Renal function and acute heart failure outcome | Medicina Clínica (English Edition)

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BUN, blood urea nitrogen; Cr, creatinine; CysC, cystatin C; AHF, acute heart failure; NGAL, neutrophil gelatinase-associated lipocalin; eGFR, estimated glomerular filtration rate." ] ] ] "textoCompleto" => "IntroductionHeart failure is a clinical syndrome whose prevalence reaches more than 10% in people over 70 years of age in developed countries.<a class="elsevierStyleCrossRef" href="#bib0305">1</a> In Spain, AHF is the leading cause of hospitalization in adults over 65 years of age, represents more than 100,000 hospital admissions per year and is a turning point in the prognosis of heart failure, with approximately a 30% mortality rate within a year following a decompensation event.<a class="elsevierStyleCrossRef" href="#bib0310">2</a>Acute heart failure (AHF) affects other organs too, therefore its approach is predominantly multidisciplinary, involving different health system levels.<a class="elsevierStyleCrossRefs" href="#bib0315">3,4</a> Despite efforts to find therapies that modify the natural evolution of AHF, its prognosis has remained essentially unchanged during the last decades<a class="elsevierStyleCrossRefs" href="#bib0325">5,6</a> and the different clinical trials have failed to provide new drugs for its treatment.<a class="elsevierStyleCrossRef" href="#bib0335">7</a> For this reason, Spain has recently developed different proposals to improve pre-hospitalization care,<a class="elsevierStyleCrossRefs" href="#bib0340">8–10</a> to assess the fragility that patients often associate with AHF,<a class="elsevierStyleCrossRefs" href="#bib0355">11,12</a> to identify precipitating decompensation factors<a class="elsevierStyleCrossRefs" href="#bib0365">13,14</a> or to improve decision-making regarding admission or discharge<a class="elsevierStyleCrossRefs" href="#bib0375">15–17</a>; and specialized care circuits have been designed for the early stages of decompensation or follow-up after the initial treatment,<a class="elsevierStyleCrossRefs" href="#bib0390">18,19</a> all with the purpose of improving the prognosis of these patients. In this sense, and with the aim of helping decision-making in patients with AHF, various variables and predictive models have been studied.<a class="elsevierStyleCrossRef" href="#bib0400">20</a>Renal function and its worsening has the most relevant association with a poor prognosis and its prevalence in heart failure is high, as shown by the results of a meta-analysis in which 53% of patients with AHF had chronic kidney disease (CKD) and whose coexistence was associated with higher mortality (OR 2.35, 95% CI: 2.25–2.54, p<0.001).<a class="elsevierStyleCrossRef" href="#bib0405">21</a> In the EAHFE registry, with data on 5845 patients treated due to AHF in the Spanish hospital emergency services, 22.3% had CKD, defined as having a serum creatinine >2mg/dl and, during the acute event, an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 was observed in 57% of patients, an eGFR <30ml/min/1.73m2 in 14% of patients and an eGFR <15ml/min/1.73m2 in 5% of patients.<a class="elsevierStyleCrossRef" href="#bib0320">4</a>The pathophysiological relationship that is established between the heart and the kidney is complex. The definition of cardiorenal syndrome, initially classified into 5 categories and then extended to 7, aims to clarify this complexity. Within this cardiorenal syndrome classification, cases of AHF with worsening renal function (WRF) are classified as type 1 or hemodynamic,<a class="elsevierStyleCrossRef" href="#bib0410">22</a> but the concept of WRF defined by the European Society of Cardiology continues to be used as an increase in serum creatinine ≥0.3mg/dl or 25%, or a decrease in eGFR of 20%, compared to baseline.<a class="elsevierStyleCrossRef" href="#bib0305">1</a> It is also difficult to know how to assess renal function in patients with AHF, essentially due to the variety of methods of doing so.<a class="elsevierStyleCrossRef" href="#bib0415">23</a>With the aim of analysing published studies that investigate the relationship between different ways of assessing renal function and relating their abnormalities with prognosis in patients with AHF, the following systematic review has been carried out.Method of review and selection of articlesA literature search was conducted between May 2016 and December 2017, in the Pubmed and Web of Science databases. The search criteria that were used are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. We selected papers written in Spanish, English, French or German, that had a summary and that evaluated the prognostic role of any renal function variable in AHF in non-selected samples of patients. We discarded review articles, communications to conferences, clinical trials (considering them selected samples) and studies with specialized unit samples or less than 200 patients. The cross references were checked to verify that the inclusion of any relevant work was not omitted from the papers selected.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The review process identified 33 papers that met the inclusion criteria, 29 coming directly from the search strategy and 4 from the cross-references review. The authors agreed to limit the analysis to laboratory parameters, and it was ruled out to analyze other variables that influenced the progression and prognosis of renal function, such as, for example, loop diuretic therapy. The variables analyzed in the different studies have been grouped according to the parameter considered and analyzed: 1) serum creatinine, 2) BUN or BUN/creatinine ratio, 3) CKD, 4) formula for calculating eGFR, 5) acute kidney injury (AKI) and 6) new markers of kidney damage. Given that no meta-analysis was planned to aggregate the results of the different studies, a homogeneous definition of these parameters was not required. On the other hand, the particularities referring to the definition of each parameter are discussed in the text corresponding to the discussion of each of them.ResultsSerum creatinineSerum creatinine has been used for decades as a marker of kidney function. It is a protein that comes from the skeletal muscles and is filtered almost exclusively in the glomerulus. Given this origin, there will be variations depending on age and sex. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the studies that analyze the prognostic significance of serum creatinine in AHF.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>WRF refers to a serum creatinine variation ≥0.3 or 0.5mg/dl, or the increase ≥25% of creatinine, but it is not a parameter for which there is a homogeneous definition.<a class="elsevierStyleCrossRef" href="#bib0420">24</a> WRF is described as a variable in which various physiopathological mechanisms intervene, such as neurohormonal activation, decreased renal perfusion, the presence of renal venous congestion, the use of drugs with renal involvement and the presence of CKD, and globally its presence is related to an increased risk of death or rehospitalization. In a retrospective cohort study of 646 patients admitted for AHF, the WRF during the first 7 days of admission was associated with higher mortality or readmission (HR 1.24, 95% CI: 1.06–1.45, p=0.0059).<a class="elsevierStyleCrossRef" href="#bib0425">25</a> These results coincide with another study that analyzed data from an administrative base of 14,017 patients admitted for AHF, of which 5035 (35.9%) had an WRF during hospitalization (42.7% persistent, 37.5% persistent but of unknown duration and 19.8% transient). Hospital re-admission at 30 days was higher in all groups with RR 1.29 (95% CI: 1.17–1.42); RR 1.12 (95% CI: 1.01–1.26) and RR 1.14 (95% CI: 1.01–1.31), respectively.<a class="elsevierStyleCrossRef" href="#bib0430">26</a> The ADHERE registry describes a 20.3% persistent WRF and 11.7% transient WRF, with an HR of 1.73 (95% CI: 1.57–1.91) and 1.19 (95% CI: 1.05–1.35), respectively, for mortality 90 days after discharge. In this study, the presence of previous CKD was related to more persistent WRF and mortality at 90 days.<a class="elsevierStyleCrossRef" href="#bib0435">27</a>In the absence of congestion, it is suggested that WRF could have no prognostic value and that it could be due to a diuretic or ACEI therapy.<a class="elsevierStyleCrossRef" href="#bib0440">28</a> On the other hand, persistent congestion along with an WRF would be indicative of poor progression.<a class="elsevierStyleCrossRef" href="#bib0445">29</a> On the other hand, whether an improvement in renal function could have a prognostic significance has also been raised and similar conclusions have been reached. Up to 31.4% of 903 patients hospitalized for AHF showed an improvement in renal function during hospitalization but showed a higher mortality with congestion and diuretic resistance (HR 1.3, 95% CI: 1.1–1.7; p=0.011).<a class="elsevierStyleCrossRef" href="#bib0450">30</a>Urea nitrogen and urea nitrogen/creatinine ratioBlood urea nitrogen (BUN) and creatinine are products of the metabolism of nitrogen compounds. Its prognostic value has been described due to its association with the activation of the neurohormonal and the renin–angiotensin–aldosterone axis, a phenomenon related to congestion that characterizes AHF. In this context, it has been suggested that there is an expansion of intravascular volume as a compensation mechanism, so that the amount of urea excreted is disproportionately reduced compared to the glomerular filtration, which results in a BUN/creatinine ratio increase. The results of the studies analyzed are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>When the 1-year mortality of a total of 610 patients with AHF was analyzed, age and BUN were identified as the best independent predictors of mortality, and 3 risk groups were created: high risk (BUN >27.5mg/dl and age >86 years), intermediate risk (BUN >27.5mg/dl and age ≤86 years) and low risk (BUN ≤27.5mg/dl); in the groups of more risk there were more cases with CKD.<a class="elsevierStyleCrossRef" href="#bib0455">31</a> Baseline BUN increase is related to more in-hospital mortality and is interpreted as the expression of an intrinsically abnormal renal function or of a potentially reversible vasomotor nephropathy, both of which are secondary to hemodynamic and neurohormonal abnormalities typical of AHF.<a class="elsevierStyleCrossRef" href="#bib0460">32</a> The analysis of the ADHERE registry concludes that the eGFR and the BUN provide complementary information. Both mortality and hospital stay were associated with the degree of renal dysfunction and the increase of BUN, and the latter was the most potent predictor of in-hospital death.<a class="elsevierStyleCrossRef" href="#bib0465">33</a> In the presence of AKI along with a high BUN/creatinine ratio (but not BUN or creatinine on their own) there is an increased risk of mortality, indicating that stratifying the risk of AKI is useful.<a class="elsevierStyleCrossRef" href="#bib0470">34</a> In addition, the existence of a high BUN/creatinine ratio associated with a transient improved renal function during admission was associated with higher mortality.<a class="elsevierStyleCrossRef" href="#bib0475">35</a>In the presence of renal dysfunction, BUN/creatinine has also been proposed as a discriminating variable in relation to greater diuretic resistance and worse survival.<a class="elsevierStyleCrossRef" href="#bib0480">36</a> One of the most important predictors for BUN increase is systolic blood pressure, reason why it is suggested that caution should be exercised regarding a decrease in blood pressure. On the other hand, it seems that beta-blocker treatment could prevent the increase of BUN, by blocking the sympathetic nervous system, so its early initiation during AHF is recommended.<a class="elsevierStyleCrossRef" href="#bib0485">37</a>Chronic kidney diseaseAnother aspect to consider is the time of onset of renal dysfunction, that is, evaluating whether the patient who has AHF decompensation already has established CKD. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows an already established CKD as a risk variable for AHF. The Italian registry IN-HF Outcome studied the group of patients with CKD, specifically with an eGFR <40ml/min/1.73m2 and found that the predictors of in-hospital mortality in this group were: altered level of consciousness, advanced age, hyponatremia, systolic blood pressure and baseline eGFR. In 1-year mortality, the same predictors were maintained, except eGFR.<a class="elsevierStyleCrossRef" href="#bib0490">38</a> In this analysis, the authors describe the paradox of diabetes, in which the presence of its association with CKD was associated with a lower 1-year mortality. However, they acknowledge that it may be due to a selection bias or the size of the sample. Miguel-Yanes et al.,<a class="elsevierStyleCrossRef" href="#bib0495">39</a> based on the analysis of the Spanish minimum basic data set, corroborated that the established renal disease is associated with higher in-hospital mortality, but there was no apparent relationship with the presence of diabetic nephropathy. CKD and a worsening of it during an AHF admission are also related to worse prognosis,<a class="elsevierStyleCrossRef" href="#bib0500">40</a> as shown by the analysis of the ATTEND registry. In-hospital mortality associated with renal dysfunction was similar in all groups but was independent of the presence of signs of renal congestion or hypoperfusion.