Macaulay Amechi Chukwukadibia Onuigbo
1,2,3*1 Mayo Clinic College of Medicine, Rochester, MN, USA
2 Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI, USA
3 College of Business, University of Wisconsin MBA Consortium, Wisconsin, USA
Implication for health policy/practice/research/medical education:
The Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart
Failure (GUIDE-IT) study, a randomized clinical trial of nearly 1000 patients with heart
failure and reduced ejection fraction, compared amino-terminal pro-B-type natriuretic
peptide (NT-proBNP)-guided treatment strategy versus usual care. The study failed to
show any differences in the primary end point of the composite of time-to-first heart
failure hospitalization or cardiovascular mortality. Remarkably, despite the proBNPguided
titration in the intervention group, there were no significant differences in medical
therapy over time, between the two groups in relation to percentage exposure to the
ACEI/ARB at 12 months. We had recently shown in a small case series that rising BNP
levels at presentation in patients with type 1 cardiorenal syndrome portended improved
cardiorenal outcomes as well as responsiveness to combination diuretics or decongestive
diuresis. Further larger studies of these observations are warranted.
Please cite this paper as: Onuigbo MAC. The guiding evidence based therapy using
biomarker intensified treatment in heart failure (GUIDE-IT) study; the utility of
decongestive diuresis in type 1 cardiorenal syndrome with rising pro-BNP levels. J
Nephropharmacol. 2018;7(2):66-67.