title: Associations of anemia and renal dysfunction with outcomes among patients hospitalized for acute decompensated heart failure with preserved or reduced ejection fraction.
abstract: OBJECTIVE
  The relationship among anemia, renal dysfunction, left ventricular ejection fraction, and outcomes of patients hospitalized for acute decompensated heart failure is unclear. The aim of this study was to evaluate the association between cardiorenal anemia syndrome and postdischarge outcomes in patients hospitalized for heart failure with a preserved or reduced ejection fraction.
  
  
  METHODS
  Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes Registry between April 1, 2007 and December 31, 2011, 4393 patients were evaluated to investigate the association among anemia, renal dysfunction, preserved or reduced ejection fraction, and the primary end point (mortality and readmission for heart failure since discharge). The patients were divided into four groups on the basis of eGFR and hemoglobin at discharge. The median follow-up period after discharge was 432 (range=253-659) days.
  
  
  RESULTS
  The primary end point was reached in 37.6% and 34.8% of the preserved and reduced ejection fraction groups, respectively. After adjustment for multiple comorbidities, there was no significant association of either renal dysfunction or anemia alone with the primary end point in patients with preserved ejection fraction, but the combination of renal dysfunction and anemia was associated with a significantly higher risk than that without either condition (hazard ratio, 1.54; 95% confidence interval, 1.12 to 2.12; P<0.01). In patients with reduced ejection fraction, adjusted analysis showed that a significantly higher risk of the primary end point was associated with renal dysfunction alone (hazard ratio, 1.65; 95% confidence interval, 1.21 to 2.25; P=0.002) and also, renal dysfunction plus anemia relative to the risk without either condition (hazard ratio, 2.19; 95% confidence interval, 1.62 to 2.96; P<0.001).
  
  
  CONCLUSIONS
  The findings show that renal dysfunction combined with anemia is associated with an increased risk of adverse postdischarge outcomes in patients with preserved ejection fraction, whereas renal dysfunction is an independent predictor of the risk of adverse outcomes in patients with reduced ejection fraction, regardless of anemia.
authors.affiliation: Division of Cardiology, Sensoji Hospital, Tokyo, Japan; kkajimoto@gmail.com.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kajimoto
authors.affiliation: Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School, Musashi-Kosugi Hospital, Kanagawa, Japan;
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.affiliation: Department of Cardiovascular Medicine, Edogawa Hospital, Tokyo, Japan;
authors.forename: Takehiko
authors.initials: T
authors.lastname: Keida
authors.affiliation: Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan; and.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.affiliation: Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000401:mortality*; D002303:Cardiac Output, Low / Q000503:physiopathology; D059347:Cardio-Renal Syndrome / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology
chemical_list: D006454:Hemoglobins
keywords: anemia; heart failure; kidney dysfunction