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Prognostic implications of renal dysfunction in patients hospitalized with heart failure: data from the last decade of clinical investigations

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Abstract

Numerous studies over the last decade have demonstrated that renal dysfunction and worsening renal function (WRF) are common in patients hospitalized for heart failure (HHF) and appear to be associated with poor in-hospital and post-discharge outcomes. Unfortunately, its etiology has not been completely understood, and its prediction during hospitalization remains challenging. The evaluation of renal impairment during hospitalization should take into consideration the underlying renal substrate (e.g., predisposing clinical comorbidities such as diabetes and hypertension), initiating mechanisms (e.g., in-hospital therapies such as diuretics), and amplifying factors (neurohormonal and hemodynamic profile changes). Various patterns of WRF may have different prognostic implications and may require different therapeutic approaches. WRF may be initially classified by duration (transient vs. persistent) and by etiology (elevated venous pressures vs. arterial underfilling). Other critical contributing factors during hospitalization include progressive left ventricular dysfunction, neurohormonal activation, and medications. Transient WRF as a result of aggressive therapy targeting congestion may not be associated with poor outcomes. Persistent WRF seen in patients with severe hemodynamic derangements may be associated with poor post-discharge prognosis. Future investigations must clarify the pathophysiological correlates of various patterns of WRF. To date, there is an unmet clinical need to achieve adequate control over congestion while preserving renal function in HHF patients. Thus, the aim of this review is to provide an in-depth and critical interpretation of the available data on the prognostic importance of RD and WRF during hospitalization in an effort to improve HF management.

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Abbreviations

ACEi:

Angiotensin converting enzymes inhibitors

AKI:

Acute kidney injury

ARB:

Angiotensin receptor blocker

BUN:

Blood urea nitrogen

CGE:

Cockcroft-Gault equation

CAD:

Coronary artery diseases

CI:

Confidence interval

CO:

Cardiac output

CrCl:

Creatinine clearance

EF:

Ejection fraction

GFR:

Glomerular filtration rate

HF:

Heart failure

HHF:

Hospitalized for heart failure

HR:

Hazard ratio

LV:

Left ventricular

MDRD:

Modification of diet in renal disease

NYHA:

New York heart association

OR:

Odds ratio

RD:

Renal dysfunction

RR:

Relative risk

SBP:

Systolic blood pressure

sCr:

Serum creatinine

References

  1. Jones CA, McQuillan GM, Kusek JW, Eberhardt MS, Herman WH, Coresh J, Salive M, Jones CP, Agodoa LY (1998) Serum creatinine levels in the US population: third national health and nutrition examination survey. Am J Kidney Dis 32(6):992–999

    Article  PubMed  CAS  Google Scholar 

  2. Devereux RB, Roman MJ, Liu JE, Welty TK, Lee ET, Rodeheffer R, Fabsitz RR, Howard BV (2000) Congestive heart failure despite normal left ventricular systolic function in a population-based sample: the strong heart study. Am J Cardiol 86(10):1090–1096

    Article  PubMed  CAS  Google Scholar 

  3. Luke RG (1998) Chronic renal failure–a vasculopathic state. N Engl J Med 339(12):841–843. doi:10.1056/NEJM199809173391211

    Article  PubMed  CAS  Google Scholar 

  4. Reis SE, Olson MB, Fried L, Reeser V, Mankad S, Pepine CJ, Kerensky R, Merz CN, Sharaf BL, Sopko G, Rogers WJ, Holubkov R (2002) Mild renal insufficiency is associated with angiographic coronary artery disease in women. Circulation 105(24):2826–2829

    Article  PubMed  Google Scholar 

  5. Chae CU, Albert CM, Glynn RJ, Guralnik JM, Curhan GC (2003) Mild renal insufficiency and risk of congestive heart failure in men and women  > or = 70 years of age. Am J Cardiol 92(6):682–686

    Article  PubMed  Google Scholar 

  6. Bibbins-Domingo K, Chertow GM, Fried LF, Odden MC, Newman AB, Kritchevsky SB, Harris TB, Satterfield S, Cummings SR, Shlipak MG (2006) Renal function and heart failure risk in older black and white individuals: the health, aging, and body composition study. Arch Intern Med 166(13):1396–1402. doi:10.1001/archinte.166.13.1396