<a class="elsevierStyleCrossRef" href="#bib0505">41</a><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Formula for calculating the estimated glomerular filtration rateRenal function is defined from the calculation of eGFR, which is estimated with the clearance of serum creatinine using different formulas, mostly MDRD and CKD-EPI.<a class="elsevierStyleCrossRef" href="#bib0510">42</a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows 2 studies that have investigated which would be the most suitable formula to assess the prognosis. The MDRD-4 and CKD-EPI formulas were evaluated from the RICA registry regarding patients admitted for AHF in Internal Medicine. More patients with baseline renal dysfunction were identified with the CKD-EPI formula. The only difference between the two formulas was that in patients with preserved ejection fraction, CKD-EPI predicted mortality more accurately.<a class="elsevierStyleCrossRef" href="#bib0515">43</a> In another study that evaluates up to 5 formulas for calculating eGFR, this was a predictor of mortality for all of them: the most accurate was that of Cockroft-Gault, which includes the weight of the patient.<a class="elsevierStyleCrossRef" href="#bib0520">44</a> In obese patients, this formula calculates a greater eGFR than the rest of the formulas for a specific creatinine, which could explain the so-called paradox of obesity in the estimation of the risk of death in AHF.<a class="elsevierStyleCrossRef" href="#bib0525">45</a> That is, a higher weight is associated with lower mortality, given the lower estimated renal dysfunction. Finally, as discussed below, it is important to mention that the addition of cystatin C to the CKD-EPI formula improves its prognostic ability.Criteria for acute kidney injuryThe NICE criteria recommend defining the magnitude of renal involvement in dynamic terms.<a class="elsevierStyleCrossRef" href="#bib0530">46</a> This would be the objective of the term AKI and for its definition different criteria have been published (RIFLE, AKIN and KDIGO) which are the ones that have been used a posteriori to evaluate its prognostic meaning.<a class="elsevierStyleCrossRef" href="#bib0415">23</a><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarizes the studies that explore the different AKI criteria. In all of them, the classification is based on the variation of serum creatinine and the volume of diuresis. It seems that the KDIGO criteria may be superior for predicting short-term results, although it is an Asian population study.<a class="elsevierStyleCrossRef" href="#bib0535">47</a> The same authors add that we must bear in mind that the RIFLE criteria were derived and validated in very selected populations. When AKI criteria are compared as an alternative to WRF, defined by the increase in serum creatinine ≥0.3mg/dl, these better identify the severe stages that are associated with adverse events (re-admission due to AHF, use of renal replacement therapy or death from all causes) at 30 days and a year.<a class="elsevierStyleCrossRef" href="#bib0540">48</a> Finally, it should be noted that prediction scores for the occurrence of AKI have been designed, in which prior CKD and the use of diuretics during AHF are particularly relevant.<a class="elsevierStyleCrossRefs" href="#bib0545">49–52</a><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>New kidney injury biomarkersIn recent years, different biomarkers have been described and researched with the aim of detecting AKI earlier, prior to the variation of creatinine or eGFR. Among these new biomarkers are neutrophil gelatinase-associated lipocalin (NGAL) and Cystatin C.<a class="elsevierStyleCrossRef" href="#bib0565">53</a><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows several new kidney injury biomarkers.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>Plasma NGAL is a protein from the renal tubule. The AKINESIS study was designed with the assumption that the increase in serum creatinine in the context of AHF might not reflect a true AKI and, therefore, would not have a prognostic value in all cases. Their results demonstrate that plasma NGAL is not superior to creatinine in terms of predicting worsening renal function or adverse in-hospital outcomes.<a class="elsevierStyleCrossRef" href="#bib0570">54</a> NGAL can also be determined in urine and, in this case, it could be more useful. Its increase at admission or at 12–24h of treatment is associated with a WRF at 5 days, defined according to the RIFLE criteria, or by a variation in serum creatinine ≥0.3mg/dl. This increase in urine NGAL is also associated with more adverse events at 30 days. For all these reasons, the authors postulate that treatment should be individualized in patients with AHF and renal dysfunction, especially in the first 12–24h.<a class="elsevierStyleCrossRef" href="#bib0575">55</a>The use of cystatin C in the CKD-EPI formula in a Spanish cohort of 613 patients with AHF increases the predictive accuracy to independently detect death from any cause or re-admission for AHF.<a class="elsevierStyleCrossRef" href="#bib0580">56</a> The same research group compares the CKD-EPI formulas, with or without cystatin C, and MDRD and concludes that the use of cystatin C can more accurately predict the risk of adverse events, especially in patients with relatively preserved renal function.<a class="elsevierStyleCrossRef" href="#bib0585">57</a> This finding is similar to that of Breidthardt et al.,<a class="elsevierStyleCrossRef" href="#bib0590">58</a> taking into account that cystatin C did not predict AKI, but long-term mortality. Even in patients with normal creatinine, increased cystatin C was predictive of death from any cause at 1 year and, consequently, its usefulness would extend beyond the first hours or days after the acute event.<a class="elsevierStyleCrossRef" href="#bib0595">59</a>The carbohydrate antigen 125 (CA125) has been evaluated as a marker of systemic congestion and may be helpful for the titration of diuretics. In order to develop a tool for the titration of diuretics and based on the idea that the benefit of diuretics would depend on the renal status on admission and the degree of congestion, a study of 526 consecutive patients admitted for AHF, who received intravenous furosemide in the first 48h, was carried out. The study evaluated whether the early changes in creatinine associated with furosemide differed between the groups defined by volume overload with a CA125 >35U/ml and a creatinine ≥1.4mg/dl on admission. The results of the study show that the effect of furosemide differed according to the concentration of CA125.<a class="elsevierStyleCrossRef" href="#bib0600">60</a>ConclusionAs a conclusion of our review we can say that renal dysfunction in the context of AHF, defined from the variations in creatinine, eGFR or AKI criteria, is a variable associated with a worse prognosis, especially when it is associated with congestion, a phenomenon that can be explained by neurohormonal activation and confirmed by an increase in the BUN/creatinine ratio. In addition to predisposing to a worsening of multifactorial origin, a previous CKD could also predict a group with worse prognosis. Other new biomarkers, such as those that identify tubular damage or congestion, have been able to increase the discriminative capacity of predictive models for AHF, but they are still of limited use in routine clinical practice, awaiting studies with more conclusive results. It would probably be necessary to define the renal dysfunction profile so as to determine whether it is actually an established renal injury, due to a specific treatment, or a transitory phenomenon related to volume overload.Conflict of interestsThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1099628" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1040819" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1099629" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1040818" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Method of review and selection of articles" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Serum creatinine" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Urea nitrogen and urea nitrogen/creatinine ratio" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Chronic kidney disease" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Formula for calculating the estimated glomerular filtration rate" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Criteria for acute kidney injury" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "New kidney injury biomarkers" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-26" "fechaAceptado" => "2018-05-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1040819" "palabras" => array:4 [ 0 => "Renal function" 1 => "Acute heart failure" 2 => "Outcome" 3 => "Systematic review" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1040818" "palabras" => array:4 [ 0 => "Función renal" 1 => "Insuficiencia cardiaca aguda" 2 => "Pronóstico" 3 => "Revisión sistemática" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The interaction between acute heart failure (AHF) and renal dysfunction is complex. Several studies have evaluated the prognostic value of this syndrome. The aim of this systematic review, which includes non-selected samples, was to investigate the impact of different renal function variables on the AHF prognosis. The categories included in the studies reviewed included: creatinine, blood urea nitrogen (BUN), the BUN/creatinine quotient, chronic kidney disease, the formula to estimate the glomerular filtration rate, criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin (NGAL and cystatin c). The basal alterations of the renal function, as well as the acute alterations, transient or not, are related to a worse prognosis in AHF, it is therefore necessary to always have baseline, acute and evolutive renal function parameters." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La insuficiencia cardiaca aguda (ICA) y la disfunción renal son 2entidades para cuya compleja interacción se ha explorado su valor pronóstico. El objetivo de esta revisión sistemática de trabajos, que parte de muestras no seleccionadas, fue investigar el impacto que tienen diversas variables de función renal sobre el pronóstico de la ICA. La creatinina, el nitrógeno ureico (BUN), el cociente BUN/creatinina, la enfermedad renal crónica, la fórmula para estimar la tasa de filtrado glomerular, los criterios de lesión renal aguda y los nuevos biomarcadores de daño renal (NGAL y la cistatina C) son las categorías en que se han incluido los trabajos revisados. Las alteraciones basales, así como las alteraciones agudas, transitorias o no, de la función renal se relacionan con un peor pronóstico en la ICA. Es, por lo tanto, necesario tener siempre parámetros de función renal basales, del episodio agudo y evolutivos." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Llauger L, Jacob J, Miró Ò. Función renal y pronóstico de los episodios de insuficiencia cardiaca aguda. Med Clin (Barc). 2018. <a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="https://doi.org/10.1016/j.medcli.2018.05.010">https://doi.org/10.1016/j.medcli.2018.05.010</a>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2148 "Ancho" => 3167 "Tamanyo" => 414587 ] ] "descripcion" => array:1 [ "en" => "Search strategy. BUN, blood urea nitrogen; Cr, creatinine; CysC, cystatin C; AHF, acute heart failure; NGAL, neutrophil gelatinase-associated lipocalin; eGFR, estimated glomerular filtration rate." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "WRF, worsening renal function; CKD, chronic kidney disease; AHF, acute heart failure; AKI, acute kidney injury; IRF, improved renal function; NYHA, New York Heart Association." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results RR, OR, HR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metra et al.<a class="elsevierStyleCrossRef" href="#bib0420">24</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2003–2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">318 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">WRF incidence, prognostic value at one-year, clinical characteristics and risk factors in AHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 1.47 (1.13–1.81, p=0.024) for WRF and death or re-admission. OR 1.84 (1.04–3.27; p<0.0001) in CKD, OR 2.18 (1.27–3.73; p=0.004) if furosemide, OR 2.07 (1.24–3.45; p=0.005) in NYHA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">WRF in absolute (≥0.3mg/dl) and relative (≥25%) value predicted death and re-admission. The predictors of WRF were CKD, furosemide and NYHA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Berra et al.<a class="elsevierStyleCrossRef" href="#bib0425">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Switzerland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">646 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prognostic value of WRF in patients admitted for AHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 1.29 (1.13–1.47; p=0.0002) for AKI. HR 1.24 (1.06–1.45; p=0.0059) for WRF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AKI and WRF were those most related to mortality and re-admission \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Freda et al.