title: Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome.
abstract: BACKGROUND
  Chronic renal dysfunction (RD) frequently coexists with heart failure (HF) and influences outcome. Patients with acute HF (AHF) and severe RD are frequently excluded in the trials. We characterized these subjects and assessed incidence and predictors of in-hospital and one-year mortalities.
  
  
  METHODS
  We selected the 455 patients included in the "IN-HF Outcome" Italian registry belonging to the lowest quartile of estimated glomerular filtration rate (eGFR<40 ml/min/1.73 m(2)).
  
  
  RESULTS
  Mean eGFR at entry in severe RD patients was 28±9 ml/min/1.73 m(2). Compared to 1368 patients with more preserved eGFR, they were older, with more co-morbidities and more frequently ischemic etiology of HF. In-hospital and one-year all-cause mortality rates were 14% and 44% respectively, twice higher than the entire population. Predictors of in-hospital mortality were an abnormal status of consciousness, older age, hyponatremia, lower systolic blood pressure and eGFR. The same conditions (except eGFR) predicted one-year mortality together with the absence of diabetes and no treatment with beta-blockers or diuretics.
  
  
  CONCLUSIONS
  In patients with AHF and severe RD, in-hospital and one-year all-cause mortality rates are very high. Independent predictors such as older age, and signs of hypoperfusion and hyponatremia may be identified but preventing and reversing RD remain the key targets for the clinical management of these patients.
authors.affiliation: Cardiology Department, Villa Bianca Hospital Trento, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Andrea
authors.initials: A
authors.lastname: Mortara
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cacciatore
authors.forename: Alessandra
authors.initials: A
authors.lastname: Chinaglia
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007674:Kidney Diseases / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Acute heart failure; Glomerular filtration rate; Outcome; Renal dysfunction