    Article  PubMed  Google Scholar 

  7. Ezekowitz J, McAlister FA, Humphries KH, Norris CM, Tonelli M, Ghali WA, Knudtson ML (2004) The association among renal insufficiency, pharmacotherapy, and outcomes in 6,427 patients with heart failure and coronary artery disease. J Am Coll Cardiol 44(8):1587–1592. doi:10.1016/j.jacc.2004.06.072

    Article  PubMed  Google Scholar 

  8. Aronson D, Mittleman MA, Burger AJ (2004) Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure. Am J Med 116(7):466–473. doi:10.1016/j.amjmed.2003.11.014

    Article  PubMed  CAS  Google Scholar 

  9. Ismailov RM, Goldberg RJ, Lessard D, Spencer FA (2007) Decompensated heart failure in the setting of kidney dysfunction: a community-wide perspective. Nephron Clin Pract 107(4):c147–c155. doi:10.1159/000110035

    Article  PubMed  Google Scholar 

  10. Filippatos G, Rossi J, Lloyd-Jones DM, Stough WG, Ouyang J, Shin DD, O’Connor C, Adams KF, Orlandi C, Gheorghiade M (2007) Prognostic value of blood urea nitrogen in patients hospitalized with worsening heart failure: insights from the Acute and chronic therapeutic impact of a vasopressin antagonist in chronic heart failure (ACTIV in CHF) study. J Card Fail 13(5):360–364. doi:10.1016/j.cardfail.2007.02.005

    Article  PubMed  Google Scholar 

  11. Heywood JT, Fonarow GC, Costanzo MR, Mathur VS, Wigneswaran JR, Wynne J (2007) High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 13(6):422–430. doi:10.1016/j.cardfail.2007.03.011

    Article  PubMed  Google Scholar 

  12. Smilde TD, Hillege HL, Navis G, Boomsma F, de Zeeuw D, van Veldhuisen DJ (2004) Impaired renal function in patients with ischemic and nonischemic chronic heart failure: association with neurohormonal activation and survival. Am Heart J 148(1):165–172. doi:10.1016/j.ahj.2004.02.007

    Article  PubMed  CAS  Google Scholar 

  13. Smilde TD, Hillege HL, Voors AA, Dunselman PH, Van Veldhuisen DJ (2004) Prognostic importance of renal function in patients with early heart failure and mild left ventricular dysfunction. Am J Cardiol 94(2):240–243. doi:10.1016/j.amjcard.2004.03.075

    Article  PubMed  Google Scholar 

  14. Takagi A, Iwama Y, Yamada A, Aihara K, Daida H (2010) Estimated glomerular filtration rate is an independent predictor for mortality of patients with acute heart failure. J Cardiol 55(3):317–321. doi:10.1016/j.jjcc.2009.12.005

    Article  PubMed  Google Scholar 

  15. Grigorian SLVR, Pedreira PM, Gómez OI, Virgós LA, González-Juanatey JR (2006) Renal failure is an independent predictor of mortality in hospitalized heart failure patients and is associated with a worse cardiovascular risk profile. Rev Esp Cardiol 59:99–108

    Article  Google Scholar 

  16. Gotsman I, Zwas D, Planer D, Admon D, Lotan C, Keren A (2010) The significance of serum urea and renal function in patients with heart failure. Medicine (Baltimore) 89(4):197–203. doi:10.1097/MD.0b013e3181e893ee

    Article  CAS  Google Scholar 

  17. Giamouzis G, Kalogeropoulos AP, Georgiopoulou VV, Agha SA, Rashad MA, Laskar SR, Smith AL, Butler J (2009) Incremental value of renal function in risk prediction with the Seattle heart failure model. Am Heart J 157(2):299–305. doi:10.1016/j.ahj.2008.10.007

    Article  PubMed  Google Scholar 

  18. Petretta M, Scopacasa F, Fontanella L, Carlomagno A, Baldissara M, de Simone A, Petretta MP, Bonaduce D (2007) Prognostic value of reduced kidney function and anemia in patients with chronic heart failure. J Cardiovasc Med (Hagerstown) 8(11):909–916. doi:10.2459/JCM.0b013e32801464b6

    Article  Google Scholar 

  19. Vaz Perez A, Otawa K, Zimmermann AV, Stockburger M, Muller-Werdan U, Werdan K, Schmidt HB, Ince H, Rauchhaus M (2010) The impact of impaired renal function on mortality in patients with acutely decompensated chronic heart failure. Eur J Heart Fail 12(2):122–128. doi:10.1093/eurjhf/hfp184