<a class="elsevierStyleCrossRef" href="#bib0430">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2008–2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts (Cerner Health Facts) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14,017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To describe the incidence and results at discharge of persistent or transient AKI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1.29 (1.17–1.42) for persistent AKI, RR 1.14 (1.00–1.31) transient AKI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Both transient and persistent AKI represent a greater risk of re-admission at 30 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Krishnamoorthy et al.<a class="elsevierStyleCrossRef" href="#bib0435">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2001–2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts (ADHERE registry) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (>300) linked to Medicare \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27,309 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To describe the prevalence and characteristics of patients with transient or persistent WRF and compare results at 90 days, non-WRF, transient or persistent WRF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 1.19 (1.05–1.35) for transient WRF. HR 1.73 (1.57–1.91) for persistent WRF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Transient or persistent WRF have been associated with poorer outcomes, especially in persistent cases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metra et al.<a class="elsevierStyleCrossRef" href="#bib0440">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2005–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">599 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Evaluate WRF interaction and congestion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 2.44 (1.24–4.18) for mortality. HR 1.39 (0.88–2.2) for mortality and readmission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">WRF predicts the prognosis of death or readmission in patients with congestion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wattad et al.<a class="elsevierStyleCrossRef" href="#bib0445">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2008–2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Israel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">762 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persistent WRF and congestion could be associated with worse prognosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 4.16 (2.20–7.86) in WRF with persistent congestion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Persistent WRF and congestion were associated with higher mortality \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Testani et al.<a class="elsevierStyleCrossRef" href="#bib0450">30</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2004–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">903 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To describe the MFR and risk of death associated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 4.2 (2.6–6.7) in previous WRF and OR 1.8 (1.2–2.7) in post-admission WRF. HR 1.3 in IRF and death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline congestion and volume of diuresis were associated with pre/post-admission IRF and WRF. IRF was associated with a higher risk of death and, on discharge, a greater worsening in eGFR. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880622.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Studies that analyze the prognostic significance of serum creatinine in acute heart failure." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BNP, brain natriuretic peptide; BUN, blood urea nitrogen; Cr, creatinine; RD, renal dysfunction; AHF, acute heart failure; IH, in-hospital; HR, heart rate; AKI, acute kidney injury; IRF, improved renal function; SBP, systolic blood pressure; eGFR, estimated glomerular filtration rate." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results RR, OR, HR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arenja et al.<a class="elsevierStyleCrossRef" href="#bib0455">31</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2001–2002 2006–2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Switzerland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">610 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Utility of a simple algorithm in non-selected AHF, in relation to 1-year mortality \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 2 (1.7–2.4) for death in high BUN and advanced age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BUN was the best predictor of death at 1-year. The highest risk groups had the highest BUN (>27.5mg/dl) and the highest age (>86 years) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chioncel et al.<a class="elsevierStyleCrossRef" href="#bib0460">32</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2008–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Romania \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts (RO-AHFS registry) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3224 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Epidemiology, symptoms, management and progression of patients with AHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 0.488 (1.002–1.015) in baseline renal dysfunction (BUN) and death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline BUN was a predictor of IH death from any cause \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heywood et al.<a class="elsevierStyleCrossRef" href="#bib0465">33</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2001–2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts (ADHERE registry) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (280) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">118,465 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevalence and severity of renal dysfunction on admission, the relationship with treatments and in-hospital outcomes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 1.18 (1.17–1.20) if decrease of 10ml/min/1.73m2 in GFR. As an isolated predictor, statistical C 0.70 in BUN and IH death Model with 4 variables, statistical C 0.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline eGFR was an independent predictor of IH death, but the best was BUN. The best predictive model consisted of BUN, SBP, HR and age \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Takaya et al.<a class="elsevierStyleCrossRef" href="#bib0470">34</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Japan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">371 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BUN/Cr ratio or BUN or Cr for mortality risk in AKI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 4.71 (2.25–10.2) for AKI with high BUN/Cr. HR 4.26 (1.99–9.76) AKI and high BUN. HR 4.15 (1.90–9.81) and high Cr \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AKI with a high BUN/Cr ratio was associated with a higher mortality. AKI, independently of BUN or Cr, was associated with a higher mortality. BUN/Cr could be useful to stratify the risk in AKI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brisco et al.<a class="elsevierStyleCrossRef" href="#bib0475">35</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2004–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">896 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To determine if a high BUN/Cr can identify the reversible RD. To validate that RD associated with increased BUN/Cr is associated with a worse prognosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 1.5 (1.3–1.8) for high BUN/Cr and IRF. HR 2.2 (1.6–3.1) for mortality if high BUN/Cr and eGFR <45ml/min/1.73m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A high BUN/Cr allows identifying the group with IRF, but it seems to be a transient phenomenon, associated with higher mortality \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Testani et al.<a class="elsevierStyleCrossRef" href="#bib0480">36</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2004–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">908 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To determine if the combination BNP and BUN/Cr allows to identify the group of higher/lower risk with RD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 1.8 (1.2–2.7) worse survival \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The risk of death of RD in AHF can be stratified from BUN/Cr and BNP \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Miura et al.<a class="elsevierStyleCrossRef" href="#bib0485">37</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Japan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts (Tohoku Acute Heart Failure registry) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">337 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Evaluation of changes in BUN as a prognostic factor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 2.94 (1.51–5.73) for mortality from any cause if high BUN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increases in BUN during hospitalization represent a worse prognosis, independently of the calculation of renal function based on Cr at admission \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880623.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Studies analysing the prognostic significance of blood urea nitrogen (BUN) and the BUN/creatinine ratio." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; Cr, Creatinine; DM, diabetes mellitus; WRF, worsening renal function; CKD, chronic kidney disease; AHF, acute heart failure; IH, in-hospital; MDRD, Modification of Diet in Renal Disease Study; IRF, improved renal function; SBP, systolic blood pressure; eGFR, estimated glomerular filtration rate." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results RR, OR, HR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cioffi et al.<a class="elsevierStyleCrossRef" href="#bib0490">38</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2009–2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts (IN-HF Outcome record) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">455 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Clinical characteristics and prognostic markers of short and medium-term mortality in severe renal dysfunction (eGFR <40ml/min/1.73m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A 13.6% IH death and 43.5% 1-year death if severe renal dysfunction, OR 0.95 (0.919–9.83) for eGFR and IH death, in this group of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The in-hospital mortality and at 1-year in patients with severe renal dysfunction was double. The variables related to IH death were low level of consciousness, age, SBP, hyponatremia and eGFR \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">De Miguel-Yanes et al.<a class="elsevierStyleCrossRef" href="#bib0495">39</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006–2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Minimum basic data set \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (all hospitals) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">275,176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To assess the possible interaction of DM CKD in the mortality of AHF admissions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 1.01 (0.91–1.10) in CKD and DM, OR 1.46 (1.39–1.53) for CKD and IH death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CKD was associated with higher in-hospital mortality, without being clearly related to DM \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reid et al.<a class="elsevierStyleCrossRef" href="#bib0500">40</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2009–2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Canada \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">952 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Meaning of WRF/IRF according to GFR <45 on admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Survival 13.9 months (8–25) if WRF and 32.5 months (19–56) if IRF, in GFR <45ml/min/1.73m2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Changes in renal function were only significant if baseline worsening (GFR <45ml/min/1.73m2), with greater survival if there was IRF \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inohara et al.<a class="elsevierStyleCrossRef" href="#bib0505">41</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2007–2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Japan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts (ATTEND registry) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4321 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Differences in the prognostic impact of renal dysfunction in IH mortality, according to low perfusion profiles versus kidney congestion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 2.36 (1.75–3.18) for baseline renal dysfunction and IH death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline renal dysfunction, independently of the mechanism, was associated with higher in-hospital mortality \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Closed et al.