title: Renal dysfunction in African patients with acute heart failure.
abstract: OBJECTIVE
  In Western countries with typically elderly ischaemic acute heart failure patients, predictors and clinical outcome of renal dysfunction and worsening renal function are well described. However, the prevalence, predictors and clinical outcome of renal dysfunction in younger, mainly hypertensive acute heart failure patients from Africa, have not been described.
  
  
  RESULTS
  From 1006 patients enrolled in the sub-Saharan Africa Survey of Heart Failure (THESUS-HF), renal function was determined by the estimated glomerular filtration rate using the Modification of Diet in Renal Disease (MDRD) formula. Worsening renal function was defined as an increase in creatinine ≤0.3 mg/dL (26.5 µmol/L) from baseline to day 7/discharge. The mean (SD) age of the patients was 52.4 (18.2) years, 481 (50.8%) were women and the predominant race was black African [932 of 946 (98.5%)]. Heart failure was most commonly a result of hypertension (n = 363, 39.5%) and only 7.8% had ischaemic heart failure. At hospital admission, 289 patients (30.6%) had an estimated glomerular filtration rate ≤60 ml/min.1.73 m2 . Worsening renal function during hospitalization was detected in 53 (9.8 %) of 543 patients with a follow-up creatinine value, and was independently associated with the Western sub-Saharan region, body mass index, and the presence of rales. Worsening renal function was an independent predictor of death or readmission over 60 days [multivariable hazard ratio = 2.06 (1.10, 3.38); P = 0.023] and all-cause death over 180 days [multivariable hazard ratio =1.92 (1.08, 3.38); P = 0.025].
  
  
  CONCLUSIONS
  Renal dysfunction is also prevalent in younger non-ischaemic acute heart failure patients in Africa, but worsening renal function is less prevalent and has different predictors compared with Western cohorts. Nevertheless, worsening renal function is strongly and independently related with clinical outcome.
authors: Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.
authors: Mahmoud U
authors: MU
authors: Sani
authors: Beth A
authors: BA
authors: Davison
authors: Gad
authors: G
authors: Cotter
authors: Karen
authors: K
authors: Sliwa
authors: Christopher
authors: C
authors: Edwards
authors: Licette
authors: L
authors: Liu
authors: Albertino
authors: A
authors: Damasceno
authors: Bongani M
authors: BM
authors: Mayosi
authors: Okechukwu S
authors: OS
authors: Ogah
authors: Charles
authors: C
authors: Mondo
authors: Anastase
authors: A
authors: Dzudie
authors: Dike B
authors: DB
authors: Ojji
authors: Adrian A
authors: AA
authors: Voors
mesh_terms: D000208:Acute Disease; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D044383:Black People; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000097:blood / Q000453:epidemiology*
chemical_list: D003404:Creatinine
keywords: Africa; Outcome; Prognosis; Renal dysfunction; Worsening renal function