Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis.
OBJECTIVE
To determine the prevalence and incidence of renal dysfunction (RD) in patients with chronic heart failure (CHF), to identify contributory factors and predictors of worsening renal function (WRF), and to explore the relationship between RD and mortality.


RESULTS
Prospective data on 1216 patients with CHF were analysed. The glomerular filtration rate (GFR) was used to determine renal function, and WRF was defined as an increase in serum creatinine of >26.5 micromol/L (>0.3 mg/dL). The prevalence of RD defined as a GFR of <60 mL/min was 57%. During 6 months, WRF occurred in 161 (13.0%) patients. Predictors of WRF were vascular disease, the use of thiazide diuretics, and a baseline urea >9 mmol/L. Two hundred and sixty-three (21.6%) patients died, and baseline RD and WRF both predicted a higher mortality (P<0.001), whereas an improvement in renal function over the first 6 months predicted a lower mortality (hazard ratio 0.8, 95% confidence interval 0.6-1.0).


CONCLUSIONS
In ambulatory patients with CHF, RD is common, commonly deteriorates over a relatively short period of time, is unlikely to recover substantially, and augurs a poor prognosis.
de Silva
Ramesh
R
Academic Department of Cardiology, Castle Hill Hospital, University of Hull, Castle Road, Cottingham, Hull HU16 5JQ, UK. ramesh@desilva84.freeserve.co.uk
Nikitin
Nikolay P
NP
Witte
Klaus K A
KK
Rigby
Alan S
AS
Goode
Kevin
K
Bhandari
Sunil
S
Clark
Andrew L
AL
Cleland
John G F
JG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012043:Regression, Psychology; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
D003404:Creatinine