# Advanced Kidney Health Monitoring in Persons Hospitalized with Heart Failure

> **NIH NIH R01** · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · 2023 · $114,491

## Abstract

PROJECT SUMMARY
 Heart failure leads to >1.4 million hospitalizations annually in the U.S. During these acute decompensated
heart failure (ADHF) hospitalizations, the kidneys’ health influences almost every aspect of management,
including initial diuretic dosing, treatment intensification, and discharge planning. However, clinical reliance on
serum creatinine, an insensitive, nonspecific and often misleading kidney biomarker, substantially contributes
to suboptimal ADHF treatment. Although guidelines suggest that clinicians use the patient’s kidney function as
an indicator for the initial diuretic dose, the creatinine is actually a poor predictor of diuretic response and
clinicians must resort to “trial and error” in searching for each patient’s optimal dose. Further, although
creatinine elevations during treatment commonly reflect beneficial effects, clinicians typically de-escalate
diuresis from fear of worsening kidney damage. During discharge planning, this fear also drives clinicians to
prescribe an oral diuretic dose that is too low, and to avoid beneficial therapies. These obstacles to ideal care
culminate in delayed symptom relief, prolonged hospitalization, frequent readmissions, and high mortality risk.
 Given the kidney tubules’ central role in determining the effectiveness and safety of ADHF pharmacological
treatment, clinicians need tools that capture kidney tubule health to optimize diuretic strategies, improve
delivery of guideline-directed medical therapy, and minimize the risk for true kidney damage. In ambulatory
settings, our team has demonstrated the remarkable ability of tubule health measures to detect kidney damage
early, to reflect the kidneys’ response to treatment more accurately that creatinine, and to predict long-term
outcomes. Early studies of a few tubule markers in ADHF show that they improve in proportion to diuretic
response and have tremendous potential to change how kidney health is monitored during ADHF treatment.
 Given the central role of kidney health in ADHF treatment and prognosis, our overall goals are to
fundamentally change how clinicians approach kidney health monitoring and clinical decision-making during
ADHF treatment. To achieve these goals, we will capitalize on the well-characterized Mechanisms of Diuretic
Resistance (MDR) Study, a cohort of patients hospitalized for ADHF who have undergone serial biospecimen
collections timed to diuretic treatment throughout hospitalization with longitudinal follow-up for key clinical
outcomes. We will measure a broad panel of kidney biomarkers that reflect tubule reabsorptive and secretory
functions, injury, synthetic and reparative capacity, and tubulointerstitial inflammation and fibrosis. We will
identify which tubule health measures most effectively: 1) predict treatment response to initial loop diuretic
dosing and adjunctive diuretic therapy (Aim 1); 2) discern pseudo- from intrinsic kidney damage among
patients with creatinine elevations during treatment...

## Key facts

- **NIH application ID:** 10733488
- **Project number:** 3R01DK130870-03S1
- **Recipient organization:** NORTHERN CALIFORNIA INSTITUTE/RES/EDU
- **Principal Investigator:** Michelle M Estrella
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $114,491
- **Award type:** 3
- **Project period:** 2021-09-30 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10733488

## Citation

> US National Institutes of Health, RePORTER application 10733488, Advanced Kidney Health Monitoring in Persons Hospitalized with Heart Failure (3R01DK130870-03S1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10733488. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*