Thread by @anandthedoc

1/16 Inspired by #NephMadness, let’s briefly touch on:

💢Role of kidney biomarkers in patients with CHF
💢‘Worsening kidney function’ in heart failure
💢Permissive hypercreatininemia
💢Handling RAASi and SGLT2i in heart failure
#NephTwitter #MedTwitter
ajkdblog.org/2022/03/01/nep…

2/16 Let’s have a poll.
Forward failure, characterized by decreased kidney perfusion, is the main determinant of kidney dysfunction in acute decompensated heart failure. Is this true or false?

3/16 That’s false!
◀️“Backward failure” (Kidney congestion, interstitial edema and tubular dysfunction) is believed to play a more vital role compared to “Forward failure”▶️ (decreased kidney perfusion)
Neurohumoral and inflammatory mechanisms also operate
PMID:34970606

4/16 Let’s look at the blood biomarkers to evaluate kidney function in heart failure patients.
Serum creatinine remains the most commonly used.
Other #Biomarkers studied include #NGAL #KIM1 & #CystatinC
PMID:34970606

5/16 Is there a reliable urinary biomarker to diagnose AKI in heart failure?
Urinary KIM-1 is a promising biomarker for renal dysfunction in cardiac failure while urinary NGAL failed to demonstrate better performance in predicting worsening renal function in the AKINESIS study

6/16 Let’s have another poll. Plasma NGAL is superior to serum creatinine in predicting AKI in heart failure. Is this true or false?

7/16 That’s False!
The #AKINESIS Study found that Plasma NGAL was *not* superior to creatinine for predicting acute kidney injury or adverse in-hospital outcomes in acute heart failure.
#JACC
PMID: 27659464

8/16 So how do Kidney #Biomarkers fare in #CHF ❓
The elevation of tubular injury biomarkers is far less than in true AKI.
No histologic studies exist linking tubular injury in patients with #CHF and #AKI.
It is not yet possible to replace sCr, BUN & eGFR with novel biomarkers.👎

9/16 Can we use diuretic response as a marker of kidney function in heart failure❓
👍Patients with the best diuretic response often develop worsening kidney function but seem to have the best prognosis as evident from the ROSE-AHF trial.
👍What’s a good diuretic response? 👇

10/16 What is permissive #hypercreatininemia?
👉Worsening renal function during treatment of heart failure makes it difficult to continue guideline-directed medical therapy (Diuretics,RAASi).
How to distinguish a real rise in creatinine from a pseudo elevation❓
Check this out 👇

11/16 The kidney-conserving ‘nephrotoxins’?
RAAS inhibitors and SGLT2 inhibitors reduce intraglomerular pressure and offer nephroprotection despite causing a dip in GFR in the short term.
See this excellent infographic by @hellokidneyMD

12/16 Pause but restart!
Stopping RAAS inhibitors and SGLT-2 inhibitors during an intercurrent illness due to the risk of precipitating AKI is a popular clinician opinion but there is a paucity of data.
If stopped, remember to Restart !
Check out 👇
pubmed.ncbi.nlm.nih.gov/30422153/

13/16🧠What are some of the knowledge gaps in the utility of biomarkers in cardiorenal disease?
PMID:30354446

14/16 Well, the Cardiorenal Conundrum has always been fascinating and will continue to remain as we 🌉bridge those knowledge gaps !
💥💓Do checkout the exciting Cardiorenal region #NephMadness to know more!
@NishaKidneyDoc @HeartDocSadiya @DrFlashHeart @ssfarouk @anna_burgner

15/16 Hope you enjoyed reading my first tweetorial!
We are 2k22! Follow us for more exciting content!
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16/16 Thanks to the entire #NSMC2022 team!
@swastithinks @amyaimei @Nephro_sparks @docanjuyadav @menonshina @Elena_Cervants @JMTeakell @nephromythri @divyaa24

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