Prognostic value of formulas estimating excretory renal function in the elderly with systolic heart failure.
BACKGROUND
reduced renal excretory function (REF) is increasingly being appreciated as a potent prognostic factor in chronic heart failure (CHF). The Cockroft-Gault (CG) and the simplified Modification of Diet in Renal Disease (MDRD) equations have been recommended to estimate REF. However, limitations for both formulas have been reported in the elderly. Their prognostic performance in older CHF patients has not been investigated.


OBJECTIVE
to assess the factors independently associated with all-cause mortality and compare the prognostic value of formulas estimating REF in CHF patients aged > or =70 years.


METHODS
a longitudinal study with a median follow-up of 859 days. The end-point was all-cause mortality.


METHODS
Division of Cardiology and Cardiac Rehabilitation.


METHODS
two hundred and sixty-six patients aged > or =70 years with systolic CHF.


METHODS
REF was estimated using the CG (eCrCl(CG)) and the MDRD (eGFR(MDRD)) formulas. Cox proportional hazards model was used to assess the factors independently associated with mortality and compare the prognostic value of estimating formulas. Receiver-operating characteristic (ROC) curve analysis was also performed.


RESULTS
Kaplan-Meier estimates of the rates of death at 1 and 2 years were 85% and 73%, respectively At multivariate analysis, eCrCl(CG) <50 mL/min (P = 0.005), anaemia (P = 0.012), non-prescription of beta-blockers (P = 0.006) and left ventricular ejection fraction (P = 0.03) were the only independent predictors of mortality. On ROC analysis, the eCrCl(CG) was significantly more accurate than the eGFR(MDRD).


CONCLUSIONS
among CHF patients aged > or =70 years, reduced REF is the most powerful independent predictor of survival. The excess in risk conferred by reduced REF is better appraised by means of the CG than the MDRD equation.
Scrutinio
Domenico
D
Division of Cardiology and Cardiac Rehabilitation, S. Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Cassano Murge, Bari, Italy. domenico.scrutinio@fsm.it
Passantino
Andrea
A
Santoro
Daniela
D
Cacciapaglia
Erasmo
E
Farinola
Giuseppe
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000401:mortality; D002908:Chronic Disease; D003404:Creatinine / Q000378:metabolism*; D005919:Glomerular Filtration Rate; D054143:Heart Failure, Systolic / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008954:Models, Biological; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
D000319:Adrenergic beta-Antagonists; D003404:Creatinine