    Article  PubMed  Google Scholar 

  20. Krumholz HM, Chen YT, Vaccarino V, Wang Y, Radford MJ, Bradford WD, Horwitz RI (2000) Correlates and impact on outcomes of worsening renal function in patients > or = 65 years of age with heart failure. Am J Cardiol 85(9):1110–1113

    Article  PubMed  CAS  Google Scholar 

  21. Gottlieb SS, Abraham W, Butler J, Forman DE, Loh E, Massie BM, O’Connor CM, Rich MW, Stevenson LW, Young J, Krumholz HM (2002) The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 8(3):136–141

    Article  PubMed  Google Scholar 

  22. Klein L, Massie BM, Leimberger JD, O’Connor CM, Pina IL, Adams KF Jr, Califf RM, Gheorghiade M (2008) Admission or changes in renal function during hospitalization for worsening heart failure predict postdischarge survival: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF). Circ Heart Fail 1(1):25–33. doi:10.1161/CIRCHEARTFAILURE.107.746933

    Article  PubMed  CAS  Google Scholar 

  23. Hata N, Yokoyama S, Shinada T, Kobayashi N, Shirakabe A, Tomita K, Kitamura M, Kurihara O, Takahashi Y (2010) Acute kidney injury and outcomes in acute decompensated heart failure: evaluation of the RIFLE criteria in an acutely ill heart failure population. Eur J Heart Fail 12(1):32–37. doi:10.1093/eurjhf/hfp169

    Article  PubMed  Google Scholar 

  24. Smith GL, Vaccarino V, Kosiborod M, Lichtman JH, Cheng S, Watnick SG, Krumholz HM (2003) Worsening renal function: what is a clinically meaningful change in creatinine during hospitalization with heart failure? J Card Fail 9(1):13–25. doi:10.1054/jcaf.2003.3

    Article  PubMed  CAS  Google Scholar 

  25. Cowie MR, Komajda M, Murray-Thomas T, Underwood J, Ticho B (2006) Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur Heart J 27(10):1216–1222. doi:10.1093/eurheartj/ehi859

    Article  PubMed  Google Scholar 

  26. Chittineni H, Miyawaki N, Gulipelli S, Fishbane S (2007) Risk for acute renal failure in patients hospitalized for decompensated congestive heart failure. Am J Nephrol 27(1):55–62. doi:10.1159/000099012

    Article  PubMed  Google Scholar 

  27. Lassus JP, Nieminen MS, Peuhkurinen K, Pulkki K, Siirila-Waris K, Sund R, Harjola VP (2010) Markers of renal function and acute kidney injury in acute heart failure: definitions and impact on outcomes of the cardiorenal syndrome. Eur Heart J 31(22):2791–2798. doi:10.1093/eurheartj/ehq293

    Article  PubMed  CAS  Google Scholar 

  28. Metra M, Nodari S, Parrinello G, Bordonali T, Bugatti S, Danesi R, Fontanella B, Lombardi C, Milani P, Verzura G, Cotter G, Dittrich H, Massie BM, Dei Cas L (2008) Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance. Eur J Heart Fail 10(2):188–195. doi:10.1016/j.ejheart.2008.01.011

    Article  PubMed  Google Scholar 

  29. Aronson D, Burger AJ (2010) The relationship between transient and persistent worsening renal function and mortality in patients with acute decompensated heart failure. J Card Fail 16(7):541–547. doi:10.1016/j.cardfail.2010.02.001

    Article  PubMed  Google Scholar 

  30. Lanfear DE, Peterson EL, Campbell J, Phatak H, Wu D, Wells K, Spertus JA, Williams LK (2011) Relation of worsened renal function during hospitalization for heart failure to long-term outcomes and rehospitalization. Am J Cardiol 107(1):74–78. doi:10.1016/j.amjcard.2010.08.045

    Article  PubMed  Google Scholar 

  31. Belziti CA, Bagnati R, Ledesma P, Vulcano N, Fernandez S (2010) Worsening renal function in patients admitted with acute decompensated heart failure: incidence, risk factors and prognostic implications. Rev Esp Cardiol 63(3):294–302

    Article  PubMed  Google Scholar 

  32. Forman DE, Butler J, Wang Y, Abraham WT, O’Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW, Young JB, Krumholz HM (2004) Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 43(1):61–67

