title: Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure.
abstract: OBJECTIVE
  The goal of this study was to determine the prevalence of worsening renal function (WRF) among hospitalized heart failure (HF) patients, clinical predictors of WRF, and hospital outcomes associated with WRF.
  
  
  BACKGROUND
  Impaired renal function is associated with poor outcomes among chronic HF patients.
  
  
  METHODS
  Chart reviews were performed on 1,004 consecutive patients admitted for a primary diagnosis of HF from 11 geographically diverse hospitals. Cox regression model analysis was used to identify independent predictors for WRF, defined as a rise in serum creatinine of >0.3 mg/dl (26.5 micromol/l). Bivariate analysis was used to determine associations of development of WRF with outcomes (in-hospital death, in-hospital complications, and length of stay).
  
  
  RESULTS
  Among 1,004 HF patients studied, WRF developed in 27%. In the majority of cases, WRF occurred within three days of admission. History of HF or diabetes mellitus, admission creatinine > or =1.5 mg/dl (132.6 micromol/l), and systolic blood pressure >160 mm Hg were independently associated with higher risk of WRF. A point score based on these characteristics and their relative risk ratios predicted those at risk for WRF. Hospital deaths (adjusted risk ratio [ARR] 7.5; 95% confidence intervals [CI] 2.9, 19.3), complications (ARR 2.1; CI 1.5, 3.0), and length of hospitalizations >10 days (ARR 3.2, CI 2.2, 4.9) were greater among patients with WRF.
  
  
  CONCLUSIONS
  Worsening renal function occurs frequently among hospitalized HF patients and is associated with significantly worse outcomes. Clinical characteristics available at hospital admission can be used to identify patients at increased risk for developing WRF.
authors.affiliation: Section of Cardiology, Boston Medical Center, Boston, Massachusetts 02188, USA. Daniel.Forman@bmc.org
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Forman
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Gottlieb
authors.forename: Evan
authors.initials: E
authors.lastname: Loh
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rich
authors.forename: Lynne Warner
authors.initials: LW
authors.lastname: Stevenson
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D010343:Patient Admission; D012307:Risk Factors