Loop Diuretic Dosage in Patients With Acute Heart Failure and Renal Failure: Conventional Versus Carbohydrate Antigen 125-guided Therapy (IMPROVE-HF)
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 发起方
- 入组人数
- 170
- 试验地点
- 1
- 主要终点
- Change in renal function (GFR)
研究概览
简要总结
Worsening renal function (WRF) is a frequent finding in patients with decompensated acute heart failure (AHF) and it is associated to increased length of hospitalization and higher morbidity and mortality. Traditionally, WRF in AHF setting has been attributed to low cardiac output, but recent evidence also suggests venous congestion play a crucial role. Loop diuretics are the mainstay treatment of AHF, but their use traditionally has been associated to WRF, but also renal function improvement in patients with unequivocal signs of congestion. Nevertheless, traditional symptoms or signs of patients with AHF have shown a limited accuracy to neither identify nor quantify the degree of venous congestion. Recent authors have reported that plasma levels of antigen carbohydrate 125 (CA125) are closely related to the degree of venous congestion.
The investigators hypothesize that CA125 may have a role for identifying the hyperhydrated (High CA125) patients that need high loop diuretic doses, and those with normal CA125 values needing low loop diuretic doses. In this randomized study (1:1) the investigators seek to evaluate whether a CA125 loop diuretic guided management therapy is superior to a standard strategy. The primary endpoint is the magnitude of changes of renal function at 24 and 72 hours after initiation of intravenous diuretic in an acute worsening of heart failure
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with the diagnosis of acute heart failure (AHF) and the concurrence of the following conditions:
- •Presence of symptoms (dyspnea at rest or minimal exertion) and signs attributable to congestion (signs of congestion on chest radiography, or presence of peripheral edema or ascites, or jugular venous distension at 45 degrees or presence of crackles on auscultation).
- •Elevated natriuretic peptide (NT-proBNP> 1000 pg/ml or BNP> 100 mg/dl).
- •Creatinine ≥1,4 mg/dl on admission, provided that the estimated glomerular filtration rate less than 60 ml / min / m
- •Intent to be treated with loop diuretics intravenously.
排除标准
- •Life expectancy less than 6 months of life due to other comorbid conditions.
- •Cardiogenic shock.
- •Diagnosis of acute coronary syndrome in the previous 30 days.
- •Pregnancy at the time of inclusion.
- •Restrictive or Obstructive pulmonary disease or severe degree.
- •Chronic renal insufficiency in stage V (estimated glomerular filtration rate <15 ml / min / m2) or patient previously included in known dialysis program.
- •Participation in another clinical trial randomized at the time of inclusion.
- •Temperature ≥38 ° C or diagnosis of pneumonia.
研究组 & 干预措施
CA125 guided strategy
In this group loop diuretic (Furosemide) dosage will be guided by Carbohydrate Antigen 125 (CA125) plasma levels
干预措施: CA125 guided strategy (Drug)
Conventional strategy
Standard treatment strategy Therapy is based on established european guidelines
干预措施: Conventional Strategy (Drug)
结局指标
主要结局
Change in renal function (GFR)
时间窗: 24 and 72 hours
Glomerular filtration rate (GFR) estimated by MDRD. Prespecified interim analysis of primary outcome will be made by protocol when first 100 patients are included.
次要结局
- Improvement in signs and symptoms of heart failure (NYHA)(24 and 72 hours)
- Improvement in signs and symptoms of heart failure (VAS)(24 and 72 hours)
- Changes in plasma levels of natriuretic peptide (NT-proBNP)(72 hours)
- Changes in plasma levels of high sensitive troponin(72 hours)
- Time required to change intravenous diuretics to oral administration.(Through study completion (30-day follow-up))
- Composite of all-cause mortality plus acute heart failure related rehospitalization(30 days)
- Change in renal function (urea)(24 h, 72 h and 30 days)
- Change in renal function (creatinin)(24 h, 72 h and 30 days)
- Change in renal function (cystatin C)(24 h, 72 h and 30 days)
研究者
Julio Nuñez
MD, PhD
Fundación para la Investigación del Hospital Clínico de Valencia