Clinical Investigation
High Prevalence of Renal Dysfunction and Its Impact on Outcome in 118,465 Patients Hospitalized With Acute Decompensated Heart Failure: A Report From the ADHERE Database

https://doi.org/10.1016/j.cardfail.2007.03.011Get rights and content

Abstract

Background

The prevalence of renal dysfunction in patients hospitalized with acute decompensated heart failure remains poorly characterized.

Methods and Results

Data from 118,465 hospitalization episodes were evaluated. Glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease formula. At admission, 10,660 patients (9.0%) had normal renal function (GFR ≥ 90 mL·min·1.73 m2), 32,423 patients (27.4%) had mild renal dysfunction (GFR 60–89 mL·min·1.73 m2), 51,553 patients (43.5%) had moderate renal dysfunction (GFR 30–59 mL·min·1.73 m2), 15,553 patients (13.1%) had severe renal dysfunction (GFR 15–29 mL·min·1.73 m2), and 8276 patients (7.0%) had kidney failure (GFR < 15 mL·min·1.73 m2 or chronic dialysis). Despite this, only 33.4% of men and 27.3% of women were diagnosed with renal insufficiency. Diuretic dose, inotrope use, and nesiritide use increased, whereas angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use decreased, with increasing renal dysfunction (all P < .0001 across stages). In-hospital mortality increased from 1.9% for patients with normal renal function to 7.6% and 6.5% for patients with severe dysfunction and kidney failure, respectively (P < .0001).

Conclusions

The majority of patients admitted with acute decompensated heart failure have significant renal impairment, which influences treatment and outcomes.

Section snippets

Methods

The ADHERE registry was established in October of 2001 to collect information on patients hospitalized with ADHF.11 The ADHERE procedures and the clinical variables collected by the registry have been described.11 Briefly, medical records for eligible patients are retrospectively reviewed at participating sites by a research coordinator, and data from consecutive patients aged 18 years or more at the time of hospital admission are entered into the registry electronically. These data include

Results

The demographic and baseline characteristics of the study population by kidney function stage are provided in Table 1. Overall, mean (± standard deviation) serum creatinine was 1.8 ± 1.6 mg/dL, mean BUN was 31.9 ± 21.0 mg/dL, and mean estimated GFR was 55.2 ± 29.9 mL·min·1.73 m2, and the corresponding median values for serum creatinine (1.3 mg/dL; IQR: 1.0–1.9 mg/dL), BUN (26.0 mg/dL; IQR: 18.0–40.0 mg/dL), and estimated GFR (51.0 mL·min·1.73 m2; IQR: 36.0–70.0 mL·min·1.73 m2) were not

Discussion

Despite significant advances in the treatment of cardiovascular disease, the prevalence of heart failure continues to increase and will do so for the foreseeable future.14 Insofar as clinical heart failure is largely a disease of the elderly and is often accompanied by hypertension, diabetes, and coronary artery disease, it is not surprising that renal dysfunction frequently coexists with heart failure. Indeed, the public health impact and cost of chronic kidney disease is reminiscent of heart

Conclusions

Renal dysfunction is frequent in patients admitted with ADHF, is not adequately identified by serum creatinine level alone, and carries important prognostic implications. Although a major focus of heart failure therapy has been on the heart, these data suggest that treatment strategies also should be aimed at long-term preservation of renal function. Finally, it is important to note that although these data demonstrate that renal dysfunction at the time of hospitalization is associated with

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    The ADHERE database and this study were sponsored by Scios Inc., Fremont, California.

    Conflicts of Interest Disclosure: J. Thomas Heywood, MD, has a consultant/or advisory board relationship with GlaxoSmithKline, Medtronic, Inc., and Scios Inc. He is on the speaker's bureaus for and has received honoraria from GlaxoSmithKline, Guidant Corporation, Medtronic, Inc., Pfizer Inc., and Scios Inc. He has received research grant support from GlaxoSmithKline; Medtronic, Inc.; Sanofi-Aventis; Scios Inc.; and St. Jude Medical.

    Gregg C. Fonarow, MD, has a consultant/or advisory board relationship with Scios Inc.'s Steering Committee for the ADHERE Core, EM, and Longitudinal Registries. He is on the speaker's bureau for and has received honoraria from Scios Inc. He has received research grant support from Scios Inc.'s ADHERE Registries and CHF Solutions, Inc.'s UNLOAD Trial.

    Maria Rosa Costanzo, MD, has a consultant/or advisory board relationship with CHF Solutions, Inc. and Scios Inc. She has received honoraria from CHF Solutions, Inc. and Medtronic, Inc.

    Vandana S. Mathur, MD, has a consultant/or advisory board relationship with Acologix, Inc.; Corgentech Inc.; FlowMedica, Inc.; Ingenix; Ortho Biotech; RenaMed Biologics; Scios Inc.; Synecor, LLC; and XenoPort, Inc. She is on the speaker's bureau for Scios Inc. She has received honoraria from GE Healthcare and Scios Inc.

    John R. Wigneswaran, MD, is a former employee of Scios Inc. Before his employment with Scios Inc., he was on the speaker's bureau for Scios Inc. and received honoraria from Scios Inc. He is aware that at the time of his employment at Scios Inc., Scios Inc. funded this article. He owns stock in Johnson & Johnson.

    Janet Wynne, MS, is an employee of Scios Inc. She owns stock in Johnson & Johnson. She is aware that Scios, Inc. is the sponsor of the ADHERE database.

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