title: Progression of Renal Impairment and Chronic Kidney Disease in Chronic Heart Failure: An Analysis From GISSI-HF.
abstract: BACKGROUND
  Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.
  
  
  RESULTS
  Estimated glomerular filtration rate (eGFR) was assessed over 36 months in 6934 patients included in the GISSI-HF study. Associations from baseline, changes in renal function, and occurrence of cardiovascular death or HF hospitalization were assessed. Mean age was 67 years, mainly men (78%), and mean eGFR was 68 mL • min-1• 1.73 m-2. Change in eGFR in the 1st year was -1.5 ± 16 mL • min-1• 1.73 m-2, and over 36 months it was -3.7 ± 18 mL • min-1• 1.73 m-2. Over the latter period, only 25% deteriorated ≥1 Kidney Disease Outcomes Quality Initiatives (KDOQI) class of chronic kidney disease (CKD). Fifteen percent of patients had >15 mL • min-1• 1.73 m-2decrease in eGFR in the 1st 12 months. Lower eGFR was associated with outcome: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.08-1.10 (P < .001) per 10 mL • min-1• 1.73 m-2decrease, as well as every 10 mL • min-1• 1.73 m-2decrease over the 1st year (HR 1.10, 95% CI 1.04-1.17; P < .001). A deterioration in eGFR >15 mL • min-1• 1.73 m-2in the 1st year showed the highest risk of events (HR 1.22, 95% CI 1.10-1.36; P < .001).
  
  
  CONCLUSIONS
  Mean decrease in renal function over time in patients with chronic HF was modest. Only 25% deteriorated ≥1 KDOQI class of CKD after 3 years. Any decrease in eGFR over time was associated with strongly increased event rates.
authors.affiliation: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: k.damman@umcg.nl.
authors.forename: Kevin
authors.initials: K
authors.lastname: Damman
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gorini
authors.affiliation: University of Siena, Siena, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Urso
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: GVM Hospitals of Care and Research, E.S Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: UOC Cardiologia Azienda ULSS Numero 1, Belluno, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.affiliation: University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Voors
authors.affiliation: Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D000068718:Rosuvastatin Calcium / Q000008:administration & dosage*
chemical_list: D015525:Fatty Acids, Omega-3; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium; D003404:Creatinine
keywords: Renal function; chronic heart failure; chronic kidney disease; prognosis