The prognostic value of renal dysfunction in patients with chronic heart failure: 12-month follow-up.
BACKGROUND
Renal function assessment is an important element of management and therapeutic decision-making in patients with chronic heart failure (CHF).


OBJECTIVE
To evaluate the prognostic value of renal dysfunction in patients with CHF in 12-month follow-up.


METHODS
639 consecutive patients hospitalised in our department from 1 July 2002 to 31 December 2003 with diagnosis of CHF (NYHA II-IV), based on medical records, were initially enrolled in the study. Patients underwent one-year follow-up. Finally, 498 patients, aged 22-98 years (mean age 69+/-12 years) in whom creatinine concentration was measured and creatinine clearance was estimated at admission with the Cockroft-Gault quotation and with long-term follow-up results obtained, were enrolled in the study. Patients were divided into two groups according to the creatinine level: Group I without renal dysfunction (creatinine level <1.4 mg/dl), and Group II--with renal dysfunction (creatinine level >1.4 mg/dl).


RESULTS
Patients with renal dysfunction were significantly older and more likely to be male and in NYHA class III-IV (p <0.001). Analysis of pharmacotherapy for CHF revealed that patients with renal impairment significantly less frequently received beta-blockers (67% vs 81%, p <0.005), angiotensin-converting enzyme inhibitors (68% vs 82%, p <0.005) and combined treatment of beta-blocker and angiotensin-converting enzyme inhibitor (56% vs 71%, p <0.05), whereas loop diuretics were more frequently prescribed in this group (80% vs 70%, p <0.05). In patients with renal dysfunction, there was a significantly higher mortality rate at 30 days (32% vs 14%, p <0.001) as well as at 12 months (45% vs 20%, p <0.001). The incidence of re-hospitalisation for cardiovascular reasons (CHF worsening, myocardial infarction, stroke) was significantly higher in patients with renal dysfunction (70% vs 55%, p <0.005). Multivariate analysis of all factors affecting one-year mortality demonstrated that renal dysfunction is a strong and independent risk factor for death in patients with CHF (RR=2.13, 95% CI: 1.31-3.45; p <0.05) and it increases the risk of re-hospitalisation (RR=1.53, 95% CI: 1.01-2.14; p <0.05).


CONCLUSIONS
Renal dysfunction is an independent prognostic factor in patients with CHF, which allows identification of a high-risk group and administration of optimal therapy, which in turn can result in a reduction of mortality.
Roik
Marek
M
I Katedra i Klinika Kardiologii AM, ul. Banacha 1a, 02-097 Warszawa, Poland. mfroik@amwaw.edu.pl
Starczewska
Małgorzata H
MH
Stawicki
Sławomir
S
Solarska-Półchłopek
Anna
A
Warszawik
Olga
O
Oreziak
Artur
A
Kochanowski
Janusz
J
Kosior
Dariusz
D
Opolski
Grzegorz
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D020521:Stroke / Q000401:mortality*; D016019:Survival Analysis
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors