title: Incidence and predictors of development of acute renal failure related to treatment of congestive heart failure with ACE inhibitors.
abstract: 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.
authors.affiliation: Bahian School of Medicine and Public Health, Salvador-Bahia, Brazil. conscruz@terra.com.br
authors.forename: Constança S
authors.initials: CS
authors.lastname: Cruz
authors.forename: Luzia S
authors.initials: LS
authors.lastname: Cruz
authors.forename: Giulliana R
authors.initials: GR
authors.lastname: Silva
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Marcílio de Souza
mesh_terms: 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
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine; D011188:Potassium