Background
Patients with chronic heart failure (HF) have a higher prevalence of renal dysfunction and are prone to poor prognosis. However, there are little data for the impact of renal function at admission to patients with acute decompensated HF (ADHF). Thus, this study was designed to evaluate whether admission renal function is predictive of in-hospital and short-term (6 months) cardiac events in ADHF.
Methods
Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease formula in 2,679 (83.7%) from 3,200 hospitalization patients in the Korean acute Heart Failure (KorHF) Registry, and cardiac events were assessed by GFR quartiles in the entire cohort. Cardiac events were defined as death or readmission for HF, whichever came first, measured within 6 months after cardiac index event.
Results
At admission, only 318 patients (11.9%) had normal renal function (GFR �돟 90 mL/min/1.73m2). A total of 647 events (24.2%) occurred including 326 deaths and 321 HFs. There was a significant correlation between cardiac events and renal dysfunction; 17.6% events in GFR �돟 90, 19.7% in 60 �돞 GFR < 90, 24.5% in 30 �돞 GFR < 60 and 40.1% in GFR < 30, p < 0.001. On univariate analysis, renal parameters such as BUN, Cr and GFR were significant prognostic markers (HR 1.02, vs. HR 1.11 vs. HR 0.99, all p < 0.001, respectively). Furthermore, in multivariate analysis, patients with severe renal dysfunction of GFR < 30 had increased clinical deterioration with nearly two-fold higher risk of cardiac events (HR 1.95, 95% CI 1.08 to 3.51) after adjustment for significant variables that affected clinical outcomes.
Conclusions
Renal dysfunction according to GFR is not uncommon in patients hospitalized for ADHF. Importantly, reduced renal function at admission is a significant predictor of short-term cardiac events in ADHF.
|
