Renal function, neurohormonal activation, and survival in patients with chronic heart failure.
BACKGROUND
Because renal function is affected by chronic heart failure (CHF) and it relates to both cardiovascular and hemodynamic properties, it should have additional prognostic value. We studied whether renal function is a predictor for mortality in advanced CHF, and we assessed its relative contribution compared with other established risk factors. In addition, we studied the relation between renal function and neurohormonal activation.


RESULTS
The study population consisted of 1906 patients with CHF who were enrolled in a recent survival trial (Second Prospective Randomized study of Ibopamine on Mortality and Efficacy). In a subgroup of 372 patients, plasma neurohormones were determined. The baseline glomerular filtration rate (GFR(c)) was calculated using the Cockroft Gault equation. GFR(c) was the most powerful predictor of mortality; it was followed by New York Heart Association functional class and the use of angiotensin-converting enzyme inhibitors. Patients in the lowest quartile of GFR(c) values (<44 mL/min) had almost 3 times the risk of mortality (relative risk, 2. 85; P<0.001) of patients in the highest quartile (>76 mL/min). Impaired left ventricular ejection fraction (LVEF) was only modestly predictive (P=0.053). GFR(c) was inversely related with N-terminal atrial natriuretic peptide (ANP; r=-0.53) and, to a lesser extent, with ANP itself (r=-0.35; both P<0.001).


CONCLUSIONS
Impaired renal function (GFR(c)) is a stronger predictor of mortality than impaired cardiac function (LVEF and New York Heart Association class) in advanced CHF, and it is associated with increased levels of N-terminal ANP. Moreover, impaired renal function was not related to LVEF, which suggests that factors other than reduced cardiac output are causally involved.
Hillege
H L
HL
Department of Clinical Pharmacology, State University Groningen, The Netherlands.
Girbes
A R
AR
de Kam
P J
PJ
Boomsma
F
F
de Zeeuw
D
D
Charlesworth
A
A
Hampton
J R
JR
van Veldhuisen
D J
DJ
D000368:Aged; D000450:Aldosterone / Q000097:blood*; D009320:Atrial Natriuretic Factor / Q000097:blood; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002395:Catecholamines / Q000097:blood*; D002908:Chronic Disease; D003846:Deoxyepinephrine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004298:Dopamine / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000145:classification / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009518:New York; D009638:Norepinephrine / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000502:physiology*; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000145:classification / Q000188:drug therapy / Q000401:mortality; D016277:Ventricular Function, Left
D002316:Cardiotonic Agents; D002395:Catecholamines; C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; C023487:ibopamine; D012083:Renin; D003846:Deoxyepinephrine; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine