McCallum W, et al. - Using data from 435 patients recruited in the Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome Study and Diuretic Optimization Strategies Evaluation trial, researchers ascertained the prognostic value of a reduction in kidney function in the context of decongestion among patients admitted with acute decompensated heart failure. In-hospital drop, in estimated GFR (eGFR) was not significantly correlated with death and rehospitalization, whereas a reduction in N-terminal pro-b-type natriuretic peptide (NT-proBNP) was related to lower risk. A notable interaction between the drop in eGFR and alteration in NT-proBNP, where a reduction in eGFR was related to better outcomes when NT-proBNP declined, was noted—but not when NT-proBNP rose. Therefore, during therapy for acute decompensated heart failure, a reduction in kidney function was found to be correlated with enhanced outcomes, as long as NT-proBNP levels are declining as well, suggesting that the incorporation of congestion biomarkers may help in clinical interpretation of eGFR reducitons.