    Article  PubMed  Google Scholar 

  33. Kociol RD, Greiner MA, Hammill BG, Phatak H, Fonarow GC, Curtis LH, Hernandez AF (2010) Long-term outcomes of medicare beneficiaries with worsening renal function during hospitalization for heart failure. Am J Cardiol 105(12):1786–1793. doi:10.1016/j.amjcard.2010.01.361

    Article  PubMed  Google Scholar 

  34. Patel UD, Greiner MA, Fonarow GC, Phatak H, Hernandez AF, Curtis LH (2010) Associations between worsening renal function and 30-day outcomes among Medicare beneficiaries hospitalized with heart failure. Am Heart J 160(1):132–138 e131. doi:10.1016/j.ahj.2010.03.033

    Google Scholar 

  35. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R (2008) Cardiorenal syndrome. J Am Coll Cardiol 52(19):1527–1539. doi:10.1016/j.jacc.2008.07.051

    Article  PubMed  Google Scholar 

  36. Garg AX, Clark WF, Haynes RB, House AA (2002) Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int 61(4):1486–1494. doi:10.1046/j.1523-1755.2002.00270.x

    Article  PubMed  Google Scholar 

  37. Tracy RE, Malcom GT, Oalmann MC, Newman WP 3rd, Guzman MA (1994) Nephrosclerosis, glycohemoglobin, cholesterol, and smoking in subjects dying of coronary heart disease. Mod Pathol 7(3):301–309

    PubMed  CAS  Google Scholar 

  38. Gheorghiade M, Pang PS, Ambrosy AP, Lan G, Schmidt P, Filippatos G, Konstam M, Swedberg K, Cook T, Traver B, Maggioni A, Burnett J, Grinfeld L, Udelson J, Zannad F (2011) A comprehensive, longitudinal description of the in-hospital and post-discharge clinical, laboratory, and neurohormonal course of patients with heart failure who die or are re-hospitalized within 90 days: analysis from the EVEREST trial. Heart Fail Rev. doi:10.1007/s10741-011-9280-0

    Google Scholar 

  39. Koobi P, Kalliovalkama J, Jolma P, Rysa J, Ruskoaho H, Vuolteenaho O, Kahonen M, Tikkanen I, Fan M, Ylitalo P, Porsti I (2003) AT1 receptor blockade improves vasorelaxation in experimental renal failure. Hypertension 41(6):1364–1371. doi:10.1161/01.HYP.0000073782.30879.16

    Article  PubMed  Google Scholar 

  40. Magri P, Rao MA, Cangianiello S, Bellizzi V, Russo R, Mele AF, Andreucci M, Memoli B, De Nicola L, Volpe M (1998) Early impairment of renal hemodynamic reserve in patients with asymptomatic heart failure is restored by angiotensin II antagonism. Circulation 98(25):2849–2854

    Article  PubMed  CAS  Google Scholar 

  41. Mullens W, Abrahams Z, Francis GS, Sokos G, Taylor DO, Starling RC, Young JB, Tang WH (2009) Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol 53(7):589–596. doi:10.1016/j.jacc.2008.05.068

    Article  PubMed  Google Scholar 

  42. Nohria A, Hasselblad V, Stebbins A, Pauly DF, Fonarow GC, Shah M, Yancy CW, Califf RM, Stevenson LW, Hill JA (2008) Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 51(13):1268–1274. doi:10.1016/j.jacc.2007.08.072

    Article  PubMed  Google Scholar 

  43. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O’Connor CM (2011) Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364(9):797–805. doi:10.1056/NEJMoa1005419

    Article  PubMed  CAS  Google Scholar 

  44. Testani JM, Coca SG, McCauley BD, Shannon RP, Kimmel SE (2011) Impact of changes in blood pressure during the treatment of acute decompensated heart failure on renal and clinical outcomes. Eur J Heart Fail 13(8):877–884. doi:10.1093/eurjhf/hfr070

    Article  PubMed  Google Scholar 

  45. Blair JE, Pang PS, Schrier RW, Metra M, Traver B, Cook T, Campia U, Ambrosy A, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, Udelson JE, Zannad F, Konstam MA, Gheorghiade M (2011) Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial. Eur Heart J 32(20):2563–2572. doi:10.1093/eurheartj/ehr238

    Article  PubMed  Google Scholar 

  46. Ruggenenti P, Remuzzi G (2011) Worsening kidney function in decompensated heart failure: treat the heart, don’t mind the kidney. Eur Heart J 32(20):2476–2478. doi:10.1093/eurheartj/ehr242

