title: Incidence, clinical predictors, and prognostic impact of worsening renal function in elderly patients with chronic heart failure on intensive medical therapy.
abstract: BACKGROUND
  Incidence, predictors, and prognostic impact of worsening renal function (WRF) in elderly patients with chronic heart failure (HF) undergoing intensive contemporary medical therapy are unknown.
  
  
  RESULTS
  In 566 patients (age 77 ± 8 years) included in the TIME-CHF, serum creatinine (sCr) was repeatedly measured up to 6 months. Worsening renal function was classified as increase in sCr by 0.2 to 0.3 (WRFI), 0.3 to 0.5 (WRFII), or ≥0.5 mg/dL (WRFIII) within the first 6 months. Outcome events were assessed for 18 months.
  
  
  RESULTS
  The incidence of WRF I, II, and III was 12%, 19%, and 22%, respectively. Worsening renal function III was associated with increased mortality (hazard ratio 1.98 [95% CI 1.27-3.07, P = .002] vs no WRF), whereas WRF I/II was not. History of renal failure, spironolactone treatment, higher baseline dose, and higher maximal increase in loop diuretic dose were independently associated with the occurrence of WRF III, whereas angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, and β-blocker use and allocation to N-terminal pro-B-type natriuretic peptide-guided management were not. Worsening renal function III was an independent predictor of death, death or hospitalization, and death or HF hospitalization also after adjusting for baseline characteristics.
  
  
  CONCLUSIONS
  One fifth of elderly patients with chronic HF experienced WRF III on 6-month intensive HF treatment. These patients had higher mortality, whereas patients with smaller sCr rises did not. Occurrence of WRF III was associated with high doses of loop diuretics and spironolactone use but not with other treatments.
authors.affiliation: Cardiology Division, Kantonsspital St Gallen, St Gallen, Switzerland. micha.maeder@kssg.ch
authors.forename: Micha T
authors.initials: MT
authors.lastname: Maeder
authors.forename: Hans
authors.initials: H
authors.lastname: Rickli
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Pfisterer
authors.forename: Stefano
authors.initials: S
authors.lastname: Muzzarelli
authors.forename: Peter
authors.initials: P
authors.lastname: Ammann
authors.forename: Thomas
authors.initials: T
authors.lastname: Fehr
authors.forename: Dietrich
authors.initials: D
authors.lastname: Hack
authors.forename: Daniel
authors.initials: D
authors.lastname: Weilenmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Dieterle
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kiencke
authors.forename: Werner
authors.initials: W
authors.lastname: Estlinbaum
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D002316:Cardiotonic Agents; D004232:Diuretics