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European Heart Journal Advance Access published online on March 12, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn102
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
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Prevalence and significance of unrecognized renal insufficiency in patients with heart failure

Yoram Amsalem1, Moshe Garty1, Roseline Schwartz1, Amir Sandach1, Solomon Behar1, Abraham Caspi1, Shmuel Gottlieb1, David Ezra1, Basil S. Lewis2 and Jonathan Leor1,*

1 Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel
2 The Lady Davis Carmel Medical Center, Bruce Rappaport School of Medicine, Haifa, Israel

Received 6 August 2007; revised 6 February 2008; accepted 16 February 2008.

* Corresponding author. Tel: +972 3 5302614, Fax: +972 3 5351139, Email: leorj{at}post.tau.ac.il

Aims: Renal insufficiency (RI) is a strong predictor of adverse outcome in patients with heart failure (HF). We aimed to determine the prevalence of RI being unrecognized and its significance in patients hospitalized with HF.

Methods and results: We analysed data from a prospective survey of 4102 hospitalized patients with HF. RI [defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] was present in 2145 (57%) patients but, based on medical records, was unrecognized in 872 [41%, 95% confidence interval (CI) 39–43%] of them. Patients with unrecognized RI were more likely to be women, elderly, and with better functional class, compared with patients with recognized RI. In-hospital and 1 year mortality was significantly higher among patients with recognized and unrecognized RI compared with patients without RI: 6.5 and 7.1 vs. 2.1%, and 38.8 and 30.9 vs. 18.8% (P < 0.001), respectively. After adjustment, recognized and unrecognized RI comparably predicted increased in-hospital mortality: odds ratio (OR) and 95% CI of 2.34 (1.43–3.87), P < 0.001, and 2.30 (1.45–3.72), P < 0.001. After 1 year, recognized RI remained an independent predictor for mortality: OR 1.79 (1.45–2.20), P < 0.001, whereas there was a trend for increased mortality predicted by unrecognized RI: OR 1.22 (0.97–1.53), P = 0.08.

Conclusion: A high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR.

Key Words: Glomerular filtration rate • Heart failure • Kidney • Prognosis • Renal insufficiency


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