Incidence and predictors of development of acute renal failure related to treatment of congestive heart failure with ACE inhibitors.
OBJECTIVE
Recent studies have shown high rates of morbimortality associated with hyperkalemia in congestive heart failure (CHF) patients treated with angiotensin-converting enzyme inhibitors (ACEI) plus spironolactone and the best predictor of this electrolytic disorder was a decrease in renal function. We aim to identify the incidence and predictors of acute renal failure (ARF) related to treatment with ACEI associated or not with spironolactone.


METHODS
We conducted a cohort study and followed 114 consecutive cases of CHF patients treated with ACEI at admission to a University Hospital. We performed measurements of serum creatinine and potassium levels three times a week, and systolic and diastolic blood pressures every 8 h, daily.


RESULTS
Among 114 patients, 25% developed ARF, 15% hyperkalemia and 3% severe hyperkalemia. Predictors of ARF were a decrease in average blood pressure 25 mm Hg (OR 18.2; 95% CI: 6.2, 53.5); class IV CHF (OR 4.7; 95% CI: 1.7, 12.7), diabetes (OR 2.6; 95% CI: 1.1, 6.4) and hypertension (OR 3.0; 95% CI: 1.2, 7.4).


CONCLUSIONS
ARF and hyperkalemia are common complications in CHF patients after treatment with ACEI. Diabetic, hypertensive and class IV CHF patients who experienced a decrease in average blood pressure 25 mm Hg were more susceptible to ARF.
Cruz
Constança S
CS
Bahian School of Medicine and Public Health, Salvador-Bahia, Brazil. conscruz@terra.com.br
Cruz
Luzia S
LS
Silva
Giulliana R
GR
Marcílio de Souza
Carlos A
CA
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index
D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine; D011188:Potassium