Clinical InvestigationHigh 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
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
References (34)
- et al.
Development of circulatory-renal limitations to angiotensin-converting enzyme inhibitors identifies patients with severe heart failure and early mortality
J Am Coll Cardiol
(2003) - et al.
Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design and preliminary observations from the Acute Decompensated Heart Failure National Registry (ADHERE®)
Am Heart J
(2005) - et al.
In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the ADHERE registry
J Am Coll Cardiol
(2005) - et al.
Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey
Am J Kidney Dis
(2003) - et al.
Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: The NAPA trial
J Am Coll Cardiol
(2007) - et al.
Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial
Lancet
(2003) - et al.
Renal insufficiency as an independent predictor of mortality among women with heart failure
J Am Coll Cardiol
(2004) - et al.
Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure
J Am Coll Cardiol
(2004) - et al.
Correlates and impact on outcomes of worsening renal function in patients 65 years of age with heart failure
Am J Cardiol
(2000) - et al.
Worsening renal function: what is a clinically meaningful change in creatinine during hospitalization with heart failure?
J Card Fail
(2003)
Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure
Am J Med
Renal impairment and outcomes in heart failure: systematic review and meta-analysis
J Am Coll Cardiol
2002 National Hospital Discharge Survey
Adv Data
ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult—Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society
Circulation
Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: is this a cause for concern?
Arch Intern Med
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology
Eur Heart J
Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology
Eur Heart J
Cited by (0)
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.