title: Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction.
abstract: OBJECTIVE
  We sought to evaluate the relationship between the level of kidney function, level of hematocrit and their interaction on all-cause mortality in patients with left ventricular (LV) dysfunction.
  
  
  BACKGROUND
  Anemia and reduced kidney function occur frequently in patients with heart failure. The level of hematocrit and its relationship with renal function have not been evaluated as risk factors for mortality in patients with LV dysfunction.
  
  
  METHODS
  We retrospectively examined the Studies Of LV Dysfunction (SOLVD) database. Glomerular filtration rate (GFR) was predicted using a recently validated formula. Kaplan-Meier survival analyses were used to compare survival times between groups stratified by level of kidney function (predicted GFR) and hematocrit. Cox proportional-hazards regression was used to explore the relationship of survival time to level of kidney function, hematocrit and their interaction.
  
  
  RESULTS
  Lower GFR and hematocrit were associated with a higher prevalence of traditional cardiovascular risk factors. In univariate analysis, reduced kidney function and lower hematocrit, in men and in women, were risk factors for all-cause mortality (p < 0.001 for both). After adjustment for other factors significant in univariate analysis, a 10 ml/min/1.73 m(2) lower GFR and a 1% lower hematocrit were associated with a 1.064 (95% CI: 1.033, 1.096) and 1.027 (95% CI: 1.015, 1.038) higher risk for mortality, respectively. At lower GFR and lower hematocrit, the risk was higher (p = 0.022 for the interaction) than that predicted by both factors independently.
  
  
  CONCLUSIONS
  Decreased kidney function and anemia are risk factors for all-cause mortality in patients with LV dysfunction, especially when both are present. These relationships need to be confirmed in additional studies.
authors.affiliation: Division of Cardiology, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
authors.forename: A
authors.initials: A
authors.lastname: Al-Ahmad
authors.forename: W M
authors.initials: WM
authors.lastname: Rand
authors.forename: G
authors.initials: G
authors.lastname: Manjunath
authors.forename: M A
authors.initials: MA
authors.lastname: Konstam
authors.forename: D N
authors.initials: DN
authors.lastname: Salem
authors.forename: A S
authors.initials: AS
authors.lastname: Levey
authors.forename: M J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D004311:Double-Blind Method; D005919:Glomerular Filtration Rate; D006400:Hematocrit; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000503:physiopathology*