Relationship between heart failure treatment and development of worsening renal function among hospitalized patients.
BACKGROUND
Among patients who are hospitalized with heart failure (HF), worsening renal function (WRF) is associated with worse outcomes. Whether treatment for HF contributes to WRF is unknown. In this study, we sought to assess whether acute treatment for patients who were hospitalized with HF contributes to WRF.


METHODS
Data were collected in a nested case-control study on 382 subjects who were hospitalized with HF (191 patients with WRF, defined as a rise in serum creatinine level >26.5 micromol/L [0.3 mg/dL], and 191 control subjects). The association of medications, fluid intake/output, and weight with WRF was assessed.


RESULTS
Calcium channel blocker (CCB) use and loop diuretic doses were higher in patients on the day before WRF (25% vs 10% for CCB; 199 +/- 195 mg vs 143 +/- 119 mg for loop diuretics; both P <.05). There were no significant differences in the fluid intake/output or weight changes in the 2 groups. Angiotensin-converting enzyme (ACE) inhibitor use was not associated with WRF. Other predictors of WRF included elevated creatinine level at admission, uncontrolled hypertension, and history of HF or diabetes mellitus. Higher hematocrit levels were associated with a lower risk. Vasodilator use was higher among patients on the day before WRF (46% vs 35%, P <.05), but was not an independent predictor in the multivariable analysis.


CONCLUSIONS
Several medical strategies, including the use of CCBs and a higher dose of loop diuretics, but not ACE inhibitors, were associated with a higher risk of WRF. Although assessment of inhospital diuresis was limited, WRF could not be explained by greater fluid loss in these patients. Determining whether these interventions are responsible for WRF or are markers of higher risk requires further investigation.
Butler
Javed
J
Vanderbilt University, Nashville, Tenn, USA. javed.butler@vanderbilt.edu
Forman
Daniel E
DE
Abraham
William T
WT
Gottlieb
Stephen S
SS
Loh
Evan
E
Massie
Barry M
BM
O'Connor
Christopher M
CM
Rich
Michael W
MW
Stevenson
Lynne Warner
LW
Wang
Yongfei
Y
Young
James B
JB
Krumholz
Harlan M
HM
D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D004232:Diuretics; D003404:Creatinine