Risk for acute renal failure in patients hospitalized for decompensated congestive heart failure.
BACKGROUND
Congestive heart failure (CHF) is an important cause of hospital admissions and is associated with an increased risk for development of acute renal failure (ARF). The purpose of this study was to describe the incidence of ARF, to ascertain risk factors for its development, and to determine whether ARF impacts hospital outcomes.


METHODS
Review was conducted of 509 hospital medical records of patients hospitalized with a principal diagnosis of CHF during 2004. ARF was defined as an increase in serum creatinine of 0.5 mg/dl compared to the admission value. Multivariable analysis was used to identify independent predictors of ARF.


RESULTS
Most patients had reduced renal function at the time of admission with mean serum creatinine of 1.45 +/- 0.72 and calculated creatinine clearance of 43.1 ml/min. ARF developed during the hospitalization in 21% of patients, with a peak increase in serum creatinine of 0.5-3.3 mg/dl. Most cases occurred on hospital days 4-6 (69.5% of cases). ARF was associated with increased risk for in-hospital mortality and increased length of hospital stay. Risk factors for ARF included diabetes, elevated admission serum creatinine and reduced serum sodium and echocardiographic demonstration of diastolic dysfunction. Neither diuretic nor ACEI/ARB treatment was associated with increased risk.


CONCLUSIONS
ARF is a common complication among patients hospitalized for CHF, and is associated with increased risk for adverse outcomes. Certain clinical characteristics present at the time of admission help identify patients at increased risk.
Chittineni
Harini
H
Winthrop University Hospital, Mineola, NY, USA.
Miyawaki
Nobuyuki
N
Gulipelli
Sailaja
S
Fishbane
Steven
S
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood / Q000652:urine; D003971:Diastole; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume
D003404:Creatinine