<a class="elsevierStyleCrossRef" href="#bib0515">43</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2008–2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RICA Cohort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1805 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CKD-EPI versus MDRD, and prediction of risk of death in AHF with or without ventricular dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 1.55 (1.23–1.94) if eGFR 30–60ml/min/1.73m2, HR 2.31 (1.71–3.10) if eGFR <30ml/min/1.73m2 for MDRD-4. HR 1.58 (1.24–2.01) if eGFR 30–60ml/min/1.73m2, HR 2.34 (1.75–3.01) if eGFR <30ml/min/1.73m2 for CKD-EPI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">eGFR with both formulas was associated with higher 1-year mortality if renal dysfunction \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weidmann et al.<a class="elsevierStyleCrossRef" href="#bib0520">44</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">International \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">eGFR with the Cockroft-Gault formula, predicts post-discharge outcomes better than MDRD-4, MDRD-6, CKD-EPI/BIS-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Death and eGFR 30–60ml/min/1.73m2 HR 1.44 (0.66–2.80) C-G HR 1.26 (0.84,188) MDRD-4 HR 2.23 (1.60–3.10) MDRD-6 HR 1.02 (0.52–2.02) CKD-EPI/BIS-1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">EGFR was an independent predictor of mortality with any formula \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880621.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Established chronic kidney disease and formula for calculating the estimated glomerular filtration rate (eGFR)." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Cr, creatinine; DM2, type 2 diabetes mellitus; WRF, worsening renal function; CKD, chronic kidney disease; AHF, acute heart failure; IH, in-hospital; AKI, acute kidney injury; SBP, systolic blood pressure; eGFR, estimated glomerular filtration rate." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RR, OR, HR (95% CI) results \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Li et al.<a class="elsevierStyleCrossRef" href="#bib0535">47</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2008–2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Japan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To determine if the KDIGO criteria for identifying and predicting short-term CRS type 1 were superior to the RIFLE or AKIN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RIFLE OR 2.56 (1.79–3.65); AKIN OR 2.68 (1.86–3.84); KDIGO 3.22 (2.24–4.62); subgroup only identified by KDIGO OR 3.24 (1.97–5.35) for IH death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AKI was associated with higher mortality. The new KDIGO criteria were superior in predicting short-term results in CRS type 1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Roy et al.<a class="elsevierStyleCrossRef" href="#bib0540">48</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2002–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ireland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">637 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Epidemiology of AKI using new definitions, in addition to examining the association between severity and main clinical outcomes at 30 days and a year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Risk of adverse events in stage 2 AKI was 4times higher, RIFLE OR 17.7 (8.1–38.4); KDIGO OR 19.4 (7.6–48.6); AKIN OR 17.6 (7–44.1) than stage 2 AKI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">AKI with any definition was associated with an increase in risk at 30 days and a year. Few differences were observed in the direct criteria comparison \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Forman et al.<a class="elsevierStyleCrossRef" href="#bib0545">49</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1997–1998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To determine the prevalence of WRF in AHF admissions, predictive factors for WRF and in-hospital outcomes associated with WRF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 7.5 (2.9–19.3) for death, RR 2.1 (1.5–3) for IH complications, RR 3.2 (2.2–4.9) for stays >10 days, in patients with WRF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">WRF risk factors: heart failure, DM2, admission Cr, SBP >160mmHg. WRF was associated with increased IH death, IH complications, stay > 10 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breidthardt et al.<a class="elsevierStyleCrossRef" href="#bib0550">50</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2001–2002 2006–2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Switzerland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">657 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Prevalence and WRF effect on survival. To establish a risk score for WRF and validate the Forman score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HR 1.92 (1.29–2.59) for WRF and death. Previous CKD was related to WRF, HR 2.07 (1.29–3.30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CKD was the only independent predictor of WRF. Mortality was related to eGFR, and WRF strengthened this effect \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wang et al.<a class="elsevierStyleCrossRef" href="#bib0555">51</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2004–2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1709 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Design and validate a score of prediction of AKI in AHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR 3.11 (2.23–4.35) for baseline Cr >1.2mg/dl, OR 1.96 (1.16, 3.30) for furosemide >80mg/day and OR 2.09 (1.31, 3.33) if re-examination, in the prediction of AKI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Baseline Cr >1.2mg/dl, furosemide >80mg/day and re-examination were predictors of AKI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhou et al.<a class="elsevierStyleCrossRef" href="#bib0560">52</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2011–2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">676 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To develop and validate a risk score for AKI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CKD, OR 4.15 (2.36–7.28) to predict AKI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Previous CKD was included in the score \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880624.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Criteria for acute kidney injury." ] ] 5 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CA 125, carbohydrate antigen 125; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; Cr, creatinine; CysC, cystatin C; WRF, worsening renal function; FD, furosemide; AHF, acute heart failure; IH, in-hospital; AKI, acute kidney injury; MDRD, Modification of Diet in Renal Disease Study; eGFR, estimated glomerular filtration rate; u, urinary." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample (n) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results RR, OR, HR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maisel et al.<a class="elsevierStyleCrossRef" href="#bib0570">54</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2010–2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multinational \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">927 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NGAL prognostic ability to predict WRF or need for renal replacement therapy. NGAL prognostic ability for adverse IH outcomes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Peak NGAL ROC 0.656, baseline ROC 0.647, baseline Cr ROC 0.652 and WRF For adverse events baseline NGAL ROC 0.691, peak ROC 0.653, first Cr 0.686 and adverse events \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NGAL was not superior to Cr to predict WRF or adverse IH events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Collins et al.<a class="elsevierStyleCrossRef" href="#bib0575">55</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2008–2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">399 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Urine NGAL would be associated with WRF and worse prognosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NGAL (u) OR 1.02 (1.01–1.04) for WRF predictor. There are 42 cases with adverse events at 30 days versus 25, NGAL at 12–24h, p<0.035 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NGAL (u) at 12–24h was a predictor of WRF and adverse events at 30 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Flores-Blanco et al.<a class="elsevierStyleCrossRef" href="#bib0580">56</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">613 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To assess whether the CKD-EPI formula based on the Cys-C provides additional information \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CKD-EPI SCr-CysC HR 0.998 (0.983–0.994) for death or re-admission for AHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">The CKD-EPI formula based on Cys-C to estimate eGFR is an independent predictor of adverse outcomes in AHF \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Manzano-Fernández et al.<a class="elsevierStyleCrossRef" href="#bib0585">57</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2006–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">526 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To evaluate whether CKD-EPI based on Cr or CysC predicts the risk of adverse events better than MDRD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CKD-EPI Cr-CysC HR 0.984 (0.979–0.989) and MDRD HR 0.991 (0.986–0.985) in death or re-admission, but in Kapplan-Meier curves log rank test p<0.001 with formulas that include CysC vs. p=0.374 in CKD-EPI only with Cr \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">eGFR was a predictor of mortality and re-admission, independently of the formula, but this was improved by incorporating formulas based on CysC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breidthardt et al.<a class="elsevierStyleCrossRef" href="#bib0590">58</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Switzerland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">207 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To examine the diagnostic and prognostic importance of plasma CysC levels in relation to serum Cr levels in AHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ROC curve for AKI with Cr was 0.68 (0.58–0.78) and with CysC 0.67 (0.58–0.76) CysC HR 1.41 (1.02–1.95) for death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CysC did not predict AKI but did predict mortality in AHF \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lassus et al.<a class="elsevierStyleCrossRef" href="#bib0595">59</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Finland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts (FINN-AKVA registry) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicentre (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">480 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CysC prognostic impact compared to Cr and eGFR. To verify that normal Cr + high CysC is associated with an increased risk of death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CysC HR 3.2 (2.0–5.3). Kaplan–Meier curve with normal Cr + high CysC log rank test p<0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">CysC was associated with higher IH mortality at 30 days and a year, with greater predictive power than Cr or eGFR. They also identified patients with worse prognosis despite having normal Cr \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nuñez et al.<a class="elsevierStyleCrossRef" href="#bib0600">60</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2010–2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cohorts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Single center \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">526 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">To assess whether the early changes in Cr associated with FD differ between the groups defined by volume overload (CA125) and creatinine on admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">For high Cr, if CA 125 was high HR 0.84 (0.71–0.99) when FD dose was increased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ΔCr due to FD was determined by congestion. Renal dysfunction on admission, despite WRF, after FD, improved renal function. FD proved more beneficial at high doses the greater the congestion due to a reduction of mortality \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1880620.png" ] ] ] ] "descripcion" => array:1 [ "en" => "New biomarkers." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:60 [ 0 => array:3 [ "identificador" => "bib0305" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. 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Renal function and acute heart failure outcome

Función renal y pronóstico de los episodios de insuficiencia cardiaca aguda

Lluís Llaugera,

Corresponding author

llauger.doc@gmail.com

Corresponding author.

