Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH).
OBJECTIVE
The effect of worsening renal function (WRF) after discharge on outcome in patients with heart failure is unknown.


RESULTS
We assessed estimated glomerular filtration rate (eGFR) and serum creatinine at admission, discharge, and 6 and 12 months after discharge, in 1023 heart failure patients. Worsening renal function was defined as an increase in serum creatinine of >26.5 micromol/L and >25%. The primary endpoint was a composite of all-cause mortality and heart failure admissions. The mean age of patients was 71 +/- 11 years, and 62% was male. Mean eGFR at admission was 55 +/- 21 mL/min/1.73 m(2). In-hospital WRF occurred in 11% of patients, while 16 and 9% experienced WRF from 0 to 6, and 6 to 12 months after discharge, respectively. In multivariate landmark analysis, WRF at any point in time was associated with a higher incidence of the primary endpoint: hazard ratio (HR) 1.63 (1.10-2.40), P = 0.014 for in-hospital WRF, HR 2.06 (1.13-3.74), P = 0.018 for WRF between 0-6 months, and HR 5.03 (2.13-11.88), P < 0.001 for WRF between 6-12 months.


CONCLUSIONS
Both in- and out-hospital worsening of renal function are independently related to poor prognosis in patients with heart failure, suggesting that renal function in heart failure patients should be monitored long after discharge.
Damman
Kevin
K
Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Jaarsma
Tiny
T
Voors
Adriaan A
AA
Navis
Gerjan
G
Hillege
Hans L
HL
van Veldhuisen
Dirk J
DJ
D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers; D016001:Confidence Intervals; D037001:Directive Counseling / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006305:Health Status Indicators; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D007668:Kidney; D007674:Kidney Diseases / Q000503:physiopathology*; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D015415:Biomarkers