TY - JOUR
T1 - Incidence, clinical predictors, and prognostic impact of worsening renal function in elderly patients with chronic heart failure on intensive medical therapy
AU - Maeder, Micha T.
AU - Rickli, Hans
AU - Pfisterer, Matthias E.
AU - Muzzarelli, Stefano
AU - Ammann, Peter
AU - Fehr, Thomas
AU - Hack, Dietrich
AU - Weilenmann, Daniel
AU - Dieterle, Thomas
AU - Kiencke, Stephanie
AU - Estlinbaum, Werner
AU - Brunner-La Rocca, Hans-Peter
PY - 2012/3
Y1 - 2012/3
N2 - Background Incidence, predictors, and prognostic impact of worsening renal function (WRF) in elderly patients with chronic heart failure (HF) undergoing intensive contemporary medical therapy are unknown. Methods and Results In 566 patients (age 77 +/- 8 years) included in the TIME-CHF, serum creatinine (sCr) was repeatedly measured up to 6 months. Worsening renal function was classified as increase in sCr by 0.2 to 0.3 (WRFI), 0.3 to 0.5 (WRFII), or >= 0.5 mg/dL (WRFIII) within the first 6 months. Outcome events were assessed for 18 months. Results The incidence of WRF I, II, and III was 12%, 19%, and 22%, respectively. Worsening renal function III was associated with increased mortality (hazard ratio 1.98 [95% CI 1.27-3.07, P = .002] vs no WRF), whereas WRF I/II was not. History of renal failure, spironolactone treatment, higher baseline dose, and higher maximal increase in loop diuretic dose were independently associated with the occurrence of WRF III, whereas angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, and beta-blocker use and allocation to N-terminal pro-B-type natriuretic peptide-guided management were not. Worsening renal function III was an independent predictor of death, death or hospitalization, and death or HF hospitalization also after adjusting for baseline characteristics. Conclusions One fifth of elderly patients with chronic HF experienced WRF III on 6-month intensive HF treatment. These patients had higher mortality, whereas patients with smaller sCr rises did not. Occurrence of WRF III was associated with high doses of loop diuretics and spironolactone use but not with other treatments. (Am Heart J 2012;163:407-414.e1.)
AB - Background Incidence, predictors, and prognostic impact of worsening renal function (WRF) in elderly patients with chronic heart failure (HF) undergoing intensive contemporary medical therapy are unknown. Methods and Results In 566 patients (age 77 +/- 8 years) included in the TIME-CHF, serum creatinine (sCr) was repeatedly measured up to 6 months. Worsening renal function was classified as increase in sCr by 0.2 to 0.3 (WRFI), 0.3 to 0.5 (WRFII), or >= 0.5 mg/dL (WRFIII) within the first 6 months. Outcome events were assessed for 18 months. Results The incidence of WRF I, II, and III was 12%, 19%, and 22%, respectively. Worsening renal function III was associated with increased mortality (hazard ratio 1.98 [95% CI 1.27-3.07, P = .002] vs no WRF), whereas WRF I/II was not. History of renal failure, spironolactone treatment, higher baseline dose, and higher maximal increase in loop diuretic dose were independently associated with the occurrence of WRF III, whereas angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, and beta-blocker use and allocation to N-terminal pro-B-type natriuretic peptide-guided management were not. Worsening renal function III was an independent predictor of death, death or hospitalization, and death or HF hospitalization also after adjusting for baseline characteristics. Conclusions One fifth of elderly patients with chronic HF experienced WRF III on 6-month intensive HF treatment. These patients had higher mortality, whereas patients with smaller sCr rises did not. Occurrence of WRF III was associated with high doses of loop diuretics and spironolactone use but not with other treatments. (Am Heart J 2012;163:407-414.e1.)
U2 - 10.1016/j.ahj.2011.12.003
DO - 10.1016/j.ahj.2011.12.003
M3 - Article
C2 - 22424011
SN - 0002-8703
VL - 163
SP - 407-U353
JO - American Heart Journal
JF - American Heart Journal
IS - 3
ER -