title: Relationship between worsening renal function and long-term cardiovascular mortality in heart failure patients.
abstract: BACKGROUND
  Recently several studies showed that worsening renal function (WRF) during hospitalization might be a strong independent predictor of poor prognosis in decompensated heart failure (HF) patients. However, these studies had a relatively short follow-up duration and their data were limited to in-hospital outcomes. Our purpose was to assess the relationship between WRF and long-term cardiovascular mortality in HF patients.
  
  
  METHODS
  We enrolled decompensated HF patients who were admitted to our hospital between April 2010 and March 2015. WRF was defined as a relative increase in serum creatinine of at least 25% or an absolute increase in serum creatinine ≥0.3mg/dL from the baseline. We assessed the cardiovascular mortality and all-cause mortality in HF patients with WRF (WRF group) and without WRF (no WRF group).
  
  
  RESULTS
  Among 301 patients enrolled, WRF developed in 118 patients (39.2%). During a median follow-up period of 537days [interquartile range, 304.3 to 1025.8days], cardiovascular mortality and all-cause mortality were significantly higher in the WRF group than in the no WRF group (23.2% vs. 6.1%, P<0.001; 30.3% vs. 14.7%, P<0.001, respectively). In the multivariate Cox proportional hazards model, age and serum B-type natriuretic peptide (BNP) level were associated with both cardiovascular death and all-cause death. However, WRF was not the independent predictor of cardiovascular death (P=0.19) nor all-cause death (P=0.57).
  
  
  CONCLUSIONS
  WRF was associated with cardiovascular death in patients with HF. Although not an independent predictor, WRF might be one of useful markers to identify patients who should be followed carefully after discharge.
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan. Electronic address: alone_with_music@hotmail.com.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Okabe
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Yakushiji
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kido
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oyama
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Igawa
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Ono
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Seitaro
authors.initials: S
authors.lastname: Ebara
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Kennosuke
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Myong Hwa
authors.initials: MH
authors.lastname: Yamamoto
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Saito
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Kisaki
authors.initials: K
authors.lastname: Amemiya
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Naoei
authors.initials: N
authors.lastname: Isomura
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Araki
authors.affiliation: Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ochiai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Cardiovascular mortality; Heart failure; Worsening renal function