Protecting the Kidney During HF Therapy: The ROSE-AHF Study

Eddie L. Greene, MD; Horng H. Chen, MB, BCh; Margaret Redfield, MD


December 10, 2013

Editorial Collaboration

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Eddie L. Greene, MD: Welcome to We're here at the Mayo Clinic with 2 of my colleagues from the Heart Failure Study Group, Dr. Margaret Redfield and Dr. Horng Chen. I'm Eddie Greene. I'm a nephrologist here at the Mayo Clinic, and I work closely with our heart failure group to optimize the care of patients with heart failure and kidney disease. Welcome, Dr. Chen, and welcome, Dr. Redfield.

We're here to talk about the optimization of therapies to reduce the volume overload in patients with acute decompensated heart failure who also have renal dysfunction. As you both know, it's a very common problem and an important problem that causes significant morbidity in our patients and prolongs hospital stays, causes multiple readmissions, and also increases the cost of heart failure-- sometimes estimates suggest as high as 80% above normal hospitalization cost. We're here to talk about that and mention one of the very new studies that have come up, the ROSE-AHF study (renal optimization strategies and evaluation for treatment of patients with acute heart failure).[1] I'd like you to tell us a little bit about that study, and what did it test and its importance, for the audience.

Horng H. Chen, MB, BCh: Great. Maybe I'll start, Maggie. The ROSE-AHF study was done as part of the National Heart, Lung, and Blood Institute Heart Failure Clinical Research Network study. It targets patients with acute heart failure and renal dysfunction, and as we know, these patients are at risk for inadequate decongestion and worsening renal function during acute therapy. As you have stated before, that is also associated with worse outcomes. It is a study that is designed to test 2 independent hypotheses, the first being low-dose dopamine and the second being low-dose nesiritide. If we add these medications to standardized diuretic therapy, will we enhance diuresis and natriuresis? Our target population of patients was those admitted for acute decompensated heart failure with renal dysfunction with an estimated glomerular filtration rate (GFR) between 15 and 16 mL/min.

Dr. Greene: Those patients are usually very difficult to diurese. Dr. Redfield, would you like to make any points about your experience with those patients?

Margaret Redfield, MD: Well, they are often very difficult to diurese, or if you start to diurese them, then the creatinine starts going up, and you're in this conundrum where you don't want to worsen the kidneys but you recognize that you really need to get the patient adequately decongested. They are a tough population. And quite frequently you can't adequately diurese them, and their creatinine goes up. But it doesn't happen all the time. This study really looked at the patients who are at increased risk -- ie, those with acute heart failure with renal dysfunction -- and asked whether we should prophylactically treat them with these agents (either dopamine or nesiritide) or should we wait and see who we can't decongest and who gets the worsening renal function, and then just use these therapies in those situations. This was a new kind of concept to prophylactically target this group.


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