, Javier Jacobc, Òscar Mirób

a Servicio de Urgencias, Hospital Universitari de Vic, Vic, Barcelona, Spain

b Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

c Servicio de Urgencias, Hospital Clínic de Barcelona, Barcelona, Spain

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    "titulo" => "Renal function and acute heart failure outcome"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Search strategy&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">BUN&#44; <span class="elsevierStyleItalic">blood urea nitrogen</span>&#59; Cr&#44; creatinine&#59; CysC&#44; cystatin C&#59; AHF&#44; acute heart failure&#59; NGAL&#44; <span class="elsevierStyleItalic">neutrophil gelatinase-associated lipocalin</span>&#59; eGFR&#44; estimated glomerular filtration rate&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Heart failure is a clinical syndrome whose prevalence reaches more than 10&#37; in people over 70 years of age in developed countries&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">1</span></a> In Spain&#44; AHF is the leading cause of hospitalization in adults over 65 years of age&#44; represents more than 100&#44;000 hospital admissions per year and is a turning point in the prognosis of heart failure&#44; with approximately a 30&#37; mortality rate within a year following a decompensation event&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Acute heart failure &#40;AHF&#41; affects other organs too&#44; therefore its approach is predominantly multidisciplinary&#44; involving different health system levels&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">3&#44;4</span></a> Despite efforts to find therapies that modify the natural evolution of AHF&#44; its prognosis has remained essentially unchanged during the last decades<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">5&#44;6</span></a> and the different clinical trials have failed to provide new drugs for its treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">7</span></a> For this reason&#44; Spain has recently developed different proposals to improve pre-hospitalization care&#44;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">8&#8211;10</span></a> to assess the fragility that patients often associate with AHF&#44;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">11&#44;12</span></a> to identify precipitating decompensation factors<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">13&#44;14</span></a> or to improve decision-making regarding admission or discharge<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">15&#8211;17</span></a>&#59; and specialized care circuits have been designed for the early stages of decompensation or follow-up after the initial treatment&#44;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">18&#44;19</span></a> all with the purpose of improving the prognosis of these patients&#46; In this sense&#44; and with the aim of helping decision-making in patients with AHF&#44; various variables and predictive models have been studied&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">20</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Renal function and its worsening has the most relevant association with a poor prognosis and its prevalence in heart failure is high&#44; as shown by the results of a meta-analysis in which 53&#37; of patients with AHF had chronic kidney disease &#40;CKD&#41; and whose coexistence was associated with higher mortality &#40;OR 2&#46;35&#44; 95&#37; CI&#58; 2&#46;25&#8211;2&#46;54&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">21</span></a> In the EAHFE registry&#44; with data on 5845 patients treated due to AHF in the Spanish hospital emergency services&#44; 22&#46;3&#37; had CKD&#44; defined as having a serum creatinine &#62;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and&#44; during the acute event&#44; an estimated glomerular filtration rate &#40;eGFR&#41; &#60;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> was observed in 57&#37; of patients&#44; an eGFR &#60;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> in 14&#37; of patients and an eGFR &#60;15<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> in 5&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The pathophysiological relationship that is established between the heart and the kidney is complex&#46; The definition of cardiorenal syndrome&#44; initially classified into 5 categories and then extended to 7&#44; aims to clarify this complexity&#46; Within this cardiorenal syndrome classification&#44; cases of AHF with worsening renal function &#40;WRF&#41; are classified as type 1 or hemodynamic&#44;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">22</span></a> but the concept of WRF defined by the European Society of Cardiology continues to be used as an increase in serum creatinine &#8805;0&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl or 25&#37;&#44; or a decrease in eGFR of 20&#37;&#44; compared to baseline&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">1</span></a> It is also difficult to know how to assess renal function in patients with AHF&#44; essentially due to the variety of methods of doing so&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">23</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">With the aim of analysing published studies that investigate the relationship between different ways of assessing renal function and relating their abnormalities with prognosis in patients with AHF&#44; the following systematic review has been carried out&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Method of review and selection of articles</span><p id="par0030" class="elsevierStylePara elsevierViewall">A literature search was conducted between May 2016 and December 2017&#44; in the Pubmed and Web of Science databases&#46; The search criteria that were used are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; We selected papers written in Spanish&#44; English&#44; French or German&#44; that had a summary and that evaluated the prognostic role of any renal function variable in AHF in non-selected samples of patients&#46; We discarded review articles&#44; communications to conferences&#44; clinical trials &#40;considering them selected samples&#41; and studies with specialized unit samples or less than 200 patients&#46; The cross references were checked to verify that the inclusion of any relevant work was not omitted from the papers selected&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The review process identified 33 papers that met the inclusion criteria&#44; 29 coming directly from the search strategy and 4 from the cross-references review&#46; The authors agreed to limit the analysis to laboratory parameters&#44; and it was ruled out to analyze other variables that influenced the progression and prognosis of renal function&#44; such as&#44; for example&#44; loop diuretic therapy&#46; The variables analyzed in the different studies have been grouped according to the parameter considered and analyzed&#58; 1&#41; serum creatinine&#44; 2&#41; BUN or BUN&#47;creatinine ratio&#44; 3&#41; CKD&#44; 4&#41; formula for calculating eGFR&#44; 5&#41; acute kidney injury &#40;AKI&#41; and 6&#41; new markers of kidney damage&#46; Given that no meta-analysis was planned to aggregate the results of the different studies&#44; a homogeneous definition of these parameters was not required&#46; On the other hand&#44; the particularities referring to the definition of each parameter are discussed in the text corresponding to the discussion of each of them&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Serum creatinine</span><p id="par0040" class="elsevierStylePara elsevierViewall">Serum creatinine has been used for decades as a marker of kidney function&#46; It is a protein that comes from the skeletal muscles and is filtered almost exclusively in the glomerulus&#46; Given this origin&#44; there will be variations depending on age and sex&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the studies that analyze the prognostic significance of serum creatinine in AHF&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">WRF refers to a serum creatinine variation &#8805;0&#46;3 or 0&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; or the increase &#8805;25&#37; of creatinine&#44; but it is not a parameter for which there is a homogeneous definition&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">24</span></a> WRF is described as a variable in which various physiopathological mechanisms intervene&#44; such as neurohormonal activation&#44; decreased renal perfusion&#44; the presence of renal venous congestion&#44; the use of drugs with renal involvement and the presence of CKD&#44; and globally its presence is related to an increased risk of death or rehospitalization&#46; In a retrospective cohort study of 646 patients admitted for AHF&#44; the WRF during the first 7 days of admission was associated with higher mortality or readmission &#40;HR 1&#46;24&#44; 95&#37; CI&#58; 1&#46;06&#8211;1&#46;45&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0059&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">25</span></a> These results coincide with another study that analyzed data from an administrative base of 14&#44;017 patients admitted for AHF&#44; of which 5035 &#40;35&#46;9&#37;&#41; had an WRF during hospitalization &#40;42&#46;7&#37; persistent&#44; 37&#46;5&#37; persistent but of unknown duration and 19&#46;8&#37; transient&#41;&#46; Hospital re-admission at 30 days was higher in all groups with RR 1&#46;29 &#40;95&#37; CI&#58; 1&#46;17&#8211;1&#46;42&#41;&#59; RR 1&#46;12 &#40;95&#37; CI&#58; 1&#46;01&#8211;1&#46;26&#41; and RR 1&#46;14 &#40;95&#37; CI&#58; 1&#46;01&#8211;1&#46;31&#41;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">26</span></a> The ADHERE registry describes a 20&#46;3&#37; persistent WRF and 11&#46;7&#37; transient WRF&#44; with an HR of 1&#46;73 &#40;95&#37; CI&#58; 1&#46;57&#8211;1&#46;91&#41; and 1&#46;19 &#40;95&#37; CI&#58; 1&#46;05&#8211;1&#46;35&#41;&#44; respectively&#44; for mortality 90 days after discharge&#46; In this study&#44; the presence of previous CKD was related to more persistent WRF and mortality at 90 days&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">27</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the absence of congestion&#44; it is suggested that WRF could have no prognostic value and that it could be due to a diuretic or ACEI therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">28</span></a> On the other hand&#44; persistent congestion along with an WRF would be indicative of poor progression&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">29</span></a> On the other hand&#44; whether an improvement in renal function could have a prognostic significance has also been raised and similar conclusions have been reached&#46; Up to 31&#46;4&#37; of 903 patients hospitalized for AHF showed an improvement in renal function during hospitalization but showed a higher mortality with congestion and diuretic resistance &#40;HR 1&#46;3&#44; 95&#37; CI&#58; 1&#46;1&#8211;1&#46;7&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">30</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Urea nitrogen and urea nitrogen&#47;creatinine ratio</span><p id="par0055" class="elsevierStylePara elsevierViewall">Blood urea nitrogen &#40;BUN&#41; and creatinine are products of the metabolism of nitrogen compounds&#46; Its prognostic value has been described due to its association with the activation of the neurohormonal and the renin&#8211;angiotensin&#8211;aldosterone axis&#44; a phenomenon related to congestion that characterizes AHF&#46; In this context&#44; it has been suggested that there is an expansion of intravascular volume as a compensation mechanism&#44; so that the amount of urea excreted is disproportionately reduced compared to the glomerular filtration&#44; which results in a BUN&#47;creatinine ratio increase&#46; The results of the studies analyzed are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">When the 1-year mortality of a total of 610 patients with AHF was analyzed&#44; age and BUN were identified as the best independent predictors of mortality&#44; and 3 risk groups were created&#58; high risk &#40;BUN &#62;27&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and age &#62;86 years&#41;&#44; intermediate risk &#40;BUN &#62;27&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and age &#8804;86 years&#41; and low risk &#40;BUN &#8804;27&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#59; in the groups of more risk there were more cases with CKD&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">31</span></a> Baseline BUN increase is related to more in-hospital mortality and is interpreted as the expression of an intrinsically abnormal renal function or of a potentially reversible vasomotor nephropathy&#44; both of which are secondary to hemodynamic and neurohormonal abnormalities typical of AHF&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">32</span></a> The analysis of the ADHERE registry concludes that the eGFR and the BUN provide complementary information&#46; Both mortality and hospital stay were associated with the degree of renal dysfunction and the increase of BUN&#44; and the latter was the most potent predictor of in-hospital death&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">33</span></a> In the presence of AKI along with a high BUN&#47;creatinine ratio &#40;but not BUN or creatinine on their own&#41; there is an increased risk of mortality&#44; indicating that stratifying the risk of AKI is useful&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">34</span></a> In addition&#44; the existence of a high BUN&#47;creatinine ratio associated with a transient improved renal function during admission was associated with higher mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">35</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In the presence of renal dysfunction&#44; BUN&#47;creatinine has also been proposed as a discriminating variable in relation to greater diuretic resistance and worse survival&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">36</span></a> One of the most important predictors for BUN increase is systolic blood pressure&#44; reason why it is suggested that caution should be exercised regarding a decrease in blood pressure&#46; On the other hand&#44; it seems that beta-blocker treatment could prevent the increase of BUN&#44; by blocking the sympathetic nervous system&#44; so its early initiation during AHF is recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">37</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Chronic kidney disease</span><p id="par0070" class="elsevierStylePara elsevierViewall">Another aspect to consider is the time of onset of renal dysfunction&#44; that is&#44; evaluating whether the patient who has AHF decompensation already has established CKD&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows an already established CKD as a risk variable for AHF&#46; The Italian registry <span class="elsevierStyleItalic">IN-HF Outcome</span> studied the group of patients with CKD&#44; specifically with an eGFR &#60;40<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> and