title: 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.
abstract: 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.
authors.affiliation: Academic Department of Cardiology, Castle Hill Hospital, University of Hull, Castle Road, Cottingham, Hull HU16 5JQ, UK. ramesh@desilva84.freeserve.co.uk
authors.forename: Ramesh
authors.initials: R
authors.lastname: de Silva
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
authors.forename: Klaus K A
authors.initials: KK
authors.lastname: Witte
authors.forename: Alan S
authors.initials: AS
authors.lastname: Rigby
authors.forename: Kevin
authors.initials: K
authors.lastname: Goode
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhandari
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: 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
chemical_list: D003404:Creatinine