Renal dysfunction in African patients with acute heart failure

Abstract

Aims In Western countries with typically elderly ischaemic acute heart failure patients, predictors and clinical outcome of renal dysfunction and worsening renal function are well described. However, the prevalence, predictors and clinical outcome of renal dysfunction in younger, mainly hypertensive acute heart failure patients from Africa, have not been described. Methods and results From 1006 patients enrolled in the sub‐Saharan Africa Survey of Heart Failure (THESUS‐HF), renal function was determined by the estimated glomerular filtration rate using the Modification of Diet in Renal Disease (MDRD) formula. Worsening renal function was defined as an increase in creatinine ≤0.3 mg/dL (26.5 µmol/L) from baseline to day 7/discharge. The mean (SD) age of the patients was 52.4 (18.2) years, 481 (50.8%) were women and the predominant race was black African [932 of 946 (98.5%)]. Heart failure was most commonly a result of hypertension (n = 363, 39.5%) and only 7.8% had ischaemic heart failure. At hospital admission, 289 patients (30.6%) had an estimated glomerular filtration rate ≤60 ml/min.1.73m2. Worsening renal function during hospitalization was detected in 53 (9.8 %) of 543 patients with a follow‐up creatinine value, and was independently associated with the Western sub‐Saharan region, body mass index, and the presence of rales. Worsening renal function was an independent predictor of death or readmission over 60 days [multivariable hazard ratio = 2.06 (1.10, 3.38); P = 0.023] and all‐cause death over 180 days [multivariable hazard ratio =1.92 (1.08, 3.38); P = 0.025]. Conclusions Renal dysfunction is also prevalent in younger non‐ischaemic acute heart failure patients in Africa, but worsening renal function is less prevalent and has different predictors compared with Western cohorts. Nevertheless, worsening renal function is strongly and independently related with clinical outcome.

Clinical Pattern and Outcome of Acute Heart Failure at the Yaounde Central Hospital

“…American and European studies show that treatment recommendations for heart failure are poorly applied [16]. This is particularly true in sub-Saharan Africa, where the implementation of an optimal treatment with titration is particularly difficult because of the lack of patient follow-up.…”

Heart Failure in Sub-Saharan Africa

“…It is also associated with overweight/ obesity and presence of basal crackles at admission. Presence of renal dysfunction is also independently associated with higher readmission rate over 60 days and all-cause mortality over 180 days [36].…”

Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana

“…Renal dysfunction has been associated with longer hospital stay and increased hospital mortality in patients with HF. [1,24,27] We found an insignificant increase in mortality and length of hospital stay in patients with renal dysfunction, possibly owing to our sample size. Furthermore, estimation of renal function was done at enrolment, using a single (baseline) serum creatinine value.…”

“…[23] We found that a third of participants had renal dysfunction, comparable to the findings of the sub-Saharan Africa Survey of Heart Failure (THESUS-HF), in which 30.6% of HF patients had renal dysfunction when admitted to hospital. [24] Similarly, in a metaanalysis of 65 324 HF patients, moderate to severe renal impairment was found in up to 29% of all patients, the prevalence being lower in outpatients than hospitalised patients. [1] In addition to structural renal abnormalities related to hypertension, diabetes or atherosclerosis, renal dysfunction in HF patients may result from renal hypoperfusion caused by haemodynamic, neurohumoral and inflammatory factors.…”