found that the predictors of in-hospital mortality in this group were&#58; altered level of consciousness&#44; advanced age&#44; hyponatremia&#44; systolic blood pressure and baseline eGFR&#46; In 1-year mortality&#44; the same predictors were maintained&#44; except eGFR&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">38</span></a> In this analysis&#44; the authors describe the paradox of diabetes&#44; in which the presence of its association with CKD was associated with a lower 1-year mortality&#46; However&#44; they acknowledge that it may be due to a selection bias or the size of the sample&#46; Miguel-Yanes et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">39</span></a> based on the analysis of the Spanish minimum basic data set&#44; corroborated that the established renal disease is associated with higher in-hospital mortality&#44; but there was no apparent relationship with the presence of diabetic nephropathy&#46; CKD and a worsening of it during an AHF admission are also related to worse prognosis&#44;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">40</span></a> as shown by the analysis of the ATTEND registry&#46; In-hospital mortality associated with renal dysfunction was similar in all groups but was independent of the presence of signs of renal congestion or hypoperfusion&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">41</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Formula for calculating the estimated glomerular filtration rate</span><p id="par0075" class="elsevierStylePara elsevierViewall">Renal function is defined from the calculation of eGFR&#44; which is estimated with the clearance of serum creatinine using different formulas&#44; mostly MDRD and CKD-EPI&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">42</span></a><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows 2 studies that have investigated which would be the most suitable formula to assess the prognosis&#46; The MDRD-4 and CKD-EPI formulas were evaluated from the RICA registry regarding patients admitted for AHF in Internal Medicine&#46; More patients with baseline renal dysfunction were identified with the CKD-EPI formula&#46; The only difference between the two formulas was that in patients with preserved ejection fraction&#44; CKD-EPI predicted mortality more accurately&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">43</span></a> In another study that evaluates up to 5 formulas for calculating eGFR&#44; this was a predictor of mortality for all of them&#58; the most accurate was that of Cockroft-Gault&#44; which includes the weight of the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">44</span></a> In obese patients&#44; this formula calculates a greater eGFR than the rest of the formulas for a specific creatinine&#44; which could explain the so-called paradox of obesity in the estimation of the risk of death in AHF&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">45</span></a> That is&#44; a higher weight is associated with lower mortality&#44; given the lower estimated renal dysfunction&#46; Finally&#44; as discussed below&#44; it is important to mention that the addition of cystatin C to the CKD-EPI formula improves its prognostic ability&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Criteria for acute kidney injury</span><p id="par0080" class="elsevierStylePara elsevierViewall">The NICE criteria recommend defining the magnitude of renal involvement in dynamic terms&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">46</span></a> This would be the objective of the term AKI and for its definition different criteria have been published &#40;RIFLE&#44; AKIN and KDIGO&#41; which are the ones that have been used <span class="elsevierStyleItalic">a posteriori</span> to evaluate its prognostic meaning&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">23</span></a><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarizes the studies that explore the different AKI criteria&#46; In all of them&#44; the classification is based on the variation of serum creatinine and the volume of diuresis&#46; It seems that the KDIGO criteria may be superior for predicting short-term results&#44; although it is an Asian population study&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">47</span></a> The same authors add that we must bear in mind that the RIFLE criteria were derived and validated in very selected populations&#46; When AKI criteria are compared as an alternative to WRF&#44; defined by the increase in serum creatinine &#8805;0&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; these better identify the severe stages that are associated with adverse events &#40;re-admission due to AHF&#44; use of renal replacement therapy or death from all causes&#41; at 30 days and a year&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">48</span></a> Finally&#44; it should be noted that prediction scores for the occurrence of AKI have been designed&#44; in which prior CKD and the use of diuretics during AHF are particularly relevant&#46;<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">49&#8211;52</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">New kidney injury biomarkers</span><p id="par0085" class="elsevierStylePara elsevierViewall">In recent years&#44; different biomarkers have been described and researched with the aim of detecting AKI earlier&#44; prior to the variation of creatinine or eGFR&#46; Among these new biomarkers are <span class="elsevierStyleItalic">neutrophil gelatinase-associated lipocalin</span> &#40;NGAL&#41; and Cystatin C&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">53</span></a><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows several new kidney injury biomarkers&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Plasma NGAL is a protein from the renal tubule&#46; The AKINESIS study was designed with the assumption that the increase in serum creatinine in the context of AHF might not reflect a true AKI and&#44; therefore&#44; would not have a prognostic value in all cases&#46; Their results demonstrate that plasma NGAL is not superior to creatinine in terms of predicting worsening renal function or adverse in-hospital outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">54</span></a> NGAL can also be determined in urine and&#44; in this case&#44; it could be more useful&#46; Its increase at admission or at 12&#8211;24<span class="elsevierStyleHsp" style=""></span>h of treatment is associated with a WRF at 5 days&#44; defined according to the RIFLE criteria&#44; or by a variation in serum creatinine &#8805;0&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; This increase in urine NGAL is also associated with more adverse events at 30 days&#46; For all these reasons&#44; the authors postulate that treatment should be individualized in patients with AHF and renal dysfunction&#44; especially in the first 12&#8211;24<span class="elsevierStyleHsp" style=""></span>h&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">55</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The use of cystatin C in the CKD-EPI formula in a Spanish cohort of 613 patients with AHF increases the predictive accuracy to independently detect death from any cause or re-admission for AHF&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">56</span></a> The same research group compares the CKD-EPI formulas&#44; with or without cystatin C&#44; and MDRD and concludes that the use of cystatin C can more accurately predict the risk of adverse events&#44; especially in patients with relatively preserved renal function&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">57</span></a> This finding is similar to that of Breidthardt et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">58</span></a> taking into account that cystatin C did not predict AKI&#44; but long-term mortality&#46; Even in patients with normal creatinine&#44; increased cystatin C was predictive of death from any cause at 1 year and&#44; consequently&#44; its usefulness would extend beyond the first hours or days after the acute event&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">59</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The carbohydrate antigen 125 &#40;CA125&#41; has been evaluated as a marker of systemic congestion and may be helpful for the titration of diuretics&#46; In order to develop a tool for the titration of diuretics and based on the idea that the benefit of diuretics would depend on the renal status on admission and the degree of congestion&#44; a study of 526 consecutive patients admitted for AHF&#44; who received intravenous furosemide in the first 48<span class="elsevierStyleHsp" style=""></span>h&#44; was carried out&#46; The study evaluated whether the early changes in creatinine associated with furosemide differed between the groups defined by volume overload with a CA125 &#62;35<span class="elsevierStyleHsp" style=""></span>U&#47;ml and a creatinine &#8805;1&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dl on admission&#46; The results of the study show that the effect of furosemide differed according to the concentration of CA125&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">60</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">As a conclusion of our review we can say that renal dysfunction in the context of AHF&#44; defined from the variations in creatinine&#44; eGFR or AKI criteria&#44; is a variable associated with a worse prognosis&#44; especially when it is associated with congestion&#44; a phenomenon that can be explained by neurohormonal activation and confirmed by an increase in the BUN&#47;creatinine ratio&#46; In addition to predisposing to a worsening of multifactorial origin&#44; a previous CKD could also predict a group with worse prognosis&#46; Other new biomarkers&#44; such as those that identify tubular damage or congestion&#44; have been able to increase the discriminative capacity of predictive models for AHF&#44; but they are still of limited use in routine clinical practice&#44; awaiting studies with more conclusive results&#46; It would probably be necessary to define the renal dysfunction profile so as to determine whether it is actually an established renal injury&#44; due to a specific treatment&#44; or a transitory phenomenon related to volume overload&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Method of review and selection of articles"
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          "titulo" => "Results"
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            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Serum creatinine"
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            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Urea nitrogen and urea nitrogen&#47;creatinine ratio"
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              "identificador" => "sec0030"
              "titulo" => "Chronic kidney disease"
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              "identificador" => "sec0035"
              "titulo" => "Formula for calculating the estimated glomerular filtration rate"
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              "identificador" => "sec0040"
              "titulo" => "Criteria for acute kidney injury"
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              "titulo" => "New kidney injury biomarkers"
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          "titulo" => "Conclusion"
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    "fechaRecibido" => "2018-03-26"
    "fechaAceptado" => "2018-05-01"
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:4 [
            0 => "Renal function"
            1 => "Acute heart failure"
            2 => "Outcome"
            3 => "Systematic review"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1040818"
          "palabras" => array:4 [
            0 => "Funci&#243;n renal"
            1 => "Insuficiencia cardiaca aguda"
            2 => "Pron&#243;stico"
            3 => "Revisi&#243;n sistem&#225;tica"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The interaction between acute heart failure &#40;AHF&#41; and renal dysfunction is complex&#46; Several studies have evaluated the prognostic value of this syndrome&#46; The aim of this systematic review&#44; which includes non-selected samples&#44; was to investigate the impact of different renal function variables on the AHF prognosis&#46; The categories included in the studies reviewed included&#58; creatinine&#44; blood urea nitrogen &#40;BUN&#41;&#44; the BUN&#47;creatinine quotient&#44; chronic kidney disease&#44; the formula to estimate the glomerular filtration rate&#44; criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin &#40;NGAL and cystatin c&#41;&#46; The basal alterations of the renal function&#44; as well as the acute alterations&#44; transient or not&#44; are related to a worse prognosis in AHF&#44; it is therefore necessary to always have baseline&#44; acute and evolutive renal function parameters&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La insuficiencia cardiaca aguda &#40;ICA&#41; y la disfunci&#243;n renal son 2<span class="elsevierStyleHsp" style=""></span>entidades para cuya compleja interacci&#243;n se ha explorado su valor pron&#243;stico&#46; El objetivo de esta revisi&#243;n sistem&#225;tica de trabajos&#44; que parte de muestras no seleccionadas&#44; fue investigar el impacto que tienen diversas variables de funci&#243;n renal sobre el pron&#243;stico de la ICA&#46; La creatinina&#44; el nitr&#243;geno ureico &#40;BUN&#41;&#44; el cociente BUN&#47;creatinina&#44; la enfermedad renal cr&#243;nica&#44; la f&#243;rmula para estimar la tasa de filtrado glomerular&#44; los criterios de lesi&#243;n renal aguda y los nuevos biomarcadores de da&#241;o renal &#40;NGAL y la cistatina C&#41; son las categor&#237;as en que se han incluido los trabajos revisados&#46; Las alteraciones basales&#44; as&#237; como las alteraciones agudas&#44; transitorias o no&#44; de la funci&#243;n renal se relacionan con un peor pron&#243;stico en la ICA&#46; Es&#44; por lo tanto&#44; necesario tener siempre par&#225;metros de funci&#243;n renal basales&#44; del episodio agudo y evolutivos&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Llauger L&#44; Jacob J&#44; Mir&#243; &#210;&#46; Funci&#243;n renal y pron&#243;stico de los episodios de insuficiencia cardiaca aguda&#46; Med Clin &#40;Barc&#41;&#46; 2018&#46; <a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="https://doi.org/10.1016/j.medcli.2018.05.010">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;medcli&#46;2018&#46;05&#46;010</a></p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Search strategy&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">BUN&#44; <span class="elsevierStyleItalic">blood urea nitrogen</span>&#59; Cr&#44; creatinine&#59; CysC&#44; cystatin C&#59; AHF&#44; acute heart failure&#59; NGAL&#44; <span class="elsevierStyleItalic">neutrophil gelatinase-associated lipocalin</span>&#59; eGFR&#44; estimated glomerular filtration rate&#46;</p>"
