Effect on kidney function recovery guiding decongestion with VExUS in patients with cardiorenal syndrome 1, a randomized control trial

Introduction: In cardiorenal syndrome type 1 (CRS1) vascular congestion is central to the pathophysiology of heart failure and thus a key target for management. The Venous Evaluation by Ultrasound System (VExUS) could guide decongestion effectively and thereby improve outcomes. Methods: In this randomized clinical trial, patients with CRS1 (i.e., increase in creatinine ≥0.3 mg/dL) were randomized to guide decongestion with VExUS compared to usual clinical evaluation. The primary endpoint was to assess kidney function recovery (KFR), and the key secondary endpoint was decongestion evaluated by physical examination and changes in brain natriuretic peptide (BNP) and CA-125. Exploratory endpoints included days of hospitalization and mortality. Results: From March 2022 to February 2023, a total of 140 patients were randomized 1:1 (70 in the VExUS and 70 in the Control group). KFR was not statistically different between groups. However, VExUS improved more than twice the odds to achieve decongestion (OR 2.6, 95% CI 1.9-3.0, p=0.01) and the odds to reach a decrease of BNP >30% (OR 2.4; 95% CI 1.3-4.1, p = 0.01). The survival at 90 days, recongestion and CA-125 were similar between groups. Conclusion: In patients with CRS1, we observed that VExUS-guided decongestion did not improve the probability of KFR but improved the odds to achieve decongestion.