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European Heart Journal Advance Access published online on December 19, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi696
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received January 31, 2005
Revised November 6, 2005
Accepted December 1, 2005

Clinical research

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 Silva 1 *, Nikolay P. Nikitin 1, Klaus K.A. Witte 1, Alan S. Rigby 1, Kevin Goode 1, Sunil Bhandari 2, Andrew L. Clark 1, and John G.F. Cleland 1

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

* To whom correspondence should be addressed.
Ramesh de Silva, E-mail: ramesh{at}desilva84.freeserve.co.uk


  Abstract

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.

Keywords: Chronic heart failure; Renal dysfunction.
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