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at1"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">WRF&#44; worsening renal function&#59; CKD&#44; chronic kidney disease&#59; AHF&#44; acute heart failure&#59; AKI&#44; acute kidney injury&#59; IRF&#44; improved renal function&#59; NYHA&#44; New York Heart Association&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results RR&#44; OR&#44; HR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2003&#8211;2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Italy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">318&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WRF incidence&#44; prognostic value at one-year&#44; clinical characteristics and risk factors in AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 1&#46;47 &#40;1&#46;13&#8211;1&#46;81&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41; for WRF and death or re-admission&#46;<br>OR 1&#46;84 &#40;1&#46;04&#8211;3&#46;27&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; in CKD&#44; OR 2&#46;18 &#40;1&#46;27&#8211;3&#46;73&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41; if furosemide&#44; OR 2&#46;07 &#40;1&#46;24&#8211;3&#46;45&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41; in NYHA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WRF in absolute &#40;&#8805;0&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; and relative &#40;&#8805;25&#37;&#41; value predicted death and re-admission&#46;<br>The predictors of WRF were CKD&#44; furosemide and NYHA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Berra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Switzerland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">646&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prognostic value of WRF in patients admitted for AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 1&#46;29 &#40;1&#46;13&#8211;1&#46;47&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0002&#41; for AKI&#46;<br>HR 1&#46;24 &#40;1&#46;06&#8211;1&#46;45&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0059&#41; for WRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AKI and WRF were those most related to mortality and re-admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Freda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&#8211;2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts &#40;Cerner Health Facts&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To describe the incidence and results at discharge of persistent or transient AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 1&#46;29 &#40;1&#46;17&#8211;1&#46;42&#41; for persistent AKI&#44; RR 1&#46;14 &#40;1&#46;00&#8211;1&#46;31&#41; transient AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Both transient and persistent AKI represent a greater risk of re-admission at 30 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Krishnamoorthy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2001&#8211;2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts &#40;ADHERE registry&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;&#62;300&#41; linked to Medicare&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To describe the prevalence and characteristics of patients with transient or persistent WRF and compare results at 90 days&#44; non-WRF&#44; transient or persistent WRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 1&#46;19 &#40;1&#46;05&#8211;1&#46;35&#41; for transient WRF&#46;<br>HR 1&#46;73 &#40;1&#46;57&#8211;1&#46;91&#41; for persistent WRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Transient or persistent WRF have been associated with poorer outcomes&#44; especially in persistent cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2005&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Italy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">599&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Evaluate WRF interaction and congestion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 2&#46;44 &#40;1&#46;24&#8211;4&#46;18&#41; for mortality&#46;<br>HR 1&#46;39 &#40;0&#46;88&#8211;2&#46;2&#41; for mortality and readmission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WRF predicts the prognosis of death or readmission in patients with congestion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wattad et al&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&#8211;2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Israel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">762&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Persistent WRF and congestion could be associated with worse prognosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 4&#46;16 &#40;2&#46;20&#8211;7&#46;86&#41; in WRF with persistent congestion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Persistent WRF and congestion were associated with higher mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Testani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2004&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">903&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To describe the MFR and risk of death associated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OR 4&#46;2 &#40;2&#46;6&#8211;6&#46;7&#41; in previous WRF and OR 1&#46;8 &#40;1&#46;2&#8211;2&#46;7&#41; in post-admission WRF&#46;<br>HR 1&#46;3 in IRF and death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline congestion and volume of diuresis were associated with pre&#47;post-admission IRF and WRF&#46;<br>IRF was associated with a higher risk of death and&#44; on discharge&#44; a greater worsening in eGFR&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Studies that analyze the prognostic significance of serum creatinine in acute heart failure&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">BNP&#44; brain natriuretic peptide&#59; BUN&#44; <span class="elsevierStyleItalic">blood urea nitrogen</span>&#59; Cr&#44; creatinine&#59; RD&#44; renal dysfunction&#59; AHF&#44; acute heart failure&#59; IH&#44; in-hospital&#59; HR&#44; heart rate&#59; AKI&#44; acute kidney injury&#59; IRF&#44; improved renal function&#59; SBP&#44; systolic blood pressure&#59; eGFR&#44; estimated glomerular filtration rate&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results RR&#44; OR&#44; HR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arenja et al&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2001&#8211;2002<br>2006&#8211;2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Switzerland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">610&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Utility of a simple algorithm in non-selected AHF&#44; in relation to 1-year mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 2 &#40;1&#46;7&#8211;2&#46;4&#41; for death in high BUN and advanced age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BUN was the best predictor of death at 1-year&#46; The highest risk groups had the highest BUN &#40;&#62;27&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; and the highest age &#40;&#62;86 years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chioncel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Romania&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts &#40;RO-AHFS registry&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epidemiology&#44; symptoms&#44; management and progression of patients with AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OR 0&#46;488 &#40;1&#46;002&#8211;1&#46;015&#41; in baseline renal dysfunction &#40;BUN&#41; and death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline BUN was a predictor of IH death from any cause&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heywood et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2001&#8211;2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts &#40;ADHERE registry&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;280&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">118&#44;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prevalence and severity of renal dysfunction on admission&#44; the relationship with treatments and in-hospital outcomes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OR 1&#46;18 &#40;1&#46;17&#8211;1&#46;20&#41; if decrease of 10<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> in GFR&#46;<br>As an isolated predictor&#44; statistical C 0&#46;70 in BUN and IH death<br>Model with 4 variables&#44; statistical C 0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline eGFR was an independent predictor of IH death&#44; but the best was BUN&#46;<br>The best predictive model consisted of BUN&#44; SBP&#44; HR and age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Takaya et al&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2006&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Japan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">371&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BUN&#47;Cr ratio or BUN or Cr for mortality risk in AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 4&#46;71 &#40;2&#46;25&#8211;10&#46;2&#41; for AKI with high BUN&#47;Cr&#46;<br>HR 4&#46;26 &#40;1&#46;99&#8211;9&#46;76&#41; AKI and high BUN&#46;<br>HR 4&#46;15 &#40;1&#46;90&#8211;9&#46;81&#41; and high Cr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AKI with a high BUN&#47;Cr ratio was associated with a higher mortality&#46;<br>AKI&#44; independently of BUN or Cr&#44; was associated with a higher mortality&#46;<br>BUN&#47;Cr could be useful to stratify the risk in AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brisco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2004&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">896&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To determine if a high BUN&#47;Cr can identify the reversible RD&#46;<br>To validate that RD associated with increased BUN&#47;Cr is associated with a worse prognosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OR 1&#46;5 &#40;1&#46;3&#8211;1&#46;8&#41; for high BUN&#47;Cr and IRF&#46; HR 2&#46;2 &#40;1&#46;6&#8211;3&#46;1&#41; for mortality if high BUN&#47;Cr and eGFR &#60;45<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A high BUN&#47;Cr allows identifying the group with IRF&#44; but it seems to be a transient phenomenon&#44; associated with higher mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Testani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2004&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">908&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To determine if the combination BNP and BUN&#47;Cr allows to identify the group of higher&#47;lower risk with RD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 1&#46;8 &#40;1&#46;2&#8211;2&#46;7&#41; worse survival&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The risk of death of RD in AHF can be stratified from BUN&#47;Cr and BNP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Miura et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">37</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Japan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts &#40;Tohoku Acute Heart Failure registry&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Evaluation of changes in BUN as a prognostic factor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 2&#46;94 &#40;1&#46;51&#8211;5&#46;73&#41; for mortality from any cause if high BUN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increases in BUN during hospitalization represent a worse prognosis&#44; independently of the calculation of renal function based on Cr at admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Studies analysing the prognostic significance of blood urea nitrogen &#40;BUN&#41; and the BUN&#47;creatinine ratio&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CKD-EPI&#44; <span class="elsevierStyleItalic">Chronic Kidney Disease Epidemiology Collaboration</span>&#59; Cr&#44; Creatinine&#59; DM&#44; diabetes mellitus&#59; WRF&#44; worsening renal function&#59; CKD&#44; chronic kidney disease&#59; AHF&#44; acute heart failure&#59; IH&#44; in-hospital&#59; MDRD&#44; <span class="elsevierStyleItalic">Modification of Diet in Renal Disease Study</span>&#59; IRF&#44; improved renal function&#59; SBP&#44; systolic blood pressure&#59; eGFR&#44; estimated glomerular filtration rate&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results RR&#44; OR&#44; HR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cioffi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">38</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2009&#8211;2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Italy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts &#40;IN-HF Outcome record&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">455&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Clinical characteristics and prognostic markers of short and medium-term mortality in severe renal dysfunction &#40;eGFR &#60;40<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A 13&#46;6&#37; IH death and 43&#46;5&#37; 1-year death if severe renal dysfunction&#44;<br>OR 0&#46;95 &#40;0&#46;919&#8211;9&#46;83&#41; for eGFR and IH death&#44; in this group of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The in-hospital mortality and at 1-year in patients with severe renal dysfunction was double&#46; The variables related to IH death were low level of consciousness&#44; age&#44; SBP&#44; hyponatremia and eGFR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">De Miguel-Yanes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2006&#8211;2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Minimum basic data set&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;all hospitals&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">275&#44;176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To assess the possible interaction of DM CKD in the mortality of AHF admissions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OR 1&#46;01 &#40;0&#46;91&#8211;1&#46;10&#41; in CKD and DM&#44; OR 1&#46;46 &#40;1&#46;39&#8211;1&#46;53&#41; for CKD and IH death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CKD was associated with higher in-hospital mortality&#44; without being clearly related to DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reid et al&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">40</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2009&#8211;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Canada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">952&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meaning of WRF&#47;IRF according to GFR &#60;45 on admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Survival 13&#46;9 months &#40;8&#8211;25&#41; if WRF and 32&#46;5 months &#40;19&#8211;56&#41; if IRF&#44; in GFR &#60;45<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Changes in renal function were only significant if baseline worsening &#40;GFR &#60;45<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; with greater survival if there was IRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inohara et al&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">41</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2007&#8211;2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Japan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts &#40;ATTEND