title: Estimated glomerular filtration rate is an independent predictor for mortality of patients with acute heart failure.
abstract: BACKGROUND
  Heart failure is a major public health problem in developed countries including Japan, therefore it is important to estimate the future risk in patients with heart failure. Recently, it has been reported that chronic kidney disease (CKD) is an independent predictor for mortality in chronic heart failure. However, it is unknown whether CKD is an independent predictor for mortality in acute heart failure. We retrospectively investigated the relationship between estimated glomerular filtration rate (eGFR) on admission for acute heart failure and long-term mortality.
  
  
  METHODS
  We analyzed 194 patients who were admitted for acute heart failure from January, 2002 to February, 2005. Patients were divided into two groups, high-eGFR group (eGFR <60 ml/min, n=75) and low-eGFR group (eGFR > or =60 ml/min, n=119). eGFR was calculated by equation of MDRD (modification of the diet in renal disease) study. eGFR level <60 ml/min/1.73 m(2) is impaired renal function according to the guidelines of the Japanese Society of Nephrology and of the National Kidney Foundation. Serum B-type natriuretic peptide (BNP) level and left ventricular ejection fraction (LVEF), anemia, age, gender, and etiology of heart failure were also evaluated. Median observation period was 609 days (range: 30-1627). Mean age was 69 years and 138 patients were male.
  
  
  RESULTS
  Median eGFR on admission was 74.2 ml/min (range: 5.48-238.7), median BNP level was 840 pg/ml (range: 200-4800), and median LVEF was 36% (range: 11-81%). Forty-two percent of patients had eGFR <60 ml/min of eGFR at the time of coronary care unit admission. Patients with low-eGFR had a significantly lower mortality rate by Kaplan-Meier analysis (log rank test, p=0.013). By Cox's proportional-hazard analysis, eGFR was an independent factor for long-term mortality of acute heart failure (p=0.039).
  
  
  CONCLUSIONS
  Lower eGFR at the time of admission could be an independent predictor for mortality of acute heart failure.
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. a.taka@juntendo.ac.jp
authors.forename: Atsutoshi
authors.initials: A
authors.lastname: Takagi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Iwama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamada
authors.forename: Koichiro
authors.initials: K
authors.lastname: Aihara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000150:complications; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012189:Retrospective Studies; D012737:Sex Factors; D013318:Stroke Volume
chemical_list: D020097:Natriuretic Peptide, Brain