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European Heart Journal Advance Access originally published online on December 19, 2005
European Heart Journal 2006 27(5):569-581; doi:10.1093/eurheartj/ehi696
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis

Ramesh de Silva1,*, Nikolay P. Nikitin1, Klaus K.A. Witte1, Alan S. Rigby1, Kevin Goode1, Sunil Bhandari2, Andrew L. Clark1 and John G.F. Cleland1

1Academic Department of Cardiology, Castle Hill Hospital, University of Hull, Castle Road, Cottingham, Hull HU16 5JQ, UK
2Department of Nephrology, Hull and East Yorkshire NHS Trust, Hull, UK

Received 31 January 2005; revised 6 November 2005; accepted 1 December 2005; online publish-ahead-of-print 19 December 2005.

* Corresponding author. Tel: +44 1482 624073; fax: +44 1482 624085.E-mail address: ramesh{at}desilva84.freeserve.co.uk

Aims To determine the prevalence and incidence of renal dysfunction (RD) in patients with chronic heart failure (CHF), to identify contributory factors and predictors of worsening renal function (WRF), and to explore the relationship between RD and mortality.

Methods and results Prospective data on 1216 patients with CHF were analysed. The glomerular filtration rate (GFR) was used to determine renal function, and WRF was defined as an increase in serum creatinine of >26.5 µmol/L (>0.3 mg/dL). The prevalence of RD defined as a GFR of <60 mL/min was 57%. During 6 months, WRF occurred in 161 (13.0%) patients. Predictors of WRF were vascular disease, the use of thiazide diuretics, and a baseline urea >9 mmol/L. Two hundred and sixty-three (21.6%) patients died, and baseline RD and WRF both predicted a higher mortality (P<0.001), whereas an improvement in renal function over the first 6 months predicted a lower mortality (hazard ratio 0.8, 95% confidence interval 0.6–1.0).

Conclusion In ambulatory patients with CHF, RD is common, commonly deteriorates over a relatively short period of time, is unlikely to recover substantially, and augurs a poor prognosis.

Key Words: Chronic heart failure • Renal dysfunction


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