registry&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4321&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Differences in the prognostic impact of renal dysfunction in IH mortality&#44; according to low perfusion profiles <span class="elsevierStyleItalic">versus</span> kidney congestion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OR 2&#46;36 &#40;1&#46;75&#8211;3&#46;18&#41; for baseline renal dysfunction and IH death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline renal dysfunction&#44; independently of the mechanism&#44; was associated with higher in-hospital mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Closed et al&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">43</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&#8211;2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RICA Cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1805&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CKD-EPI <span class="elsevierStyleItalic">versus</span> MDRD&#44; and prediction of risk of death in AHF with or without ventricular dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 1&#46;55 &#40;1&#46;23&#8211;1&#46;94&#41; if eGFR 30&#8211;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; HR 2&#46;31 &#40;1&#46;71&#8211;3&#46;10&#41; if eGFR &#60;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> for MDRD-4&#46;<br>HR 1&#46;58 &#40;1&#46;24&#8211;2&#46;01&#41; if eGFR 30&#8211;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; HR 2&#46;34 &#40;1&#46;75&#8211;3&#46;01&#41; if eGFR &#60;30<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> for CKD-EPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">eGFR with both formulas was associated with higher 1-year mortality if renal dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weidmann et al&#46;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">44</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">International&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">eGFR with the Cockroft-Gault formula&#44; predicts post-discharge outcomes better than MDRD-4&#44; MDRD-6&#44; CKD-EPI&#47;BIS-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Death and eGFR 30&#8211;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span><br>HR 1&#46;44 &#40;0&#46;66&#8211;2&#46;80&#41; C-G<br>HR 1&#46;26 &#40;0&#46;84&#44;188&#41; MDRD-4<br>HR 2&#46;23 &#40;1&#46;60&#8211;3&#46;10&#41; MDRD-6<br>HR 1&#46;02 &#40;0&#46;52&#8211;2&#46;02&#41; CKD-EPI&#47;BIS-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EGFR was an independent predictor of mortality with any formula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Established chronic kidney disease and formula for calculating the estimated glomerular filtration rate &#40;eGFR&#41;&#46;</p>"
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        "etiqueta" => "Table 4"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Cr&#44; creatinine&#59; DM2&#44; type 2 diabetes mellitus&#59; WRF&#44; worsening renal function&#59; CKD&#44; chronic kidney disease&#59; AHF&#44; acute heart failure&#59; IH&#44; in-hospital&#59; AKI&#44; acute kidney injury&#59; SBP&#44; systolic blood pressure&#59; eGFR&#44; estimated glomerular filtration rate&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RR&#44; OR&#44; HR &#40;95&#37; CI&#41; results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">47</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&#8211;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Japan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To determine if the KDIGO criteria for identifying and predicting short-term CRS type 1 were superior to the RIFLE or AKIN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RIFLE OR 2&#46;56 &#40;1&#46;79&#8211;3&#46;65&#41;&#59; AKIN OR 2&#46;68 &#40;1&#46;86&#8211;3&#46;84&#41;&#59; KDIGO 3&#46;22 &#40;2&#46;24&#8211;4&#46;62&#41;&#59; subgroup only identified by KDIGO OR 3&#46;24 &#40;1&#46;97&#8211;5&#46;35&#41; for IH death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AKI was associated with higher mortality&#46;<br>The new KDIGO criteria were superior in predicting short-term results in CRS type 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Roy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">48</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2002&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ireland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">637&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Epidemiology of AKI using new definitions&#44; in addition to examining the association between severity and main clinical outcomes at 30 days and a year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Risk of adverse events in stage 2 AKI was 4<span class="elsevierStyleHsp" style=""></span>times higher&#44; RIFLE OR 17&#46;7 &#40;8&#46;1&#8211;38&#46;4&#41;&#59; KDIGO OR 19&#46;4 &#40;7&#46;6&#8211;48&#46;6&#41;&#59; AKIN OR 17&#46;6 &#40;7&#8211;44&#46;1&#41; than stage 2 AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AKI with any definition was associated with an increase in risk at 30 days and a year&#46; Few differences were observed in the direct criteria comparison&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Forman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">49</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1997&#8211;1998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To determine the prevalence of WRF in AHF admissions&#44; predictive factors for WRF and in-hospital outcomes associated with WRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 7&#46;5 &#40;2&#46;9&#8211;19&#46;3&#41; for death&#44; RR 2&#46;1 &#40;1&#46;5&#8211;3&#41; for IH complications&#44; RR 3&#46;2 &#40;2&#46;2&#8211;4&#46;9&#41; for stays &#62;10 days&#44; in patients with WRF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">WRF risk factors&#58; heart failure&#44; DM2&#44; admission Cr&#44; SBP &#62;160<span class="elsevierStyleHsp" style=""></span>mmHg&#46; WRF was associated with increased IH death&#44; IH complications&#44; stay &#62; 10 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breidthardt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2001&#8211;2002<br>2006&#8211;2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Switzerland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">657&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prevalence and WRF effect on survival&#46;<br>To establish a risk <span class="elsevierStyleItalic">score</span> for WRF and validate the Forman <span class="elsevierStyleItalic">score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HR 1&#46;92 &#40;1&#46;29&#8211;2&#46;59&#41; for WRF and death&#46;<br>Previous CKD was related to WRF&#44; HR 2&#46;07 &#40;1&#46;29&#8211;3&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CKD was the only independent predictor of WRF&#46;<br>Mortality was related to eGFR&#44; and WRF strengthened this effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2004&#8211;2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1709&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Design and validate a <span class="elsevierStyleItalic">score</span> of prediction of AKI in AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OR 3&#46;11 &#40;2&#46;23&#8211;4&#46;35&#41; for baseline Cr &#62;1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; OR 1&#46;96 &#40;1&#46;16&#44; 3&#46;30&#41; for furosemide &#62;80<span class="elsevierStyleHsp" style=""></span>mg&#47;day and OR 2&#46;09 &#40;1&#46;31&#44; 3&#46;33&#41; if re-examination&#44; in the prediction of AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Baseline Cr &#62;1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; furosemide &#62;80<span class="elsevierStyleHsp" style=""></span>mg&#47;day and re-examination were predictors of AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zhou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2011&#8211;2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">676&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To develop and validate a risk <span class="elsevierStyleItalic">score</span> for AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CKD&#44; OR 4&#46;15 &#40;2&#46;36&#8211;7&#46;28&#41; to predict AKI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Previous CKD was included in the <span class="elsevierStyleItalic">score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CA 125&#44; carbohydrate antigen 125&#59; CKD-EPI&#44; <span class="elsevierStyleItalic">Chronic Kidney Disease Epidemiology Collaboration</span>&#59; Cr&#44; creatinine&#59; CysC&#44; cystatin C&#59; WRF&#44; worsening renal function&#59; FD&#44; furosemide&#59; AHF&#44; acute heart failure&#59; IH&#44; in-hospital&#59; AKI&#44; acute kidney injury&#59; MDRD&#44; <span class="elsevierStyleItalic">Modification of Diet in Renal Disease Study</span>&#59; eGFR&#44; estimated glomerular filtration rate&#59; u&#44; urinary&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Centers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sample &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Main hypotheses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results RR&#44; OR&#44; HR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maisel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">54</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2010&#8211;2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multinational&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">927&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NGAL prognostic ability to predict WRF or need for renal replacement therapy&#46;<br>NGAL prognostic ability for adverse IH outcomes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Peak NGAL ROC 0&#46;656&#44; baseline ROC 0&#46;647&#44; baseline Cr ROC 0&#46;652 and WRF<br>For adverse events baseline NGAL ROC 0&#46;691&#44; peak ROC 0&#46;653&#44; first Cr 0&#46;686 and adverse events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NGAL was not superior to Cr to predict WRF or adverse IH events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Collins et al&#46;<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urine NGAL would be associated with WRF and worse prognosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NGAL &#40;u&#41; OR 1&#46;02 &#40;1&#46;01&#8211;1&#46;04&#41; for WRF predictor&#46;<br>There are 42 cases with adverse events at 30 days <span class="elsevierStyleItalic">versus</span> 25&#44; NGAL at 12&#8211;24<span class="elsevierStyleHsp" style=""></span>h&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NGAL &#40;u&#41; at 12&#8211;24<span class="elsevierStyleHsp" style=""></span>h was a predictor of WRF and adverse events at 30 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Flores-Blanco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">56</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2006&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">613&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To assess whether the CKD-EPI formula based on the Cys-C provides additional information&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CKD-EPI SCr-CysC HR 0&#46;998 &#40;0&#46;983&#8211;0&#46;994&#41; for death or re-admission for AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The CKD-EPI formula based on Cys-C to estimate eGFR is an independent predictor of adverse outcomes in AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Manzano-Fern&#225;ndez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2006&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">526&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To evaluate whether CKD-EPI based on Cr or CysC predicts the risk of adverse events better than MDRD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CKD-EPI Cr-CysC HR 0&#46;984 &#40;0&#46;979&#8211;0&#46;989&#41; and MDRD HR 0&#46;991 &#40;0&#46;986&#8211;0&#46;985&#41; in death or re-admission&#44; but in Kapplan-Meier curves log rank test <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 with formulas that include CysC <span class="elsevierStyleItalic">vs&#46; p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;374 in CKD-EPI only with Cr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">eGFR was a predictor of mortality and re-admission&#44; independently of the formula&#44; but this was improved by incorporating formulas based on CysC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breidthardt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">58</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Switzerland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">207&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To examine the diagnostic and prognostic importance of plasma CysC levels in relation to serum Cr levels in AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ROC curve for AKI with Cr was 0&#46;68 &#40;0&#46;58&#8211;0&#46;78&#41; and with CysC 0&#46;67 &#40;0&#46;58&#8211;0&#46;76&#41;<br>CysC HR 1&#46;41 &#40;1&#46;02&#8211;1&#46;95&#41; for death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CysC did not predict AKI but did predict mortality in AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lassus et al&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">59</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Finland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts &#40;FINN-AKVA registry&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multicentre &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">480&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CysC prognostic impact compared to Cr and eGFR&#46; To verify that normal Cr &#43; high CysC is associated with an increased risk of death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CysC HR 3&#46;2 &#40;2&#46;0&#8211;5&#46;3&#41;&#46;<br>Kaplan&#8211;Meier curve with normal Cr &#43; high CysC log rank test <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CysC was associated with higher IH mortality at 30 days and a year&#44; with greater predictive power than Cr or eGFR&#46;<br>They also identified patients with worse prognosis despite having normal Cr&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nu&#241;ez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">60</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2010&#8211;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cohorts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">526&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">To assess whether the early changes in Cr associated with FD differ between the groups defined by volume overload &#40;CA125&#41; and creatinine on admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">For high Cr&#44; if CA 125 was high HR 0&#46;84 &#40;0&#46;71&#8211;0&#46;99&#41; when FD dose was increased&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#916;Cr due to FD was determined by congestion&#46;<br>Renal dysfunction on admission&#44; despite WRF&#44; after FD&#44; improved renal function&#46;<br>FD proved more beneficial at high doses the greater the congestion due to a reduction of mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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