title: Worsening renal function and prognosis in heart failure: systematic review and meta-analysis.
abstract: BACKGROUND
  Renal impairment is associated with increased mortality in heart failure (HF). Recently, reports suggest that worsening renal function (WRF) is another predictor of clinical outcome in HF. The present study was designed to establish the proportion of patients with HF that exhibits (WRF) and the associated risk for mortality and hospitalization by conducting a systematic review and meta-analysis.
  
  
  RESULTS
  A systematic search of MEDLINE revealed 8 studies on the relationship between WRF and mortality in 18,634 patients with HF. The mortality risk associated with WRF was estimated using random-effects meta-analysis. WRF was defined as an increase in serum creatinine > or = 0.2 mg/dL or a corresponding decrease in estimated glomerular filtration rate > or = 5 mL x min x 1.73 m2. Subgroup analysis included differentiation between in- and out-hospital patients, degree of WRF and time until end point occurrence. WRF developed in 4,734 (25%) patients and was associated with a higher risk for mortality (odds ratio [OR] = 1.62; 95% confidence interval [CI] 1.45-1.82, P < .001) and hospitalization (OR = 1.30, 95% CI 1.04-1.62, P = .022). The severity of WRF was also associated with greater mortality. Patients with impaired renal function at baseline were more prone to progressive renal function loss.
  
  
  CONCLUSIONS
  WRF predicts substantially higher rates of mortality and hospitalization in patients with HF.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Kevin
authors.initials: K
authors.lastname: Damman
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Folkert W
authors.initials: FW
authors.lastname: Asselbergs
authors.forename: Tom D J
authors.initials: TD
authors.lastname: Smilde
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
mesh_terms: D018450:Disease Progression; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007668:Kidney / Q000502:physiology; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D007677:Kidney Function Tests / Q000639:trends; D011379:Prognosis