Prevalence and significance of unrecognized renal insufficiency in patients with heart failure

被引:32
作者
Amsalem, Yoram [1 ]
Garty, Moshe [1 ]
Schwartz, Roseline [1 ]
Sandach, Amir [1 ]
Behar, Solomon [1 ]
Caspi, Abraham [1 ]
Gottlieb, Shmuel [1 ]
Ezra, David [1 ]
Lewis, Basil S. [2 ]
Leor, Jonathan [1 ]
机构
[1] Tel Aviv Univ, Neufeld Cardiac Res Inst, Chaim Sheba Med Ctr, IL-52621 Tel Hashomer, Israel
[2] Lady Davis Carmel Med Ctr, Bruce Rappaport Sch Med, Haifa, Israel
关键词
glomerular filtration rate; heart failure; kidney; prognosis; renal insufficiency;
D O I
10.1093/eurheartj/ehn102
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 m(2)] 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.
引用
收藏
页码:1029 / 1036
页数:8
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