin (NGAL) doubling (baseline to 9 months) using logistic regression analysis and clinical outcomes using Cox proportional hazards regression. Additionally, we evaluated the effect of sodium-glucose transport protein 2 (SGLT2) inhibition by empagliflozin on tubular maximum phosphate reabsorption capacity in 78 patients with acute heart failure using analysis of covariance.RESULTS: Low TmP/GFR (CONCLUSIONS: TmP/GFR, a measure of proximal tubular function, is frequently reduced in heart failure, especially in patients with more advanced heart failure. Lower TmP/GFR is furthermore associated with future risk of plasma NGAL doubling and worse clinical outcomes, independent of glomerular function.
- Published
- 2022