Prognostic value of reduced kidney function and anemia in patients with chronic heart failure

Petretta, Mario; Scopacasa, Francesco; Fontanella, Luca; Carlomagno, A.; Baldissara, Maurizio; Petretta, Maria Piera; Bonaduce, Domenico

doi:10.2459/jcm.0b013e32801464b6

Cited by 7 publications

(3 citation statements)

References 38 publications

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“…The association between the severity change subgroup and the study effect estimates was non-significant ( p = 0.20) but both change groups were independently and significantly associated with mortality ( p < 0.05). One study showed that the monthly percentage reduction in eGFR of ≥ 1% was associated with an adjusted mortality risk of HR 3.6 (2.2, 5.7) [54] and a linear relationship was found between increasing eGFR and all-cause mortality risk in four other studies [55–57] .…”

Section: Resultsmentioning

confidence: 99%

Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis

Rushton

Satchithananda

Jones

et al. 2015

International Journal of Cardiology

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BackgroundNon-cardiovascular comorbidities are recognised as independent prognostic factors in selected heart failure (HF) populations, but the evidence on non-selected HF and how comorbid disease severity and change impacts on outcomes has not been synthesised. We identified primary HF comorbidity follow-up studies to compare the impact of non-cardiovascular comorbidity, severity and change on the outcomes of quality of life, all-cause hospital admissions and all-cause mortality.MethodsLiterature databases (Jan 1990–May 2013) were screened using validated strategies and quality appraisal (QUIPS tool). Adjusted hazard ratios for the main HF outcomes were combined using random effects meta-analysis and inclusion of comorbidity in prognostic models was described.ResultsThere were 68 primary HF studies covering nine non-cardiovascular comorbidities. Most were on diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD) and renal dysfunction (RD) for the outcome of mortality (93%) and hospital admissions (16%), median follow-up of 4 years. The adjusted associations between HF comorbidity and mortality were DM (HR 1.34; 95% CI 1.2, 1.5), COPD (1.39; 1.2, 1.6) and RD (1.52; 1.3, 1.7). Comorbidity severity increased mortality from moderate to severe disease by an estimated 78%, 42% and 80% respectively. The risk of hospital admissions increased up to 50% for each disease. Few studies or prognostic models included comorbidity change.ConclusionsNon-cardiovascular comorbidity and severity significantly increases the prognostic risk of poor outcomes in non-selected HF populations but there is a major gap in investigating change in comorbid status over time. The evidence supports a step-change for the inclusion of comorbidity severity in new HF interventions to improve prognostic outcomes.

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Section: Resultsmentioning

confidence: 99%

Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis

Rushton

Satchithananda

Jones

et al. 2015

International Journal of Cardiology

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“…Increasing tertiles of discharge serum urea and BUN/sCr were independent predictors of HF re-hospitalization and combined death and HF re-hospitalization [16]. Other studies provided comparable results [17][18][19].…”

Section: Baseline Renal Dysfunction and Prognosismentioning

confidence: 93%

Prognostic implications of renal dysfunction in patients hospitalized with heart failure: data from the last decade of clinical investigations

et al. 2012

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Numerous studies over the last decade have demonstrated that renal dysfunction and worsening renal function (WRF) are common in patients hospitalized for heart failure (HHF) and appear to be associated with poor in-hospital and post-discharge outcomes. Unfortunately, its etiology has not been completely understood, and its prediction during hospitalization remains challenging. The evaluation of renal impairment during hospitalization should take into consideration the underlying renal substrate (e.g., predisposing clinical comorbidities such as diabetes and hypertension), initiating mechanisms (e.g., in-hospital therapies such as diuretics), and amplifying factors (neurohormonal and hemodynamic profile changes). Various patterns of WRF may have different prognostic implications and may require different therapeutic approaches. WRF may be initially classified by duration (transient vs. persistent) and by etiology (elevated venous pressures vs. arterial underfilling). Other critical contributing factors during hospitalization include progressive left ventricular dysfunction, neurohormonal activation, and medications. Transient WRF as a result of aggressive therapy targeting congestion may not be associated with poor outcomes. Persistent WRF seen in patients with severe hemodynamic derangements may be associated with poor post-discharge prognosis. Future investigations must clarify the pathophysiological correlates of various patterns of WRF. To date, there is an unmet clinical need to achieve adequate control over congestion while preserving renal function in HHF patients. Thus, the aim of this review is to provide an in-depth and critical interpretation of the available data on the prognostic importance of RD and WRF during hospitalization in an effort to improve HF management.

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“…Anemia is a well-known, independent risk factor for cardiovascular disease in patients with chronic kidney disease (CKD) [1] , [2] , [3] . If left untreated, the anemia of CKD can result in the deterioration of cardiac function, decreased cognition, mental acuity, fatigue, and other signs and symptoms.…”

Section: Introductionmentioning

confidence: 99%

A randomized crossover study of single biweekly administration of epoetin-α compared with darbepoetin-α in chronic kidney disease patients not receiving dialysis

Lee

Shin

et al. 2014

Kidney Research and Clinical Practice

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BackgroundRecent evidence demonstrates that high doses of epoetin-alpha (EPO-α) can be administrated at extended intervals, despite its relatively short serum half-life. However, no prospective randomized trials on the effects of extended dosing intervals of EPO-α compared with darbepoetin-alpha (DA-α) have been performed. This study was designed to investigate whether a single biweekly (Q2W) administration of a high dose of EPO-α is as effective as DA-α for anemia in chronic kidney disease (CKD) patients not receiving dialysis.MethodsSixty non-dialysis CKD patients were equally randomized to either Q2W subcutaneous EPO-α (10,000 unit) or DA-α (50 μg) therapy groups for the first 6 weeks. After a 6-week washout period, the participants of the EPO-α and DA-α treatment groups switched to the alternate regimen for 6 weeks. The mean hemoglobin (Hb) levels after erythropoiesis stimulating agent (ESA) therapy and percentage change in Hb levels from baseline to the end of the study were analyzed.ResultsThe mean Hb levels of postESA therapy increased significantly compared with those of preESA therapy in both ESA regimens. The percentage increase in Hb levels and erythropoietin resistance index did not show a significant difference between the different ESA regimens. No difference was observed between the regimens regarding mean Hb levels after ESA therapy. Additionally, there were no serious adverse effects leading to withdrawal from treatment.ConclusionBiweekly high doses of EPO-α therapy may be equally as effective as Q2W DA-α therapy in maintaining target Hb levels in non-dialysis CKD patients.

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Prognostic value of reduced kidney function and anemia in patients with chronic heart failure

Abstract: Increased N-proBNP and decreased kidney function, but not anemia, are independent risk factors for mortality in patients with CHF.

Cited by 7 publications

References 38 publications

Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis

Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis

Prognostic implications of renal dysfunction in patients hospitalized with heart failure: data from the last decade of clinical investigations

A randomized crossover study of single biweekly administration of epoetin-α compared with darbepoetin-α in chronic kidney disease patients not receiving dialysis

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