    Article  PubMed  Google Scholar 

  47. Testani JM, McCauley BD, Chen J, Coca SG, Cappola TP, Kimmel SE (2011) Clinical characteristics and outcomes of patients with improvement in renal function during the treatment of decompensated heart failure. J Card Fail 17(12):993–1000. doi:10.1016/j.cardfail.2011.08.009

    Article  PubMed  Google Scholar 

  48. Brandimarte F, Mureddu GF, Boccanelli A, Cacciatore G, Brandimarte C, Fedele F, Gheorghiade M (2010) Diuretic therapy in heart failure: current controversies and new approaches for fluid removal. J Cardiovasc Med (Hagerstown) 11(8):563–570. doi:10.2459/JCM.0b013e3283376bfa

    Article  Google Scholar 

  49. Butler J, Forman DE, Abraham WT, Gottlieb SS, Loh E, Massie BM, O’Connor CM, Rich MW, Stevenson LW, Wang Y, Young JB, Krumholz HM (2004) Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Heart J 147(2):331–338. doi:10.1016/j.ahj.2003.08.012

    Article  PubMed  Google Scholar 

  50. Ljungman S, Laragh JH, Cody RJ (1990) Role of the kidney in congestive heart failure. Relationship of cardiac index to kidney function. Drugs 39(Suppl 4):10–21; discussion 22–14

    Article  PubMed  Google Scholar 

  51. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, Stough WG, Yancy CW, Young JB, Fonarow GC (2006) Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 296(18):2217–2226. doi:10.1001/jama.296.18.2217

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

Filippo Brandimarte, MD: None; Muthiah Vaduganathan, MD MPH: None; Gian francesco Mureddu, MD: None; Giuseppe Cacciatore, MD: None; Hani N. Sabbah, PhD: Research Grants from Bayer Healthcare AG, Johnson and Johnson, Stealth Peptides, Sigma Tau, Consultant to Bayer Healthcare AG, and Johnson and Johnson; Gregg C. Fonarow, MD: Consultant for Novartis, Medtronic, and Takeda; Steven R. Goldsmith, MD: Consultant for Astellas and Otsuka; Javed Butler, MD MPH: Consultant to Cardiomems, Trevena, Bayer Healthcare, Takeda, and Amgen; Events Committee for WorldHeart and Corthera, Research Support, GE Healthcare, Medtronic, National Heart Lung and Blood Institute, National Institutes of Health; Francesco Fedele, MD: None; Mihai Gheorghiade, MD: Consultant – Abbott Laboratories (modest), Astellas (modest), Astra Zeneca (modest), Bayer Schering Pharma AG (significant), CorThera, Inc (modest), Cytokinetics, Inc (modest), DebioPharm SA (significant), Errekappa Terapeutici (Milan, Italy) (modest), GlaxoSmithKline (modest), Johnson & Johnson (modest), Medtronic (significant), Merck (modest), Novartis Pharma AG (significant), Otsuka Pharmaceuticals (significant), Pericor Therapeutics (significant), Protein Design Laboratories (modest), Sanofi-Aventis (modest), Sigma Tau (significant), Solvay Pharmaceuticals (significant).

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Authors and Affiliations

  1. Department of Cardiovascular Disease, San Giovanni—Addolorata Community Hospital, Rome, Italy

    Filippo Brandimarte, Gian Francesco Mureddu & Giuseppe Cacciatore

  2. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Muthiah Vaduganathan

  3. Department of Medicine, Henry Ford Hospital, Detroit, MI, USA

    Hani N. Sabbah

  4. Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA

    Gregg C. Fonarow

  5. Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA

    Steven R. Goldsmith

  6. Heart Failure Research, Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA

    Javed Butler

  7. Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Diseases, Sapienza University, Rome, Italy

    Francesco Fedele

  8. Center for Cardiovascular Innovation, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA

    Mihai Gheorghiade

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  1. Filippo Brandimarte
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  2. Muthiah Vaduganathan
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  8. Javed Butler
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Correspondence to Filippo Brandimarte.

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Brandimarte, F., Vaduganathan, M., Mureddu, G.F. et al. Prognostic implications of renal dysfunction in patients hospitalized with heart failure: data from the last decade of clinical investigations. Heart Fail Rev 18, 167–176 (2013). https://doi.org/10.1007/s10741-012-9317-z

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